PC 223: COUNSELLING

Unit 1: Introduction to Counselling

Definition and scope of counseling. Difference between counseling and psychotherapy.
Guidance. Goals of counselling. Conditions facilitating effective counselling.
Characteristics of an effective counsellor
Process and outcome goals in counselling
Ethical codes- American Counseling Association
Generic Models of Counselling: Gerard Egan, Clara Hill, Allen Ivey
An overview of Egan’s Model. Stage 1 – The Current Picture, Stage 2- The preferred picture,
Stage 3- The Way Forward
Clara Hill’s process model of helping: Exploration through humanistic approach, Insight
through psychodynamic approach, Action through cognitive behavioral approach.
Ivey and Ivey: Five stages of counseling session: Empathic relationship, story and strength,
goals, restory, action. Basic listening sequence: Attending and empathy skills, observation
skills, questions, encouraging, paraphrasing and summarizing, reflecting feelings
Three stages of counseling in perspective (Patterson & Welfel): Initial disclosure, In-depth
exploration and Commitment to action.

Unit 2: Exploration Stage/ Initial disclosure

What clients bring to the counseling experience. Core conditions of counseling. Counselor
actions that impede communication
Goals for the exploration stage: Establishing rapport and developing a therapeutic
relationship, Attending, listening and observing, exploring thoughts, exploring feelings
Opening Techniques – Greeting, topics, physical arrangements, attitudes, Nonverbal skills
(SOLER)
Attending, Listening and Observing Skills
Non-verbal Behaviors: Eye-contact, Facial expressions, Head Nods, Body Postures, Bodily
Movements, Space, Tone of Voice, Grammatical Style, Silence
Minimal Verbal Behaviors: Minimal Encouragers, Approval-Reassurance
Non-verbal Behaviors to avoid
Listening and Observation Skills: Verbal Messages, Non-verbal Messages Skills for Exploring
Thoughts: Restatements, Open questions about Thoughts
Skills for Exploring Feelings. Reflection of feelings. How to reflect feelings. Identifying feeling
words. Sources of reflections. Open questions about feelings
Paraphrasing & reflecting meaning, Paraphrasing & reflecting feeling, helping clients manage
reluctance and resistance, Probing and Summarizing
Recognizing patterns & themes, Understanding client’s frames of reference
Structuring, Leading and Questioning techniques
Difficulties implementing the exploration stage. Coping strategies for managing difficulties.

Unit 3: In-depth Exploration / Insight Stage

Goals and methods of in-depth exploration
Feedback as the essential work in stage 2. Principles of giving feedback. Modes of providing
feedback: Advanced empathy, Immediacy, Confrontation, Interpretation/ Reframing, Role
playing. Self-disclosure
Skills for fostering awareness: Challenges, Cognitive techniques, Two-chair technique,
Humor, Non-verbal referents, Owning responsibility
Skills for facilitating Insight: Open questions, Interpretations, Disclosures of insight

Unit 4: Commitment to Action Stage

Goals of stage 3
Skills to implement action goals: Open questions for action, Giving information, Feedback
about the client, Process advisement, Direct guidance
Integrating action skills
Termination. Termination skills

Unit 5: Counseling in various settings:

Psychological First-aid, Crisis Intervention, Suicide Prevention, HIV/AIDS counseling, Marital
Counselling, Geriatric counselling, College counseling, Career Counseling and Guidance,
Palliative counseling, Group Counselling

Unit 6: Major Theories of Counseling:

Counselling process and Contributions of the following theories: Person-centered
counseling, gestalt counseling, psychoanalytic counseling, Cognitive counseling, Trait-factor
counseling, Behavior counseling
Brief strategic solution focused therapy

UNIT 1
INTRODUCTION TO COUNSELLING

DEFINITIONS
 “... individualized and personalized assistance with personal, educational, vocational
problems, in which all pertinent facts are studied and analyzed, and a solution is
sought, often with the assistance of Specialists, school and community resources,
and personal interviews in which the counselee is taught to make his own decisions”
- Good (1945)
 “Counseling is a process involving an interaction between a counselor and a client in
a private setting, worth the purpose of helping the client change his/her behavior so
that a satisfactory resolution of needs may be obtained” - Pepinsky & Pepinsky
(1954)
 “Counseling is a dynamic and purposeful relationship between two people in which
procedures vary with the nature of students’ needs, but in which there is always
mutual participation by the counselor and the student with the focus upon self-
clarification and self-determination by the student” - Wrenn (1951)
 All these definitions have a common base but are different in their emphasis and
have three different orientations.
 Hann (1953) identifies one group as the social welfare advocates with ideographic
interest, the second group is more medically oriented and the third group involving
people with student personnel administration and has great interest in
measurement.
 Along with the differences, it is worth noting the commonalities. Common to all
these perspectives are the notions that:
a) counseling is aimed at helping people make choices and act on them,
b) counseling is a learning process, and
c) counseling enables personality development
 According to Patterson & Welfel (2000), Counselling is an interactive process
characterized by a unique relationship between counsellor and client that leads to
change in the client in one or more of the following areas: Behavior (overt changes
in the ways clients act, their coping skills, decision-making skills and/or relationship
 skills) Beliefs (ways of thinking about oneself, others, and the world) or emotional
concerns relating to these perceptions. Level of emotional distress (uncomfortable
feelings or reactivity to environmental stress)
 The desire for change can stem from identified problems such as loneliness,
uncontrollable anxiety, or poor social skills (remedial) or from a desire for a fuller
life, even in the absence of clear problems in functioning (developmental).
 In all cases, counselling should result in free and responsible behavior on the part of
the client, accompanied by more insight into him- or herself and an ability to
understand and better manage negative emotions.

GOALS OF COUNSELLING
 As counselling is understood as a process, counselling goals are distinguished as
outcome goals and process goals
 Outcome goals are the intended results of counselling, described in terms of what
the client desires to achieve as a result of his/her interactions with the counsellor.
 Process goals are those events the counsellor considers helpful or instrumental in
bringing about outcome goals.
 Outcome goals manifest after the counselling and outside of the counselling setting,
while process goals are plans for events that take place during the counselling within
the counselling setting.

OUTCOME GOALS OF COUNSELLING

 CHANGE – Successful counseling results in gratifying, even exhilarating, changes for
the client.
 Change may be overt and dramatic or it may be imperceptible to anyone but the
client.
 For instance, a person formerly incapacitated with fear of flying may become a
qualified pilot, or someone who had difficulty accepting credit for accomplishments
begin to take pride in those accomplishments.
 Change can take several forms – overt behavior change, improvement in decision-
making or coping skills, modification of beliefs or values, or reduction of the level of
emotional distress.

BEHAVIOUR CHANGE
 Easiest type of change to recognize because it is observable
 Behavior changes as a solution to a problem (e.g. child learning to get what he wants
through verbal requests and negotiation rather than physical aggression) or as
enhancing potential for personal growth (e.g. middle-aged person returning to
college or start a new career)
 Many counselors believe that changes in thoughts and attitudes must precede
changes in behavior, and they work to understand those changes.
 Counselors of the traditional-behaviorist school maintain that a counselor can never
really know a client's inner thoughts and attitudes and that only observable behavior
changes serve to indicate the success of counseling.
 Modern behaviorists tend to consider changes in thinking as a mediating factor in
behavior change

IMPROVEMENT IN COPING SKILLS

 Counseling may also enhance an individual's ability to cope with life situations.
  Certain environmental conditions are adverse and difficult to change, but learning
how to manage one's life in the face of adversity creates room for accomplishment
and enjoyment in spite of such conditions.
 For example, some people with terminal illnesses refer to the period after they got
sick as one of the best of their lives because of the closeness to and honesty with
loved ones that their impending death brought. Clearly, they are not glad they got
sick; rather, they mean that they are able to appreciate the precious gains the illness
provided in spite of its devastating consequences.
 Coping ability depends on the individual's skill in identifying the questions to be
resolved, the alternatives that are available, and the likely results of different
actions.
 Sometimes, coping means learning to live with what one cannot change. For
example, a person who has suffered a permanently disabling injury in an automobile
accident may use counseling to learn to cope with his or her new situation
 Changes in ability to cope usually include both behaviors change and change in
personal constructs.

IMPROVEMENT IN DECISION-MAKING SKILLS

 Counseling may also contribute to a client's ability to make important life decisions
 The counselor teaches the client self-assessment procedures and how to use
information to arrive at personally satisfying answers
 Career decision-making, for example, is still a major focus of school and college
counselors.
 Counselors prepared in contemporary career development methods focus heavily
on helping clients identify relevant sources of information. They see career decision-
making as a lifelong process rather than a single decision made during young
adulthood

CHANGES IN BELIEFS
 Though not directly observable, a change in beliefs (also called personal constructs)
may occur in counseling and can be assessed from the client’s verbal output.
 A common goal of counseling is that the client will improve his or her self-concept
and come to think of him or herself as a more competent, lovable or worthy person.
 Kelly (1955) describes personal constructs as an individual's particular view of
reality.
 Kelly states that behaviors are based on what people believe to be true. Therefore,
people who think they are incapable and feel embarrassed about performing in
front toothers will act on those personal constructs by avoiding anything
challenging.
 Changes in beliefs often lead to behavior change, but they can also make present
behavior more satisfying. For example, a parent who changes his viewpoint about
his adolescent daughter's behavior, coming to see her mildly rebellious behavior as
normal rather than pathological, may be less upset by it and less likely to react
angrily to it.
 Ellis (1989, 1994) has developed a system for understanding how one's personal
thoughts can lead to dissatisfaction with the state of one's life. He explains that
people acquire irrational thoughts that lead to expectations that can never be
fulfilled-for example, "I must be perfectly competent in all that I do, or I am not a
good person."
  Through counseling, the client may learn to give up such thinking and instead
appreciate what he or she does well while working toward competence in other
areas.
 Beck (1976) presents a similar model that describes the impact of negative belief
systems on feelings and behaviors.
 Meichenbaum (1977) refers to this process as the internal dialogue and defines one
goal of counseling as modifying the content of the dysfunctional internal dialogue.

RELIEF OF EMOTIONAL DISTRESS

 Many clients enter counseling because they feel bad and need a place where they
can safely vent those feelings and feel sure that they will be accepted and
understood.
 Their level of emotional distress may be interfering with their daily activities.
 Many times, the relief of emotional distress is only one piece of the necessary
change, and attention to irrational thoughts, inadequate coping skills, or
dysfunctional behaviors that perpetuate the emotional distress is critical to lasting
change.
 At other times, individuals have been overwhelmed by a loss or tragedy in their lives
and benefit largely from the emotional release A person whose house has been
destroyed in a landslide may appropriately use counseling to vent the fear
experienced and the sad and angry feelings about the losses due to it.
 Once the trauma has been processed, preexisting coping skills may be sufficient for
moving on in life.
UNDERSTANDING AND MANAGING NEGATIVE FEELINGS
 Misconception - counselling eliminates negative feelings
 Negative feelings are present even when people lead satisfactory lives.
 Effective counselling aims to:
-help people understand negative feelings
-leave clients with situation-appropriate levels of negative feelings
-reduce debilitating anxiety, overwhelming sadness, or extreme anger
 It is normal to feel anxious about an important decision- clients with no fear of life-
threatening events are seen as in special need of counselling.
 What clients need is the skill to cope with such emotions, the permission to
experience their pain and the capacity to express such feelings without harming
others or themselves.
 Counselling serves as a means for clients to sort out the meaning in spite of loss,
disappointment, or fear; counsellors cannot impose their meanings or values on
clients.
 Existential theories focus largely on apprehending the meaning and purpose in spite
of pain.

PROCESS GOALS
 Process goals are sometimes described as counsellor’s actions.
 "If I am to help this client, I must actively listen to what he is saying and understand
the significance of his concerns for his present and future well-being.”
 “I must understand how the attitudes he is describing influence the way he behaves
toward significant others.”
 “I must understand the surrounding circumstances (including cultural background)
that relate to his concerns”
 “I must understand the reinforcing events that support his behavior."
  Process goals are also described in terms of the effects to be experienced by the
client, like experiencing trust, focusing more fully on primary concerns or controlling
fear
 "If I am to help this client, I believe she must feel a greater trust for me than she now
appears to be experiencing.”
 “The client seems to be talking a good deal about issues and events that do not
relate to her primary concerns. If our sessions are to be worthwhile, I think she must
focus more intently on these concerns. “
 “If the client is afraid to think about or talk about them, it will be important to help
her gain control over these anxieties. How can I help the client feel more trust and
less anxiety?"
 Another kind of process goal relates to the way the counselor can act as a model for
new ways of behaving.
 By modeling appropriate responses to frustration, disappointment, or negative
feelings, the counselor indirectly teaches the client alternatives to accustomed ways
of responding.
 For example, a counselor who deals assertively (not aggressively or sarcastically)
with a chronically late client is demonstrating to the client an alternative way to
cope with feelings of frustration.
 Some kinds of process goals are essential to all counselling relationships and define
the steps in the counselling process (like building trust, active listening), while
certain others are specific to particular clients (like client’s avoidance of primary
concerns).

SCOPE OF COUNSELLING
Individual assessment observation, information seeking, and interpretation of a person’s
behavior in areas that include performance, achievement, aptitude, personality, and
interests
Family counselling
interaction patterns that lead to dysfunctional behavior, understanding the family system,
understanding and changing communication patterns and coalitions of power.
Individual counselling one-to-one interactions with clients in which the process is applied to
resolving personal concerns, career and educational decisions, and problems of human
adjustment.
Couples counselling
helps partners articulate their vulnerable feelings to each other, with the goals of enhancing
their intimacy, resolving conflicts, or clarifying one or both partner’s decision to end the
relationship
Group counselling
individuals facing similar issues in a supportive group facilitated by counsellor - gain insights
from others’ perspectives, develop coping strategies through feedback and support from
peers
Substance Abuse Counselling
addresses the underlying issues contributing to substance abuse, develop coping
mechanisms, and work towards long-term recovery
Online counselling
a mental health intervention between the client and counsellor using digital technologies;
offers advantages of accessibility, flexibility and privacy.
Consultation
activities involve initiating changes on an organizational level - working on program
development, fixing/preventing the problems that arise from interpersonal conflict.
Mediation
help couples, business partners, or others involved in
a disagreement settles their differences in an expedient and respectful way through
structured conflict resolution and problem solving
Multicultural counselling
Client’s backgrounds influence the ways in which they view the world and the counselor’s
role must be sensitive and change to accommodate these perspectives

FUNDAMENTAL PRECEPTS OF EFFECTIVE COUNSELLING

Patterson & Welfel (2000) identified the fundamental principles that are most important in
understanding the counselling process.
PRECEPT 1: UNDERSTANDING
To be truly effective, the counsellor must have a thorough understanding of human behavior
in its social and cultural context, and be able to apply that understanding to the particular
set of problems or circumstances of each client.
PRECEPT 2: CHANGE IN THE CLIENT
The ultimate purpose of the counselling experience is to help the client achieve some kind of
change that he or she will regard as satisfying.
PRECEPT 3: THE QUALITY OF THE RELATIONSHIP
The quality of the counselling relationship is significant in providing a climate for growth.
Critical elements of the relationship that promote trust and openness are:
Respect (rather than rejection)
Empathy (rather than shallow listening and advice-giving)
Congruence or genuineness (rather than inconsistency)
Facultative self-disclosure (rather than being closed)
Immediacy (rather than escapism to the past or future)
Concreteness (rather than abstract intellectualizing)
PRECEPT 4: SELF-DISCLOSURE AND SELF-CONFRONTATION
The counselling process consists primarily of self-disclosure and self-confrontation on the
part of the client, facilitated by interaction with the counsellor.
PRECEPT 5: AN INTENSE WORKING EXPERIENCE
Counselling is an intense working experience for the participants. For the counsellor,
intellectual activities and the emotional experience of caring require sustained energy; for
the client, the effort to understand, the endurance of conflict, and the commitment to
disclose requires a level of concentration and hard work.
PRECEPT 6: ETHICAL CONDUCT
Offering to provide professional people-helping service obligates the counsellor to function
in an ethical manner, aligning with the Code of Ethics.

CONDITIONS FOR EFFECTIVE CHANGE

 Carl Rogers was instrumental in defining a type of alliance with people based on
nurturance, warmth, genuineness, respect, and authenticity.
 Rogers (1957) describes the core conditions of the helping relationship
 Congruence: most important ingredient in the relationship; counselors should work
toward developing more congruence between what they are feeling on the inside
and what they are communicating on the outside.
 Positive regard: The counselor does not evaluate and judge clients’ actions or
statements; behavior is viewed neutrally, and all people are worthy of respect.
 Empathy: the process of attempting to understand, from the client’s frame of
reference, the thoughts and feelings underlying behavior—that is, the ability to walk
around in the client’s shoes and know how he or she feels.
CHARACTERISTICS OF AN EFFECTIVE COUNSELLOR
 Much attention has been given in the counselling and psychotherapy literature to
the notion of counselling skills.
 The concept of skill refers to a sequence of counsellor actions or behaviors carried
out in response to client actions or behaviors.
 the Rogerian ‘core conditions’ of empathy, unconditional positive regard and
congruence (genuineness) have stirred up many models on counselling skills.
 The aim of an analysis of skilled performance is to break down the actions of a
person into simple sequences that can be learned and mastered in isolation from
each other.
 The micro counselling or micro skills training approach (Ivey and Galvin 1984) breaks
down the task of counselling into a number of discrete skills, necessary for effective
counselling, and that can be acquired through systematic training:
 Some argue that this way of looking at the task of the counsellor is inappropriate
because: Many of the essential abilities of the counsellor refer to internal,
unobservable processes. For example, a good counsellor is someone who is aware of
how she feels in the presence of the client, or who anticipates the future
consequences in the family system of an intervention that she plans to initiate with a
client. Neither of these counsellor actions is easily understood in terms of
observable skills.
 One of the differences between truly effective and less able counsellors is that the
former are able to see their own actions, and those of the client, in the context of
the total meaning of the relationship. Therefore, the ‘skillfulness’ of an intervention
can rarely be assessed by dissecting it into smaller and smaller micro-elements.
 Personal qualities, such as genuineness or presence, are at least as important as
skills.
 A more useful concept would appear to be to adopt the much broader idea of
competence, which refers to any skill or quality exhibited by a competent performer
in a specific occupation.
 In recent years, there has been an increasing amount of research interest devoted to
identifying the competencies associated with success in counselling and
psychotherapy.
 Larson et al. (1992) have constructed a model that breaks down counsellor
competence (which they term ‘counsellor self-efficacy’) into five areas: micro-skills,
process, dealing with difficult client behaviors, cultural competence and awareness
of values.
 A composite model consisting of seven distinct competence areas was developed by
McLeod (2004)
Counselling Skills and Techniques

GUIDANCE AND COUNSELLING

 Dunsfor & Miller states “Guidance is a means of helping individuals to understand
and use wisely the educational, vocational and personal opportunities they have or
can develop and as a form of systematic assistance whereby students are aided in
achieving satisfactory adjustment to school and in life.”
 Guidance is a more comprehensive process which includes counselling.
Guidance services include many other services apart from counselling.
 Counselling is the most specialized and most important service in the whole
guidance programme.

DIFFERENCES
COUNSELLING AND PSYCHOTHERAPY

 Attempts to distinguish between counselling and psychotherapy not wholly

successful and there is no agreement on this issue.
 One distinction suggests that psychotherapists work with mental disorders and do
longer-term, deeper work than counsellors.
 Another distinction is the identification of counsellors by the context of the work.
 Psychotherapists seem more likely than counsellors to work in private practice and
less likely to be in paid employment.
 One of the distinctions made has been to see counselling as vocational, that is skills
based, with little theoretical or research base and psychotherapy as more academic
and a science.
 Another distinction has linked psychotherapy to mental illness and a medical model
of patients and treatment, as opposed to counselling’s clients and process.
 This distinction comes directly from the historical origins of counselling and
psychotherapy.

THE CONTINUUM
A model for understanding the terms was put forth by Neukrug (2012) – The Guidance
Counselling Psychotherapy Continuum

ACA Code of Ethics

 The American Counseling Association (ACA) is an educational, scientific, and

professional organization whose members work in a variety of settings and serve in
multiple capacities.
 Professional values are an important way of living out an ethical commitment. The
following are the core professional values of the counseling profession:
enhancing human development throughout the life span; honoring diversity and
embracing a multicultural approach in support of the worth, dignity, potential, and
uniqueness of people within their social and cultural contexts;
promoting social justice; safeguarding the integrity of the counselor-client
relationship; and practicing in a competent and ethical manner.

Fundamental Ethical Principles

These professional values provide a conceptual basis for the ethical principles, which are
 the foundation for ethical behavior and decision making. Autonomy, or fostering the
right to control the direction of one’s life; non maleficence, or avoiding actions that
cause harm; beneficence, or working for the good of the individual and society by
promoting mental health and well-being; justice, or treating individuals equitably and
fostering fairness and equality; fidelity, or honoring commitments and keeping
promises, including fulfilling one’s responsibilities of trust in professional relationships;
and veracity, or dealing truthfully with individuals with whom counselors come into
professional contact.

Purpose of ACA Code of Ethics

 The Code sets forth the ethical obligations of ACA members and provides guidance
intended to inform the ethical practice of professional counselors.
 The Code identifies ethical considerations relevant to professional counselors and
counselors-in-training.
 The Code enables the association to clarify for current and prospective members, and
for those served by members, the nature of the ethical responsibilities held in
common by its members.
 The Code serves as an ethical guide designed to assist members in constructing a
course of action that best serves those utilizing counseling services and establishes
expectations of conduct with a primary emphasis on the role of the professional
counselor.
 The Code helps to support the mission of ACA.
 The standards contained in this Code serve as the basis for processing inquiries and
ethics complaints concerning ACA members
 The ACA Code of Ethics contains nine main sections that address the following areas:
Section A: The Counseling Relationship
Section B: Confidentiality and Privacy
Section C: Professional Responsibility
Section D: Relationships With Other Professionals
Section E: Evaluation, Assessment, and Interpretation
Section F: Supervision, Training, and Teaching
Section G: Research and Publication
Section H: Distance Counseling, Technology, and Social Media
Section I: Resolving Ethical Issues
Supervision, Training, and Teaching
 Counselor supervisors, trainers, and educators aspire to foster meaningful and
respectful professional relationships and to maintain appropriate boundaries with
supervisees and students in both face-to-face and electronic formats.
 They have theoretical and pedagogical foundations for their work; have knowledge of
supervision models; and aim to be fair, accurate, and honest in their assessments of
counselors, students, and supervisees.
 Counseling supervisors monitor client welfare and supervisee performance and
professional development.
 Prior to offering supervision services, counselors are trained in supervision methods
and techniques.
 Counselors who offer supervision services regularly pursue continuing education
activities, including both counseling and supervision topics and skills.
 Counseling supervisors clearly define and maintain ethical professional, personal, and
social relationships with their supervisees.
  Supervisors document and provide supervisees with ongoing feedback regarding
their performance and schedule periodic formal evaluative sessions throughout the
supervisory relationship.
 Counselor educators who are responsible for developing, implementing, and
supervising educational programs are skilled as teachers and practitioners.
 They are knowledgeable regarding the ethical, legal, and regulatory aspects of the
profession; are skilled in applying that knowledge; and make students and
supervisees aware of their responsibilities.

The Counseling Relationship

 The primary responsibility of counselors is to respect the dignity and promote the
welfare of clients.
 Clients have the freedom to choose whether to enter into or remain in a counseling
relationship and need adequate information about the counseling process and the
counselor – Informed consent
 Counselors act to avoid harming their clients, trainees, and research participants and
to minimize or to remedy unavoidable or unanticipated harm.
 Counselors actively attempt to understand the diverse cultural backgrounds of the
clients they serve, explore their own cultural identities, and how these affect their
values and beliefs about the counseling process
 Sexual and/or romantic counselor–client interactions or relationships with current
clients, their romantic partners, or their family members are prohibited.
 Counselors consider the risks and benefits of accepting as clients those with whom
they have had a previous relationship as well as extending counseling boundaries
beyond conventional parameters (egg; attending a formal ceremony)

Confidentiality and Privacy

 Counselors aspire to earn the trust of clients by creating an ongoing partnership,

establishing and upholding appropriate boundaries, and maintaining confidentiality.
 Counselors communicate the parameters of confidentiality in a culturally competent
manner - maintain awareness and sensitivity regarding cultural meanings of
confidentiality and privacy.
 Exceptions – The general requirement that counselors keep information confidential
does not apply when disclosure is required to protect clients or identified others from
serious and foreseeable harm or when legal requirements demand that confidential
information must be revealed (e.g. life-threatening or contagious diseases, court-
ordered disclosure etc.)
 When services provided to the client involve participation by an interdisciplinary or
treatment team, the client will be informed of the team’s existence and composition,
the information being shared, and the purposes of sharing such information.
 When counseling minor clients or adult clients who lack the capacity to give
voluntary, informed consent, counselors protect the confidentiality of information
received—in any medium— through appropriate, collaborative relationships with
parents/guardians to best serve clients.
 Counselors ensure that records and documentation kept in any medium are secure
and that only authorized persons have access to them.

Professional Responsibility
 Counselors have a responsibility to read and follow the Code of Ethics and adhere to
applicable laws and regulations.
  Counselors practice only within the boundaries of their competence, based on their
education, training, supervised experience, state and national professional
credentials, and appropriate professional experience
 Counselors continually monitor their effectiveness as professionals and take steps to
improve when necessary
 When advertising or otherwise representing their services to the public, counselors
identify their credentials in an accurate manner that is not false, misleading,
deceptive, or fraudulent
 Counselors are accurate, honest, and objective in reporting their professional
activities and judgments to appropriate third parties, including courts, health
insurance companies, those who are the recipients of evaluation reports, and others.
 Counselors are encouraged to contribute to society by devoting a portion of their
professional activity to services for which there is little or no financial return (pro
bono public).
 counselors engage in self-care activities to maintain and promote their own
emotional, physical, mental, and spiritual well-being to best meet their professional
responsibilities.
 When providing services, counselors use techniques/procedures/ modalities that are
grounded in theory and/or have an empirical or scientific foundation - do not use
them when substantial evidence suggests harm, even if such services are requested

Relationships With Other Professionals

 Counselors develop positive working relationships and systems of communication

with colleagues to enhance services to clients – acknowledge the expertise of other
professional groups and be respectful of approaches grounded in theory/evidence-
based
 When counselors are required by law, institutional policy, or extraordinary
circumstances to serve in more than one role in judicial or administrative
proceedings, they clarify role expectations and the parameters of confidentiality with
their colleagues.
 Counselors take reasonable steps to ensure that they have the appropriate resources
and competencies when providing consultation services. Counselors provide
appropriate referral resources when requested or needed.

Evaluation, Assessment, and Interpretation

 Counselors use assessment as one component of the counseling process - developing
and using appropriate educational, mental health, psychological, and career
assessments to promote the well-being of individual clients
 The primary purpose of educational, mental health, psychological, and career
assessment is to gather information regarding the client for a variety of purposes,
including, but not limited to, client decision-making, treatment planning, and forensic
proceedings.
 Assessment may include both qualitative and quantitative methodologies.

 Counselors do not misuse assessment results and interpretations, and they take
reasonable steps to prevent others from misusing the information provided.
 They respect the client’s right to know the results, the interpretations made, and the
bases for counselors’ conclusions and recommendations.
 Counselors use only those testing and assessment services for which they have been
trained and are competent.
  Prior to assessment, counselors explain the nature and purposes of assessment and
the specific use of results by potential recipients.
 Counselors carefully consider the validity, reliability, psychometric limitations, and
appropriateness of instruments when selecting assessments and, when possible, use
multiple forms of assessment, data, and/or instruments in forming conclusions,
diagnoses, or recommendations.
 When providing forensic evaluations, the primary obligation of counselors is to
produce objective findings that can be substantiated based on information and
techniques appropriate to the evaluation, which may include examination of the
individual and/or review of records.
 Individuals being evaluated are informed in writing that the relationship is for the
purposes of an evaluation and is not therapeutic in nature, and entities or individuals
who will receive the evaluation report are identified.

Research and Publication

 Counselors plan, design, conduct, and report research in a manner that is consistent
with pertinent ethical principles, federal and state laws, host institutional regulations,
and scientific standards governing research – even when conducting independent
research without access to an institutional review board.
 Research participant rights – confidentiality, voluntary participation, informed
consent
 Counselors do not engage in misleading or fraudulent research, distort data,
misrepresent data, or deliberately bias their results.
 Counselors who review materials submitted for publication, research, or other
scholarly purposes respect the confidentiality and proprietary rights of those who
submitted it.

Distance Counseling, Technology, and Social Media

 Counselors who engage in the use of distance counseling, technology, and/ or social
media develop knowledge and skills regarding related technical, ethical, and legal
considerations (e.g., special certifications, additional course work).
 Such counsellors understand that they may be subject to laws and regulations of
both the counselor’s practicing location and the client’s place of residence.
 Counselors inform clients about the inherent limits of confidentiality when using
technology- of authorized and/ or unauthorized access to information disclosed using
this medium in the counseling process.
 The following issues, unique to the use of distance counseling, technology, and/ or
social media, are addressed in the informed consent process:
distance counseling credentials, physical location of practice, and contact
information; risks and benefits of engaging in the use of distance counseling,
technology, and/or social media; possibility of technology failure and alternate
methods of service delivery; anticipated response time; emergency procedures to
follow when the counselor is not available; time zone differences; cultural and/or
language differences that may affect delivery of services; possible denial of insurance
benefits; and social media policy
 Counselors take steps to verify the client’s identity at the beginning and throughout
the therapeutic process, like using code words, numbers, graphics, or other
nondescript identifiers.
 Counsellors discuss and establish professional boundaries with clients regarding the
appropriate use and/or application of technology and the limitations of its use within
 the counseling relationship (e.g., lack of confidentiality, times when not appropriate
to use).

Resolving Ethical Issues

 Counselors strive to resolve ethical dilemmas with direct and open communication
among all parties involved and seek consultation with colleagues and supervisors
when necessary
 When counselors have reason to believe that another counselor is violating or has
violated an ethical standard and substantial harm has not occurred, they attempt to
first resolve the issue informally with the other counselor if feasible, provided such
action does not violate confidentiality rights that may be involved.
 If an apparent violation has substantially harmed or is likely to substantially harm a
person or organization and is not appropriate for informal resolution or is not
resolved properly, counselors take further action depending on the situation, which
may include referral to state or national committees on professional ethics, or
appropriate institutional authorities.
 The confidentiality rights of clients should be considered in all actions

EGAN’S SKILLED HELPER MODEL

Gerard Egan’s Skilled Helper Model

 A structured and solution-focused approach to help people solve their own
problems through empowerment and help them develop future opportunities.
 It is a three-stage model in which each stage consists of specific skills that the
therapist uses to help the client move forward.
 By mastering the process of using these basic skills in an appropriate manner, the
skilled helper may be able to increase their efficiency and structure their work in a
more logical way, thus helping clients in a more consistent manner and being less
reliant upon their fluctuating ‘therapeutic inspiration’.

Therapeutic Orientations

 The Egan Skilled Helper approach encourages clients to become active interpreters
of the world, giving meanings to actions, events, and situations, facing and
overcoming challenges, exploring problem issues, seeking new opportunities, and
establishing goals.
 Success usually comes when human beings become active in initiating positive
behaviors and developing problem-solving strategies.
 The Skilled Helper aims to help their clients develop the skills and the knowledge
necessary to solve both their current problems and ones that may arise in the
future.
 To facilitate client development the helper builds a healthy therapeutic alliance with
the client based on collaboration, warmth and acceptance.
 The Skilled Helper facilitates the client by helping them to formulate a plan of action,
helping them accept their responsibility for becoming a more effective person and
helping them to develop their own inner resources.
 The Skilled Helper also:
1. helps their client to transfer newly acquired skills and knowledge to fresh
situations,
2. facilitates them in establishing appropriate and realistic goals (that match
their problem-solving skills),
 3. encourages them to become self-directive and develop the skills of problem-
solving,
4. helps them to build on their inner strengths and to utilize external resources
and support groups,
5. helps them realize their potential and facilitates them in developing goals
which are specific, measurable, achievable, realistic, ethical and reasonable.

Theoretical Origins

 Theoretically, the Skilled Helper approach draws on: Carkuff's theory of high-level
functioning helpers (which explains that helpers with the skills of empathy, respect,
concreteness, congruence, self-disclosure, confrontation and immediacy are most
effective);
 Strong's Social influence theory (which explains that helping is a process whereby
clients are influenced by others because they perceive therapists as having particular
attributes and with this influence being most powerful when the therapist avoids
both laxity and coercion and is instead collaborative, empowering and democratic)
and Albert Bandura's Learning theory (in which clients are seen as acquiring skills
through coming to understand the processes of learning and developing appropriate
self-efficacy expectations - expecting to achieve their goals by learning useful
behaviors).
The skilled helper problem-management and opportunity development approach to
helping
 Because all approaches to therapy must eventually help clients manage problems
and develop unused resources, the model or approach of choice is a flexible,
humanistic, broadly based problem-management and opportunity development— a
model that is straightforward without ignoring the complexities of clients’ lives or of
the helping process itself.
 Indeed, because the problem management and opportunity- development process
is embedded in almost all approaches to helping, this model provides an excellent
foundation for any “brand” of helping you eventually choose

Ingredients of Successful Helping

 The client and the contextual factors of the client’s life - Clients and their needs are
the centerpiece of the problem-management helping process. Keeping the client in
the driver’s seat has been and remains one of the imperatives of therapy.
 The person of the therapist. the therapist’s becoming competent in the skills
needed to become a consultant and catalyst in the client’s efforts to manage
problem situations and develop unused opportunities. But the therapist is not the
main character in this drama. The client is.
 The helping relationship. The client and the therapist are not equal partners in the
problem-management process rather they collaborate. Clients must manage their
problem situations. Therapists have a tool kit that helps clients do just that. The
more successful counselors are in helping clients bring out the best in themselves,
the more successful they are. Helpers are successful only to the degree that clients
are.
 The therapeutic dialogue between client and helper. It is important for therapists
to use their skills to help clients communicate more effectively. These
communication skills are at the heart of the therapist’s role as consultant to the
problem-management process.
  Two-way feedback between client and helper. Session-to-session feedback with
respect to both progress toward outcomes and the usefulness of the helping
sessions themselves is critical to the problem-management process.
 The standard problem-management process as a human universal. It is clear that
the standard problem-management model is used, directly or indirectly, in just
about every approach to therapy. And, in its basic form, it is readily understood by
clients.
 The model or method of treatment and the assumptions behind it. It is now clear
that the standard problem-management model is also a method of treatment in
itself. It is an experiential cognitive-behavioral-emotive model covering the totality
of human behavior.
 Decision making as a human universal. Decision making is at the heart of problem
management. Because problem management is impossible without making
decisions, a fuller understanding of the ins and outs and the ups and downs of
decision making is essential to both helper and clients.
 The beliefs, values, norms, ethics, and morality that drive human behavior. This
package permeates the totality of human behavior. Because it is not a “scientific”
package, it introduces a degree of messiness to all human transactions, including
that transaction called therapy. But it, too, is at the heart of therapy.

The Helping Relationship

 The importance of helping relationship is acknowledged - the better both clients and
helpers understand themselves in terms how they establish and maintain
relationships, the better they might be in establishing a working alliance in therapy
 The relationship is seen as a working alliance - “The alliance represents an emergent
quality of partnership and mutual collaboration between therapist and client…. Its
development can take different forms and may be achieved quickly or nurtured over
a longer period of time …” (Horvath et al., 2011)
 In the working alliance, helpers and clients are collaborators - Helping is not
something that helpers do to clients; rather, it is a process that helpers and clients
work through together (Frankel, 2007).
 Relationship as a means to an end - Overstressing the relationship is a mistake
because it obscures the ultimate goal of helping: managing problem situations and
developing life-enhancing opportunities
 In the working alliance, the relationship itself is often a forum or a vehicle for social-
emotional relearning (Mallinckrodt, 1996). Effective helpers model attitudes and
behavior that help clients challenge and change their own attitudes and behavior.
 Protected by the safety of the helping relationship, clients can experiment with
different behaviors during the sessions themselves - the shy person can speak up,
the reclusive person can open up, the aggressive person can back off, the overly
sensitive person can ask to be challenged, and so forth.
 Clients can then transfer what they are learning to other social settings
 Relationship flexibility - Different clients have different needs, and those needs are
best met through different kinds of relationships and different modulations within
the same relationship.

The Values that drive the Relationship

 Values-in-use are not just mental states. They are tools that guide decision making.
They give rise to client-enabling helping behavior.
  Respect for clients is the foundation value on which all helping interventions are
built.
 Empathy is the primary orientation value –a basic value that informs and drives all
helping behavior
 One way of showing respect is empathy - an understanding and feeling for the
mental states and emotions of another person and how the person’s context
influences his or her thinking and feeling
 Proactive Appreciation of Diversity - Dealing knowledgeably and sensitively with
diversity (Muran, 2006) and that particular form of diversity called multiculturalism
is part of both respect and empathy and is related to client empowerment.
 Self-responsibility as an Empowerment-focused Value - Client responsibility
assumes that the client has the power to do what is right for self and others. helpers
do not empower clients. Rather they help clients discover, acquire, develop, and use
the power they have at the service of constructive life change.
 A bias for action as an Outcome value -helping clients move into action, beyond
inertia, beyond avoidance; helping them become more effective “agents” in the
helping process and in their daily lives—doers rather than mere reactors, preventers
rather than fixers, initiators rather than followers.

Therapeutic Dialogue: Communication and Relationship-building skills

1. Dialogue-focused interactions with clients - Four requirements of true dialogue – turn-

taking, connecting, mutual influencing and cocreating outcomes that benefit both parties.
2. Tuning in/Empathic Presence - Geller and Greenberg (2012) see therapeutic presence as
a “foundational therapeutic stance that supports deep listening and understanding of the
client in the moment.”
3. Active Listening – Focused, unbiased and empathic listening of the client’s stories – their
experiences, thoughts, behaviors and affect; listening involves thoughtful processing –
understanding client through context, identifying key messages and feelings, and tough-
minded listening for detecting the gaps, distortions, and dissonance that are part of the
client’s experienced reality

Guidelines for Visibly Tuning In - SOLER

RESPONDING SKILLS
 Helpers respond by sharing their understanding, checking to make sure that they’ve
got things right, probing for clarity, summarizing the issues being discussed, and
helping clients challenge themselves in a variety of ways.
 Counselors use the responding skills of empathy, probing, summarizing, and
facilitating client self-challenge.
  The communication skills involved in responding to clients have three dimensions:
perceptiveness, know-how, and assertiveness.
 Feeling empathy for others is not helpful if the helper’s perceptions are not
accurate. Ickes (1993) defined “empathic accuracy” as “the ability to accurately infer
the specific content of another person’s thoughts and feelings”.
 Such people are not only accurate perceivers but they can also weave their
perceptions into their dialogues with their clients.
 Once the counsellor is aware of what kind of response is called for, you need to be
able to deliver it - the know-how needed to communicate accurate empathic
understanding.
 Accurate perceptions and excellent know-how are meaningless if they remain locked
up inside the counselor

Probing

 Prompts and probes are verbal and sometimes nonverbal tactics for helping clients
talk more freely and concretely about any issue at any stage of the helping process
 Prompts are brief verbal or nonverbal interventions designed to let clients know that
you are with them and to encourage clients to talk further.
 Bodily movements, gestures, nods, eye movement, and the like can be used as
nonverbal prompts; responses like “um,” “uh-huh,” “sure,” “yes,” “I see,” “ah,”
“okay,” and “oh” as vocal or verbal prompts.
 Probes help clients name, take notice of, explore, clarify, or further define any issue
at any point in the helping process. Probes are designed to provide clarity and to
move things forward. They take the form of statements, requests or questions.
“It’s still not clear to me whether you want to challenge her to leave the nest or
not.”
“Tell me what you mean when you say that three’s a crowd at home.”
“In situations like that, what keeps you from making a decision?”

Summarizing
Goals of summarizing (Brammer, 1973)— “warming up” the client, focusing scattered
thoughts and feelings, bringing the discussion of a particular theme to a close, and
prompting the client to explore a theme more thoroughly.
There are certain times when summaries prove particularly useful: at the beginning of a
new session, when the session seems to be going nowhere, and when the client needs a new
perspective.

Self-challenging
Goals of challenging
To help clients challenge themselves to change ways of thinking, expressing emotions, and
acting that keep them mired in problem situations and prevent them from identifying and
developing opportunities
To help them challenge themselves to find possibilities in their problems, to discover unused
strengths and resources, both internal and external, to invest these resources in the
problems and opportunities of their lives, to spell out possibilities for a better future, to find
ways of making that future a reality, and to commit themselves to the actions needed to
make it all happen.

Targets of Self-challenge:
• self-defeating mind-sets, such as prejudice
• self-limiting internal behavior, such as dysfunctional daydreaming
• self-defeating expressions of feelings and emotions, such as flying off the handle
• dysfunctional external behavior, such as putting people down
• distorted understanding of what the world is really like
• discrepancies between thinking and acting
• unused strengths and resources
• the predictable dishonesties of everyday life (distortions, tricks, excuses etc.)

The Skilled Helper Model

Stage I: The Present – where you are at now
Help the client to tell their story - use prompts, active listening, open questions, S.O.L.E.R
Help the client to break through any blind spots - use reflection
Help the client to find the right problem/opportunity to work on – prioritizing.
Stage II: Preferred – where you want to be
Help the client to use their imagination to find possibilities
Help the client choose realistic and challenging goals - think of an action plan
Help the client to find incentives that will enable and assist them with commitment.
Stage III: Strategies – How are you going to get where you want to be?
Help the client find possible actions
Help the client to find the best fit strategies - what will work for the client
Help the client to draft an action plan

Stage 1: The Current Picture

 Stage 1 is about providing a safe place for the speaker to tell their story in their own
way, and to be fully heard and acknowledged. It is about a space where a person can
hear and understand their own story.
 It is also about gently helping them lift their head to see the wider picture and other
perspectives, and to find a point from which to go forward with hope.
 Contains three parts:
I-A: an expansive part
I-B: a challenging part
I-C: Focusing and moving forward

Stage I-A: Expansive Part

 The helper encourages the speaker to tell their story, and by using good active
listening skills and demonstrating the core conditions, helps them to explore and
unfold the tale, and to reflect.
 For some, this is enough, for others it is just the beginning.
 Skills: - active listening, reflecting, paraphrasing, checking understanding, open
questions, summarizing.
 Useful Questions: How do/did you feel about that? What are/were you
thinking? What is/was that like for you? Keep them open! What else is there about
that
Guidelines for Stage I-A

Stage I-B: Challenging part

 Since they are in the situation, it can be difficult for the clients to see it clearly, or
from different angles.
 With the help of empathic reflections and challenges, the speaker uncovers blind
spots or gaps in their perceptions and assessment of the situation, of others and of
themselves – their patterns, the impact of their behavior on the situation, their
strengths.
“I’d never thought about how it might feel from my colleague’s point of view.”
 Skills: Challenging different perspectives, patterns and
 connections, should and ought’s, negative self-talk, blind spots (discrepancies,
distortions, incomplete awareness, things implied, what’s not said), ownership,
specific strengths.
 The role of the helper is to help clients challenge themselves to participate as fully as
possible in the helping process. Helpers invite them to: own their problems and
unused opportunities state their problems as solvable explore their “problem-
maintenance structure “move on to the right stage and task of the helping process
 Useful Questions: How do others see it/you? Is there anything you’ve overlooked?
What does he/she think/feel? What would s/he say about all this? What about all of
this is a problem for you? Any other way of looking at it?

I-C -Focusing and moving forward

People often feel stuck; that is why they want to talk.
In this stage, the helper seeks to move the speaker from stuckness to hope by helping
them choose an area that they have the energy to move forward on, that would make a
difference and benefit them.
“I see now the key place to get started is my relationship with K”
Stage I can be 5 minutes or 5 years; it may be all someone needs.
 Skills: Facilitating focusing and prioritizing an area to work on.
 Useful Questions:
What in all of this is the most important?
What would be best to work on now?
What would make the most difference?
What is manageable?

Principles for helping clients in Stage I-C

 Determine whether or not helping is called for or should be continued.
 If there is a crisis, first help the client manage the crisis.
 Begin with the issue that seems to be causing the client the most pain.
 Begin with issues the client sees as important and is willing to work on.
 Begin with some manageable sub-problem of a larger problem situation.
 Move as quickly as possible to a problem that, if handled, will lead to some kind of
general improvement.
 Focus on a problem for which the benefits will outweigh the costs.

Stage II: The Preferred Picture

 People often move from problem to action, or problem to solution, without
reflecting on what they really want, or in what way their problems might be
opportunities.
 Stage II is about this, about helping the speaker to open up a picture of what they
really want, and how things could be better. This stage is very important in
generating energy and hope.
 Contains three parts:
II-A - a creative part
II-B - a reality testing part
II-C - moving forward

Stage II-A: Creative part

 The helper helps the client to brainstorm their ideal scenario; ‘if you could wake up
tomorrow with everything just how you want it, like your ideal world, what would it
be like?’
 The client is encouraged to broaden their horizon and be imaginative, rather than
reflect on practicalities. For some people this is scary, for some liberating.
“At first it was really difficult but after a while I Jet my imagination go and began to
get really excited about what we could achieve in the department”.
 Useful Questions: What do you ideally want instead? What would be happening?
What would you be doing/thinking/feeling? What would you have that you don’t
have now? What would it be like if it were better / a bit better?

Skills for identifying possibilities

 Help clients to focus on their “possible selves”
 Help clients to tap their creativity
 Help clients to engage in divergent thinking
 Help clients to review exemplars and role models as source of possibilities
  Use brainstorming adaptively
 Use future-oriented probes

Stage II-B: Reality testing part

From the creative and visionary brainstorm, the speaker formulates goals which are specific,
measurable, achievable/appropriate (for them, in their circumstances), realistic (with
reference to the real world), and have a time frame attached, i.e. SMART goals. Goals which
are demanding yet achievable are motivating.
“It feels good to be clear that I want a clear understanding with my colleagues about our
respective rules and responsibilities.”
 Skills: facilitating selecting and reality checking with respect to internal and external
landscape.
 Useful Questions: What exactly is your goal? How would you know when you’ve got
there? What could you manage/are you likely to achieve? Which feels best for you?
Out of all that, what would be realistic? When do you want to achieve it by?

Stage II-C: Moving Forward

This stage aims to test the realism of the goal before the person moves to action, and to help
the speaker check their commitment to the goal by reviewing the costs and benefits to them
of achieving it. Is it worth it?
“It feels risky but I need to resolve this.”
 Skills: facilitation of exploring costs and benefits, and checking commitment to goal.
 Useful Questions: What will be the benefits when you achieve this? How will it be
different for you when you’ve done this? What will be the costs of doing this? Any
disadvantages/downsides to doing this?
Stage III: The Way Forward
 This is the ‘how’ stage… how will the person move towards the goals they have
identified in Stage 2?
 It is about possible strategies and specific actions, about doing something to get
started, whilst considering what/who might help and hinder making the change.
 Contains three parts
III-A – Possible Strategies
III-B – Best-fit Strategies
III-C - Plans

Stage III-A: Possible Strategies

 The client is helped to develop possible strategies for accomplishing their goals.
“What kind of actions will help me get what I need and want?”
What people, places, ideas, organizations could help?
 The client is helped to brainstorm strategies again with prompting and
encouragement to think widely. The aim is to free up the person to generate new
and different ideas for action, breaking out of old mind-sets.
 Skills: Facilitation of brainstorming
 Useful Questions: How many different ways are there for you to do this? Who/what
might help? What has worked before/for others? What about some wild ideas?

Stage III-B – Best-fit Strategies

 What from the brainstorm might be selected as a strategy that is realistic for the
speaker, in their circumstances, consistent with their values?
 Forcefield analysis can be used here to look at what internal and external factors
(individuals and organizations) are likely to help and hinder action and how these
can be strengthened or weakened respectively.
“I would feel comfortable trying to have a conversation with him about how he sees
things”.
 Skills: Facilitation of selecting and reality checking.
 Useful Questions: Which of these ideas appeals most? Which is most likely to work
for you? Which are within your resources/control?

Criteria for choosing strategies

  Specific Strategies - Strategies for achieving goals should be specific enough to drive
behavior.
 Effective Strategies - Strategies are effective to the degree that, when implemented,
actually achieve the goal.
 Realistic Strategies - Strategies are realistic when they can be carried out with the
resources the client has, are under the client’s control, and are unencumbered by
obstacles.
 Strategies that are consistent with the client’s values.

Stage III-C – Plans

 The aim is to help the client plan the next steps. The strategy is broken into bite-size
chunks of action. Here the client is doing almost all the work, producing their action
plan. The helper works with them to turn good intention into specific plans with
time scales.
 Skills: Facilitation of action planning.
 Useful Questions:
What will you do first? When? What will you do next? When?

How plans add value to clients’ change programs?

 Plans help clients develop needed discipline
 Plans keep clients from being overwhelmed
 Formulating plans helps clients search for more useful ways of accomplishing goals
—that is, even better strategies.
 Plans provide an opportunity to evaluate the realism and adequacy of goals
 Plans make clients aware of the resources they will need to implement their
strategies
 Formulating plans helps clients uncover unanticipated obstacles to the
accomplishment of goals
 After Stage III If the client has passed through all three stages and produced an
action plan, the experience of trying it out could be the starting point for a follow-up
mentoring/co-mentoring session. The work could start again in stage 1, with the
client choosing to tell a new story. If an action plan has not been reached, that is
also okay. The model can still be used over a series of sessions, effectively.
 If the end point of producing an action plan has been reached, the experience of
trying it out could be the starting point for a follow-up mentoring/co-mentoring
session. The work would start in stage I again, telling a new story. If an action
plan had not been reached, that’s fine too, and the model can be used over a series
of sessions.
 The key in using the model, as with any theory or model, is to keep the client’s
agenda central, the individual in the foreground and theory in the background, and
to use the model for the person, rather than vice versa.

Clara Hill’s Process Model of Helping:

 Exploration through humanistic approach,
 Insight through psychodynamic approach,
 Action through cognitive behavioral approach.

Exploration Stage
When one pours out one's heart, one feels lighter. -Yiddish proverb

Theoretical Background: Carl Rogers

  The exploration stage is influenced by Carl Rogers's theory of personality
development and psychological change.
 His client-centered orientation was rooted in phenomenology, which places a strong
emphasis on the experiences, feelings, values, and inner life of the client.
 Rogerian ideas:
(1) perceptions of reality vary from person to person; subjective experience
guides behavior, and people are guided by their internal experience rather
than by external reality.
(2) To understand another person, one needs to suspend judgment and try to
see things from that person's perspective.
(3) The basic motivational force is the tendency toward self-actualization, which
propels people to become what they are meant to become.
(4) Each person has an innate blueprint, or set of potentialities, that can be
developed.
(5) People have an inherent ability to fulfill their potential.
(6) People are resilient and can bounce back from adversity given this innate
growth potential.

THEORY OF PERSONALITY DEVELOPMENT

 According to Rogers, infants evaluate each experience in terms of how it makes
them feel - the organismic valuing process (OVP).
 Because behavior is governed by the OVP, infants can perceive experiences as they
actually occur without distorting them.
 With the OVP, no experiences are more or less worthy; they just are. In other words,
every event is interesting and open for investigation without prejudice.
 Infants thus evaluate experiences as to whether they enhance or maintain the
organism. For example, if an experience (e.g., being hugged) enhances the organism,
the infant feels good and is satisfied and might smile or laugh.
 Infants evaluate events by how they actually feel, not by how someone else tells
them they should feel.
 The OVP, then, is an internal guide that everyone has at birth, and it leads the
person toward self-actualization.
 People freely seek those experiences that enhance them when they trust this
internal guide.
 Rogers believed that because infants have positive strivings toward self-actualization
and a natural curiosity about life, they can trust these inner feelings.
 In addition to having the OVP, children also have a need for unconditional positive
regard.
 In other words, they need acceptance, respect, warmth, and love without
conditions of worth (COWs); that is, they need to be loved just because they are
themselves and not because they meet certain standards or fulfill certain
requirements.
 When children feel prized, accepted, and understood by significant others (usually
parents), they begin to experience self-love and self-acceptance and develop a
healthy sense of self with little or no conflict.
 A prized child is able to attend to his or her OVP and make good choices on the basis
of inner experience.
 Unfortunately, because parents themselves are not perfect, they place COWs on
their children, demanding that children fulfill certain requirements to be loved
 The more COWs there are, the more distorted the person becomes from his or her
own experiencing.
  The self-actualizing tendency can be derailed when the self-concept is altered by
conditions of worth (COWs), which supplant a person’s basic, positive self-regard
with others’ conditional evaluations of worth.
 The incongruence between actual experience and self-concept typically results in
inauthentic expressions of feelings, low self-regard, defensiveness, anxiety, and
depression
 Children feel positive self-regard only when their experiences are consistent with
feedback they receive from others (e.g., if a girl feels talented in playing the violin
and others tell her that she is talented).
 Feelings of self-worth become dependent on the COWs that are learned in
interaction with significant others.
 A child with too many COWS will not be open to experience, accepting of feelings,
capable of living in the present, free to make choices, trusting, capable of feeling
both aggression and affection, and capable of creativity. He or she will have a
conflicted sense of self.
 When parents humiliate a child (e.g., “Real men don’t cry,” “Shut up, or I’ll give you
something to cry about”) or deny that the child has feelings (e.g., “You don’t hate
your teacher,” “You don’t feel hurt”), the child becomes confused about her or his
feelings.
 The child may feel sad or hateful, but the parents say he or she does not have these
feelings. What should the child trust, the inner experience or what parents tell him
or her to feel?
 If the child does not pay attention to his or her parents, she or he risks losing
parental approval and love. If she or he does not pay attention to inner feelings and
instead tries to please others, the child loses her or his sense of self.
 One can easily see how children come not to trust their inner experiences. Children
must survive, so they often choose parents’ attention and “love” over inner
experiencing.
 When COWs are pervasive and the OVP is disabled, the sense of self is weakened to
the point at which a person is unable to experience or recognize feelings as
belonging to the self.
 For example, a woman might not even be aware of feeling angry and hurt when
being verbally and physically abused by her husband because she thinks she
deserves the abuse.
 When people cannot allow themselves to have their feelings, they often feel a sense
of emptiness, phoniness, or lack of genuineness.
 This lack of genuineness about one’s feelings reflects a split or incongruence
between the real and ideal self and is the source of anxiety, depression, and
defensiveness in relationships.

DEFENSES
 Rogers (1957) suggested that when there is an incongruence between who one is
and who one thinks one ought to be, the person feels threatened.
 For example, a person who acts pleasant and happy but is actually feeling grumpy
and depressed is in danger of losing touch with his or her inner self. If she or he
were to perceive her or his depression accurately, his or her self would be
threatened because he or she has built an image of self as always happy.
 When a person feels such a threat, she or he typically responds with anxiety, a signal
that the self is in danger.
 Feeling this anxiety, the person invokes defenses to reduce the incongruity between
experience and sense of self, thereby reducing anxiety.
  One major defense is perceptual distortion, which involves altering or
misinterpreting one’s experience to make it compatible with one’s self-concept.
 By distorting experiences, clients avoid having to deal with unpleasant feelings and
issues and can maintain their perceptions of themselves.
 For example, a person with a sense of worthlessness who is promoted at work might
misinterpret the reason for the promotion to be congruent with her negative sense
of self. She might say that the only reason she got the promotion was that “the boss
had to do it” or “no one else wanted the job.”
 A second defense is denial, which involves ignoring or denouncing reality.
 In this situation, people refuse to acknowledge experiences that are inconsistent
with the images they have of themselves.
 By denying their experiences, clients avoid anxiety.
 For example, a woman who is treated unfairly at work might ignore her anger at her
boss because she has internalized her parents’ belief that anger is bad and that she
will not be loved if she expresses anger. Rather than allow herself to experience her
anger, she may say she is not trying hard enough or is not smart enough for the job.
 Defenses block incongruent experiences from full awareness and minimize threats
to one’s sense of self and thus allow the person to function and cope.
 A certain level of defense is necessary for coping, but excessive use of defenses can
take a toll on the self.

REINTEGRATION
 According to Rogers (1957), to overcome disintegration, rigidity, or discrepancies
between real and ideal selves, a person must become aware of the distorted or
denied experience.
 In other words, a person must allow the experience to occur and accurately
perceive the event.
 For reintegration to occur, the person must reduce the COWs and increase positive
self-regard by obtaining unconditional positive regard from others.
 COWs lose their significance and ability to direct behavior when others accept the
person as he or she is. In effect, individuals return to the OVP and begin to trust the
inner self, thus becoming more open to experience and feelings
 A person can reintegrate without unconditional positive regard from another person
if there is minimal threat to the self and the incongruity between self and experience
is minor. Typically, however, individuals respond to years of having COWs imposed
on them by becoming increasingly defensive.
 Once developed, defenses are difficult to let go because the person anticipates
being vulnerable and hurt again. In effect, defenses are adaptive to help children
cope, but fear and habit make them difficult to shed when they are no longer
needed.
 A helping relationship, then, is often crucial for overcoming defenses and allowing
the person to return to trusting the OVP. A helping relationship allows the
individual’s self-actualizing tendency to overcome the restrictions that were
internalized in the COWs.
 In a helping relationship, the helper attempts to enter the client’s subjective world
and understand the client’s internal frame of reference. The helper also tries to
provide an experience in which the client is accepted and cared for without COWs.
Thus, genuine acceptance from helpers begins to enable clients to accept
themselves. This helping relationship does not necessarily need to be from a
professional helper, and in fact, people often seek healing relationships from
supportive people in their environment.
THE RELATIONSHIP OF ROGERS’S THEORY TO THE HELPING SKILLS MODEL
 Rogers’s theory forms the foundation for the exploration stage and informs the
insight and action stages.
 Hill agrees with Rogers that helpers should maintain an empathic client-centered
stance of trying to understand the client’s experience as completely as possible with
as little judgment and as few prior assumptions as possible.
 Empathy, compassion, and a therapeutic relationship can be effective in helping
clients begin to accept themselves and trust their experiences.
 In contrast to Rogers’s assertion that a facilitative attitude is more important than
specific skills, Hill believes that a facilitative attitude and skills are inseparable
 Skills are used to express a facilitative attitude, and a facilitative attitude is needed
to express the skills. In addition, awareness is also crucial because, without
awareness, the helper is likely to act out unconscious impulses in a way that could
damage clients.
 Client involvement is also important but of less focus at this point because we are
concentrating on the helper’s contribution to the helping process. Thus, a facilitative
attitude, awareness, and skills are all important components of the helper’s
contribution to the helping process.
 Another point on which Hill diverge somewhat from Rogers’s theory relates to
Roger’s assertion about the helpful components of the therapeutic process.
 For some clients, being understood and encouraged to express their feelings is
enough to get them back to a self-healing mode so they can function again and
make needed changes.
 Others need more assistance in learning how to deal with feelings and experiences,
many of which may be new to them. Furthermore, some clients need to be assisted
in moving toward insight and action.
 In addition to maintaining the facilitative conditions, Hill posits that helpers need to
be able to facilitate insight and action.
 Additional theories (psycho-analytic, cognitive, behavioral) are needed to assist
some clients in moving beyond exploration of thoughts and feelings.
 Finally, Rogers did not attend closely to cultural considerations in his theory,
probably because the United States was not as diverse then as it is now.
 Culture certainly fits into Rogers’s theory, however, in that being truly empathic and
compassionate assumes a major interest in the person, awareness of who the
person is, and an acceptance of the person.
 Thus, Hill asserts that multicultural awareness is important to genuinely being
Rogerian.

Insight Stage
Daring as it is to investigate the unknown, even more so is it to question the known.
-Kaspar
 Unfortunately, not all clients can progress on their own after exploring their
thoughts and feelings. Some clients get stuck and need someone to help them get
past obstacles and defenses that protect them against internal pain and external
harm.
 When painful events occur, these clients often compartmentalize experiences in
their minds so that they do not have to think about them, making it difficult to
integrate these experiences into their lives.
 Other clients have a hard time understanding the origins and consequences of their
feelings and behaviors. Some clients have done things a certain way for so long that
they never question their actions or think about the reasons for what they do.
 Some clients have been so damaged by their parents that they cannot see the world
as a safe place.
 Other clients are eager to learn more about themselves and their motivations but
need an outside perspective to help them move beyond their blind spots.
 For these situations, it is important for helpers to use insight skills.
 The insight stage builds on the foundation of the exploration stage. Going beyond
exploration to insight and understanding requires a deep sense of empathy and
belief in clients. In this stage, helpers see beyond defenses and inappropriate
behaviors and help clients come to accept and understand themselves more deeply.
 The helper’s role in the insight stage involves coaching the client to gain insight
rather than the helper being the one who provides the insight. Often, clients are
capable of coming up with their own insights when helpers provide the appropriate
atmosphere and ask thoughtful questions.
 In fact, clients often feel better about insights they have attained on their own rather
than interpretations that are foisted on them. Some clients, however, want more
input from helpers, and such input can be helpful if offered in a collaborative,
tentative, empathic manner.

What Is Insight?

 When clients gain insight, they see things from a new perspective, are able to make
connections between things, or have an understanding of why things happen as they
do (Castonguay & Hill, 2007; Elliott et al., 1994).
 Insight typically must be emotional as well as intellectual to lead to action (Reid &
Finesinger, 1952; Singer, 1970) - must be deeply felt as well as cognitively
understood.
 Intellectual insight provides an objective explanation for a problem (e.g., “I am
anxious because of my Oedipal conflict”), but it has a barren, sterile quality that
keeps clients stuck in understandings that lead nowhere (Gelso & Fretz, 2001).
 Sometimes people who can give a comprehensive history of their psychological
problems and the sources of their difficulties cannot express their feelings fully.
 Emotional insight connects affect to intellect and creates a sense of personal
involvement and responsibility.

Theoretical Background: Psychoanalytic Theory

 Psychoanalytic theory began with Sigmund Freud and has evolved through many
subsequent theorists (notably Adler, Jung, and Sullivan).
 Over the time that psychoanalytic theory has existed, many changes have been
made in the theory (Mitchell, 1993), with current emphasis given to the importance
of the relationship between the therapist and client.

PSYCHODYNAMIC THEORY OF PERSONALITY

 Freud suggested that all children progress through stages of development. In the
first stage, energy is focused on oral (eating) satisfaction, first with sucking and then
with biting.
 As the child has to learn to control urination and defecation, energy shifts to the anal
region, both with retaining and expelling.
 Then Freud suggested that a latent period occurs, in which the child is freer for other
pursuits.
 As the child develops further, energy shifts to the genital region and children
become attracted to parents of the opposite sex. The resolution of this conflict (the
Oedipal conflict for boys, the Electra complex for girls) leads children to give up their
fixation on the opposite-sex parent and instead identify and ally with the parent of
the same sex and take on the morals and values of society.
 As children go through each stage, they can become stuck if they are either deprived
(e.g., given too little to eat) or overindulged (e.g., given too much to eat). When
people have difficulty, they tend to regress back to a stage in which they felt
gratified (e.g., regress to overeating).
 Looking back over 100 years from a different culture, it is clear that Freud’s
developmental sequence was heavily culturally bound and is not completely
relevant for the present day.
 Furthermore, Freud postulated that at birth, infants are totally governed by the id,
or primitive urges that seek immediate gratification. As the child develops, the ego
forms to help the child delay gratification and negotiate with the outside world.
 As the child develops further and internalizes society’s morals and values through
resolution of the Oedipal or Electra conflict, she or he develops a superego (which
involves both morals and ideals).
 Throughout life, people struggle with conflicts among primitive impulses, the
moderating ego, and societal restrictions and ideals.
 A related Freudian concept is consciousness. Freud divided awareness into the
unconscious, preconscious, and conscious. He postulated that the largest
percentage of mental activity is unconscious, or not avail able to immediate
awareness. Some energy is in the preconscious, where a person can access some
thoughts and experiences by attending to them.
 And a small amount of energy is readily available to conscious awareness. Freud
proposed that most people act out of unconscious motivations and are unaware
why they act the way they do.
 Another important Freudian construct relates to defenses. Not everything goes
smoothly in the development of personality.
 Because children do not receive everything they need to develop psychologically,
they cope by developing defense mechanisms.
 Freud (1933) and more recent psychoanalysts have theorized that defense
mechanisms are unconscious methods for dealing with anxiety through denial or
distortion of reality.
 Everyone has defense mechanisms because we all have to cope with the anxiety
inherent in living. Defense mechanisms can be healthy if used appropriately and in
moderation, but repeated and frequent use of defense mechanisms is problematic.
 A more current way of understanding the unconscious dynamics or the interplay
between the id, ego, and superego is to consider the centrality of conflict in human
functioning (Summers & Barber, 2010).
 From this perspective, all mental life can be conceptualized as inner turmoil arising
from competing wishes, fears, and prohibitions, along with the attempts to resolve
these contradictions in an acceptable way. Thus, we all have intense drives and
impulses.
 Freud identified sex and aggression as the major drives, but Summers and Barber
added attachment, bonding, mastery, and affiliation.
 These wishes can be in conflict (e.g. between love and aggression, between the wish
to be close and the wish for independence), or the conflict can be between wishes
and the outside world.
ATTACHMENT THEORY
 Another important analytic construct is attachment, which has been the focus of
much recent theorizing and research.
 Bowlby developed attachment theory to explain the behavioral and emotional
responses that keep young children in close proximity to caregivers.
 According to Bowlby, infants are born with the ability to form attachment bonds
with others. When facing a threat, the attachment system becomes activated, and
the infant seeks proximity and protection from the attachment figure.
 In optimal attachment, caregivers provide a comfortable presence that reduces
anxiety and promotes a feeling of security. From this secure base, infants feel a
sense of security that allows them to “explore the environment curiously and
confidently and to engage rewardingly with other people” (Mikulincer & Shaver,
2007, p. 21).
 Unfortunately, the attachment system is disrupted when the attachment figure is
unavailable, unresponsive, or ineffective in soothing the needy infant (Mikulincer &
Shaver, 2007).
 When this happens, the child feels insecure and worries about whether she or he
can rely on others, deal with emotions, or is worthy of care. If the caretaker
repeatedly withdraws when the child seeks proximity, the child learns not to rely on
others for help when threatened.
 In contrast, if the attachment figure is unpredictable, the child typically tries even
harder to get a response from the caregiver.
 Repeated experiences with attachment figures become organized into internal
working models, which are mental representations of self, others, and relationships
(Bowlby, 1969, 1988).
 These internal working models help people predict what they can expect from
others, whether others will respond when needed, and whether the world is safe.

TREATMENT FROM A PSYCHOANALYTIC PERSPECTIVE

 McWilliams (2004) conceptualized psychodynamic treatment stressing the
importance of curiosity and awe, respect for complexity, a disposition of
identification and empathy, a valuing of subjectivity and affect, an appreciation of
attachment, and a capacity for faith.
 Thus, like Rogers (1957), she was more concerned with the helping attitudes than
the specific techniques.
 Freud (1923/1963) believed that deep examination and insight into troubling issues
could assist in the resolution of problems.
 As a foundation for treatment, the helper listens patiently, empathically, uncritically,
and receptively to the client (Arlow, 1995). The helper focuses on incidents in the
present reality, the past, and the relationship with the helper (Summers & Barber,
2010).
 Freud (1912/1958) spoke of helpers having an “evenly suspended attention,” or of
being aware both of what the client says and does as well as paying attention to his
or her own internal feelings, thoughts, and fantasies.
 Goal of psychoanalytic treatment is to work with the unconscious conflicts (to
replace the id with the ego) or to help the person become more rational and
intentional rather than acting on primitive impulses.
 Thus, rather than just eating constantly to gratify oral urges, the helper works with
the client to understand these urges and make a conscious decision to change.
 The goal is also to free the person up to feel and experience life as it happens (to
laugh when happy, to cry when sad).
  The helper’s unresolved issues (countertransference) can also influence the process
and outcome of helping. Countertransference can be defined as the helper’s
reactions to the client that originate in the unresolved issues of the helper.

How psychoanalytic theory relates to the three-stage model

 Hill agrees with the emphasis on early childhood experiences (with significant
others), defenses (helping clients cope with moderate levels of defenses in a
protective manner), insight (helping clients to make lasting changes and deal with
new problems as they occur) and dealing with therapeutic relationships (providing
clients with corrective relational experiences and imparting skills to handle
relationships outside of therapy).
 However, Hill disagrees with the over-emphasis on childhood and lack of attention
to action and behavior change.

Action Stage
It is movement, not just insight, that produces change. –Waters and Lawrence (1993, p. 40)

 After clients have explored and gained insight, they are ready for the action stage,
during which helpers collaborate with clients to explore the idea of change, explore
options for change, and help them figure out how to make changes.
 These changes can be in thoughts (e.g., fewer self-defeating statements), feelings
(e.g., less hostility), or behaviors (e.g., less overeating).
 The action stage also involves exploring feelings and examining values, priorities,
barriers, and support in relation to change.
 The emphasis in this stage is on helping clients think about and make decisions
about action rather than on dictating action to clients.
 Helpers are coaches rather than experts dispensing advice.

Theoretical Background: Behavioral and Cognitive Theories

 Behavioral theories lay the foundation for the action stage.
 Behavioral theories share several basic assumptions:
i) a focus on overt behaviors rather than unconscious motivations;
ii) a focus on what maintains symptoms rather than on what caused them;
iii) an assumption that behaviors are learned;
iv) an emphasis on the present as opposed to the past
v) an emphasis on the importance of specific, clearly defined goals;
vi) a valuing of an active, directive, and prescriptive role for helpers;
vii) a belief that the helper-client relationship is important to establish rapport and
gain client collaboration but is not enough to help clients change;
viii) a focus on determining adaptive behaviors for specific situations rather than on
seeking personality change; and a reliance on empirical data and scientific
methods.

OPERANT CONDITIONING
 In operant conditioning, behaviors are thought to be controlled by their
consequences (Kazdin, 2013; Rimm & Masters, 1979; Skinner, 1953).
 Reinforcement is anything that follows a behavior and increases the probability that
the behavior will occur again. An event, behavior, privilege, or material object that
increases the likelihood of a behavior occurring again is called a positive reinforcer.
 Primary reinforcers (e.g., food, water, sex) are biological necessities, whereas
secondary reinforcers (e.g., praise, money) gain their reinforcing properties through
association with primary reinforcers. An example of a positive reinforcer related to
 helping is an approval- reassurance given after a client talks about feelings if it leads
to the client talking more about feelings.
 Things are not always reinforcing (e.g., food is typically reinforcing only if a person is
hungry) and that reinforcers are not the same for all individuals (e.g., a long bath
may be reinforcing for one person but not another).
 Whether something is a reinforcer can only be determined by looking at whether
the target behavior increases when the reinforcer is administered. Thus, a helper
can determine whether something is reinforcing by observing the client’s response.
 To be effective, reinforcement must be contingent on, or linked directly to, the
behavior (Rimm & Masters, 1979). An office worker who receives a raise every 3
months regardless of the quality of work is less likely to change his or her behavior
than is the office worker whose raise is contingent on good performance.
 For a behavior to be reinforced, it must first be performed. Hence, helpers often
have to engage in shaping, which refers to the gradual training of a complex
response by reinforcing closer and closer approximations to the desired behavior.
 Goldfried and Davison (1994) gave the example of training a developmentally
disabled child to make his bed by first reinforcing him for fluffing up his pillow, then
for pulling the top sheet forward, and so on.
 An example of shaping is how we teach exploration skills
 We might first ask the trainee to practice listening empathically without saying
anything, then ask him or her to repeat exactly what the client said, next ask the
trainee to say the main word the client is communicating, and finally ask him or her
to give restatements and reflections of feelings. Thus, we try to shape the helper’s
skills by starting with easier skills and moving on to more difficult ones only after the
trainee has mastered the easier ones.
 Punishment occurs after a behavior and reduces the probability that the behavior
will occur again.
 Goldfried and Davison (1994) identified three punishment procedures: (a)
presenting an aversive event (e.g., a frown when the client reports something
undesirable), (b) removing a person from a situation in which she or he would
otherwise be able to earn reinforcers (e.g., a time-out in a room away from anyone
who could provide positive reinforcement), and c) reducing a person’s collection of
reinforcers (e.g., taking away candy).
 It is difficult to deliver punishment immediately after the behavior. As a result, often
a person is punished for being discovered rather than for the behavior itself. Hence,
when punishment is used as the primary mode of behavior management, people
often figure out how to avoid getting caught rather than decreasing the problematic
behavior.
 For example, a child who steals cookies feels great (is reinforced) when he steals the
cookies because they taste good, but he feels bad several hours later when he gets
caught. Because the punishment is contingent on getting caught rather than on
eating the cookies, the clever child figures out a way to get the cookies without
getting caught.
 Another important behavioral concept is generalization, which involves the transfer
of learning from one situation to other, similar situations. For example, if kicking and
hitting are punished with time-outs and cooperative behavior is positively reinforced
at school, one would expect a decrease in kicking and hitting and an increase in
cooperative behavior in the home setting.
 Extinction reduces the probability of a behavior occurring by withholding reinforcers
after the behavior is established (Goldfried & Davison, 1994).
  For example, if a parent’s attention reinforces fighting among siblings (when no
other problems are apparent), a helper might instruct the parents to ignore the
fighting and let the kids work out their problems on their own (unless one child is in
danger of getting hurt) in the hopes that it will extinguish.
 Goldfried and Davison (1994) noted that extinction is best facilitated by concurrently
reinforcing an incompatible and more adaptive behavior. Thus, in the previous
example, the parents might suggest that the siblings play separately and then praise
them if they play quietly.
 Operant conditioning is often used when working with children because they are not
usually amenable to insight-oriented approaches.
For example, using operant methods for several specific behavioral problems with
children (e.g., to reduce fighting, to help them get off to school on time in the
morning, to help them sleep through the night in their own beds).

MODELING
 People often learn things even though they have never been reinforced for
performing them.
 One explanation for this learning is that they have learned through modeling or
observational learning, which occurs when person observes another person (a
model) perform a behavior and receive consequences (Bandura, 1977; Kazdin,
2013).
 For example, children learn how to be parents by watching their parents and
experiencing the effects of their child-rearing practices. Helpers learn how to help by
observing the behaviors of effective and ineffective helpers.
 To understand how modeling works, learning and performance must be
distinguished. A person can observe a model and thus learn a behavior. Whether the
person actually performs the learned behavior, however, depends on the
consequences at the time of performance.
 Bandura (1965) demonstrated this distinction between learning and performance
with his classic Bobo doll study. Children observed a film in which an adult hit or
kicked a Bobo doll (a life-size, inflatable, plastic doll that is weighted so it pops
upright after it is punched down).
 The adult’s behavior was rewarded, punished, or met with no consequences. When
the children were put in the room with the Bobo doll, those who had observed the
aggression being punished were less aggressive than were those who had observed
the aggression being rewarded or ignored.
 When all children were given an incentive for performing the aggressive behavior,
there were no differences among conditions, indicating that children in all conditions
learned aggressive behaviors equally well.
 Bandura concluded that learning occurred through observation but performance
depended on whether the child perceived that the adult was rewarded or punished.
 Kazdin (2013) noted that imitation of models by observers is greater when models
are similar to observers, more prestigious, higher in status and expertise than
observers, and when several models perform the same behavior.
 Thus, helpers can learn about helping by watching videotapes of many experts. In
addition, clients are probably more willing to listen to and accept suggestions from
helpers whom they perceive to be credible and expert.
 Modeling is an especially important component of helper training. Watching experts
conduct therapy is incredibly useful.
 Students who have worked transcribing and coding therapy sessions often say that
this experience was incredibly valuable in terms of learning what they liked and
 disliked about therapy.

COGNITIVE THEORY
 Cognitive theorists (e.g., A. T. Beck, 1976; Ellis, 1962; Meichenbaum & Turk, 1987)
introduced a stimulus-organism-response (S-O-R) model.
 In the S-O-R model, the organism (i.e., person) processes the stimulus before
determining how to respond. Thus, people respond not to stimuli but to their
interpretation of stimuli.
 For example, how an individual reacts to a noise heard in the middle of the night is
dependent on whether he thinks it is a benign noise (the house “settling”) or
whether he thinks the noise was made by a burglar.
 Thus, it is important to look for and dispute irrational thoughts (e.g., “I must be
perfect,” “Everyone must love me”).
 Theorists such as Beck, Ellis, and Meichenbaum have suggested that it is not so
much events that cause a person to become upset but what the person thinks about
the events.
 Cognitive processes are of utmost importance to the helping situation.
 Much of the helping process takes place at covert levels. Helpers’ intentions for their
interventions as well as their perceptions of clients’ reactions influence their
subsequent interventions.
 In addition, clients have reactions to helpers’ interventions as well as intentions for
how to influence helpers. Hence, a cognitively mediated model for understanding
the helping process makes a lot of sense.

HOW BEHAVIORAL AND COGNITIVE THEORIES RELATE TO THE ACTION STAGE

 Behavioral and cognitive theories fit well into the action stage of the helping model
because they provide specific strategies for helping clients change.
 When clients have explored thoughts and feelings thoroughly and obtained insight
about themselves, action allows them to determine how they would like to change
their lives.
 When used in an empathic and collaborative manner at the appropriate time,
behavioral and cognitive treatments can facilitate change. Core components of
behavioral (e.g., reinforcement, modeling) and cognitive theories are incorporated
into the steps for working with four types of action. Four types of action – relaxation
behavior change, behavioral rehearsal and decision-making
ALLEN IVEY - FIVE STAGES OF COUNSELING SESSION

Interviewing, Counselling and Psychotherapy

 Interviewing – a more basic process of gathering data, providing information and

resolving new issues
 Counselling – a more intensive and personal process than interviewing – more about
listening to and understanding a client’s life challenges and developing strategies for
change and growth.
 Psychotherapy – focuses on deep-seated personality or behavioral difficulties and
may take longer.

Micro skills Approach

 Micro skills are communication skill units that help us to interact more effectively
with clients.
 Breaking down complex, larger skills of effective counselling into step-by-step
process makes them easier for learning and teaching.
 Ivey organizes these skill steps into a micro skills hierarchy
 These steps provide the specifics that will enable you to work with a multitude of
clients and anticipate which skill will likely be most effective with what anticipated
result.
 In addition, competence in the micro skills hierarchy will give a clear sense of
how to organize and structure a session

Micro skills Hierarchy

 Micro skills are based on seeking cultural expertise and multicultural competence
  Cultural intentionality – The intentional interviewer or counsellor is acting with a
sense of capability and choosing from among a range of alternative actions,
interviewing skills and helping theories, always considering the cultural and ethnic
characteristics of the client

Ivey’s counseling

 The five stages of the well-formed session provide an organizing framework for
using the micro skills with multiple theories of counseling and psychotherapy.
 All counselors and therapists need to establish an empathic relationship and draw
out the client’s story.
 In different ways, explicit or implicit goals are established, and all seek to develop
new ways of thinking, feeling, and behaving.
 The structure here will also serve as a way to organize your work with theories as
varying as client-centered therapy, cognitive behavioral therapy (CBT),
psychodynamic, and more.
  The circle of the five stages of a counseling session reminds us that helping is a
mutual endeavor between client and counselor. We need to be flexible in our use of
skills and strategies.
 A circle has no beginning or end; rather, a circle is a symbol of an egalitarian
relationship in which counselor and client work together. The hub of the circle is
empathy, positive assets, and wellness, a central part of all stages.

Stage 1: Empathic Relationship

 Initiating the session, Rapport, trust building, structuring, preliminary goals (say
hello)
 Introducing the session and building the rapport are the most critical in the first
session. But they will remain Central in all subsequent session.
 A major role of establishing Rapport is to use the clients name and repeat it
periodically all over the session, personalizing the session.
 Some situations require more extensive time and attention to the rapport stage than
others.
 It may take several sessions before client who are culturally different from you
develop real trust.

Empathic relationship

 Structure: structuring the session includes informed consent and ethical issues.
Clients need to know their rights and limitation of the session.
 Listen for preliminary goals: these early goes provide and initial structure for the
counselor that seat to understand and empathize with the client.
 Share yourself as appropriate: Be open, authentic, and congruent. Encourage client
to ask you questions, that is also the time to explore your cultural and gender
differences.
 Observe and listen: the first session tells a lot about the client. Not then clients style
and seek to mirror her or his language using.

Stage 2: story and strengths

  Gathering data: drawing out stories, concerns and strengths.
 Drawing out the clients’ story: what are clients thoughts feelings and behavior.
Summarizing provides a good way to put the client’s conversation in to an orderly
format.
 Elaborate the story: Explore related thoughts, feelings and interactions with others.
Gather information and data about clients and their perceptions.
 Draw out strength and resource stories: clients grow best when counselor identified
what the client can do rather than what he or she can’t do. Don’t focus just on the
difficulties and challenges

Stage 3: Goals
 Mutuality and an egalitarian approach: Counselors’ active involvement in client
gold setting is essential. If the counselor and the client don’t know where the session
is going, the session may wander with no particular direction.
 Too often, the client and counselor assume they are working toward the same
outcome when, actually, each of them wants something different.
 Refining goals and making them more precise: if you search for broad goals early in
the relationship, they can provide a focus and general direction.
 In stage 3, it helps to review early, divide them into subgoals if necessary, and make
them truly clear and doable. It has been suggested that if you don’t have a goal, you
are just complaining.
 Incremental goals: start with specific nearest steps to reach a larger goal.
 Help your clients understand and break down issues in to manageable units and
measure progress in a step-by-step fashion.
 Listen and learn their strength and what has worked with them in the past.
 The client positive assets and resources are often the best route toward resolution
or issues.
 Approach and avoidant goals: approach goals are what client speaks to improve or
achieve (intimacy, career) while avoidant goals are those that the client wants to
prevent or decrease (anxiety, depression)
 Depression and anxiety can be framed with approach goals of managing depression
and anxiety might be avoided via medication
 In each of these areas, focusing on strengths (past and present) through positive
psychology and positive reframing can make a difference.
 Exploration: with many clients, the first step toward clear goals is exploration of
possibilities rather than lying things down too quickly
 Summarizing the difference between the present story and the preferred outcome:
once the good has been established, a brief summary of the original presenting
concern as contrasted with the defined goal can be very helpful.
 This is a possible opening to stage 4 restoring using a supporting confrontation.

Stage 4: Re-story
 Starting the exploration process: How does the counselor help the client work
through new solutions? Summaries the client conflict.
 Summary of the issue is complete, including both the acts of the situation and the
clients’ thoughts and feelings. Use the BLS to facilitate the client’s resolution of the
issue.
 Encourage client creativity: counselor first goal in restoring is to encourage the client
to discover they’re on solutions. Skilled questions can be useful in helping clients
find positive solutions
1. Can you brainstorm ideas –just anything that of occurs to you?
2. What are the alternatives can you think of?
 3. Tell me about a success that you have had.
 interviewers and counsellors all try to resolve issues in clients lives in similar fashion.
The counsellor needs to establish rapport, define the issue, and help the client
identify desired outcomes.
 Relate client issues and Concerns to desired outcomes: The distinction between the
problem and the desired outcomes is the major incongruity that may be resolved in
3 basic ways

1. The counselor uses attending skills.

2. Counselors can use information, directive and psychoeducational
interventions to help clients generate new answers.
3. If clients do not generate their own answers, the counselor can use
interpretation, self-disclosure, and other influencing skills to resolve the
conflict.
 Aim for decision and a new story: this process of exploring, brainstorming and
testing strategies helps client decision making and the creation of a new story.

Stage 5: Action
 The complexity of life is such that taking a new behavior back to the home setting
maybe difficult.
 Change does not always come easily and make clients revert to earlier, less
intentional behavior.
 Terminating: Generalizing and acting on new stories (will you, do it?)
 Conclude the plan for generalizing interview learning to “real life” and eventual
termination of the interview or series of session.

BASIC LISTENING SEQUENCES (BLS)

 Each person needs to adapt these skills to meet the requirements of the client and
the situation.
 The competent counselor uses client observation skills to note client reactions and
intentionally flexes to change style, thus providing the support the client needs.
 Clients will discuss their stories, issues, or concerns, including the key facts,
thoughts, feelings, and behaviors.
 Clients will feel that their stories have been heard. In addition, these same skills will
help friends, family members, and others to be clearer with you and facilitate better
interpersonal relationships.

Attending and empathy skills

 Attention is the connective force of conversations and of empathic understanding.
We are deeply touched when it is present and usually know when someone is not
attending to us.
 The way one attends deeply affects what is talked about in the session. Also
important is to observe clients’ reactions.
 Learning what to do and what not to do will help determine what might be better
and more effective in helping that client.
 Attending behavior is the first and most critical skill of listening. It is a necessary part
of all interviewing, counseling, and psychotherapy. Sometimes listening carefully is
enough to produce change. To communicate that you are indeed listening or
attending to the client, you need the following “3 V’s 1 B”: *

1. Visual/eye contact. Look at people when you speak to them.

2. Vocal qualities. Communicate warmth and interest with your voice. Think of how
 many ways you can say, “I am really interested in what you have to say,” just by
altering your vocal tone and speech rate. Try that now, and note the importance of
changes in behavior.
3. Verbal tracking. Track the client’s story. Don’t change the subject; stay with the
client’s topic.
[Link] language/facial expression. Be yourself—authenticity is essential to building
trust.

 To show interest, face clients squarely, lean slightly forward with an

expressive face, and use encouraging gestures. Especially critical, smile to show
warmth and interest in the client.

Observation skills
 Observation is the act of watching carefully and intentionally with the purpose of
understanding behavior.
 In spite of what some professionals believe, mastering this skill is not easy.
 Through observation you get to know the client and what is conveyed by his or her
verbal and nonverbal behavior.
 Clients’ intentions, needs, meanings, and underlying emotions are often conveyed
not only with words, but also through nonverbals.
 In fact, awareness of the close connection between nonverbals and emotions is
become clearer. Some authorities say that 85% or more of communication is
nonverbal.
 How something is said can overrule the actual words used by you or your client. A
keen observer discovers the many ways clients express their needs, emotions, and
motivations.

 Nonverbal Behavior. Your own and your clients’ eye contact patterns, body
language, and vocal qualities are, of course, important. Shifts and changes in these
may be indicative of client interest or discomfort.
 A client may lean forward, indicating excitement about an idea, or cross his or her
arms to close it off.
 Facial clues (brow furrowing, lip tightening or loosening, flushing, pulse rate visible
at temples) are especially important. Larger-scale body movements may indicate
shifts in reactions, thoughts, or the topic.
 Verbal Behavior. Noting patterns of verbal tracking for both you and the client is
particularly important. At what point does the topic change, and who initiates the
change?
Where is the client on the abstraction ladder? If the client is concrete, are you
matching his or her language? Is the client making “I” statements or “other”
statements? Do the client’s negative statements become more positive as
counseling progresses? Clients tend to use certain key words to describe their
behavior and situations; noting these descriptive words and repetitive themes is
helpful.
 Discrepancies. Conflict, discrepancies, incongruities, mixed messages, and
contradictions are manifest in many and perhaps all sessions.
 The effective counselor is able to identify these discrepancies, to name them
appropriately, and sometimes to feed them back to the client.
 These discrepancies may be between nonverbal behaviors, between two
statements, between what clients say and what they do, or between incompatible
goals.
  They may also represent a conflict between people or between client and a
situation. And your own behaviors may be positively or negatively discrepant.
 Multicultural Issues. Observation skills are essential with all clients. Note individual
and cultural differences in verbal and nonverbal behavior.
 Always remember that some individuals and some cultures may have a different
meaning for a movement or use of language from your own personal meaning.
 Use caution in your interpretation of nonverbal behavior.
 Mirroring. When two people are talking together and communicating well, they
often exhibit movement synchrony or movement complementarity in that their
bodies move in a harmonious fashion.
 Increased movement synchrony suggests implicit social interaction in observable
behavior and in brain scans.
 Counselors sometimes mirror their clients deliberatively.
 When people are not communicating clearly, movement desynchrony may appear:
body shifts, jerks, and pulling away.
 Brain regions parallel what we observe in client nonverbal behavior.
 Concreteness Versus Abstraction. Clients who talk with a concrete/situational style
are skilled at providing specifics and examples of their concerns and problems.
 They may have difficulty reflecting on themselves and their situations and seeing
patterns in their lives.
 Clients who are more abstract and formal operational have strengths in self-analysis
and are often skilled at reflecting on their issues.
 They may experience difficulty reporting the concretes and specifics of what is
actually going on.
 Neither concrete nor abstract is “best.” Both are necessary for full communication.

Questions
 Skilled attending behavior is the foundation of the micro skills hierarchy;
questioning provides a useful framework for focusing the session.
 Questions help a session begin and move along smoothly. They assist in pinpointing
and clarifying issues, open up new areas for discussion, and aid in clients’ self-
exploration.
 Questions are an essential component in many theories and styles of helping,
particularly cognitive behavioral therapy (CBT), motivational interviewing, solution-
focused brief counseling, and much of career decision making.
 The employment counselor facilitating a job search, the social worker conducting an
assessment interview, and the high school guidance counselor helping a student
work on college admissions all need to use questions. Moreover, the diagnostic
process, while not counseling, uses many questions.
 This chapter focuses on two key styles of questioning: open and closed questions.
 Open Questions. Questions can be described as open or closed. Open questions are
those that can’t be answered in a few words.
 They encourage others to talk and provide you with maximum information.
 Typically, open questions begin with what, how, why, or could. One of the most
helpful of all open questions is “Could you give a specific example of . . .?”
 Closed Questions. Closed questions are those that can be answered in a few words
or sentences.
 They have the advantage of focusing the session and bringing out specifics, but they
place the prime responsibility for talk on the counselor.
 Closed questions often begin with is, are, or do. An example is “Where do you live?”
  “What Else?” Questions. What else is there to add to the story? Have we missed
any-thing? “What else?”
 Questions bring out missing data. These are maximally open and allow the client
considerable control.
 Promoting Client Elaboration. Open questions can help clients elaborate and enrich
their story.
 Questions can reveal concrete specifics from the client’s world.
 Multiple Applications of Questions. The antecedent-behavior-consequence (ABC)
model helps draw out key facts about events, especially in unclear and challenging
situations.
 By moving to ABC-TF, we bring in thoughts and feelings about the even or personal
experience.

Encouraging, paraphrasing and summarizing

 Encouraging, paraphrasing, and summarizing are active listening skills that are the
cognitive center of the basic listening sequence and are key in building the empathic
relationship.
 When we attend and client’s sense that their story is heard, they open up and
become more ready for change.
 It leads to more effective executive brain functioning, which in turn improves
cognitive understanding, organization of issues, and decision-making.
 Encouragers. Encouragers are a variety of verbal and nonverbal means the
counselor can use to encourage others to continue talking.
 They include head nods, an open palm, “Uh-huh,” and the repetition of keywords
the client has uttered.
 Restatements are extended encouragers using the exact words of the client and are
less likely to determine what the client might say next Paraphrases.
 Paraphrases. Paraphrases are key to cognitive empathy. Ey feed back to the client
the essence of what has just been said by shortening and clarifying client cognitive
comments.
 Paraphrasing is not repetition; it is using some of your own words plus the
important main words of the client.
 Summarizations. Summaries provides the basis of mentalizing.
 They are similar to paraphrases except that a longer time and more information are
involved. Attention is also given to emotions and feelings as they are expressed by
the client.
 Summarizations may be used to begin an interview, for transition to a new topic, to
provide clarity in lengthy and complex client stories, and, of course, to end the
session.
 It is wise to ask clients to summarize the interview and the important points that
they observed.
 Cognitive and affective empathy are typically shown in summaries and represent
both large and small aspects of mentalizing, which in turn enable the client to self-
reflect and integrate.

Reflecting feelings
 Reflection of Feeling. Emotions may be observed directly, drawn out through
questions
 (“How do you feel about that?” “Do you feel angry?”), and then reflected through
the following steps:
1. Begin with a sentence stem such as “You feel . . .” or “Sounds like you feel . . .” or
 “Could it be you feel . . .?” Use the client’s name.
2. Feeling word(s) may be added (sad, happy, glad).
3. The context may be added through a paraphrase or a repetition of key content
(“Looks like you feel happy about the excellent rating”).
4. In many cases a present-tense reflection is more powerful than one in the past or
future tense (“You feel happy right now” rather than “you felt” or “you will feel”).
5. Following identification of an unspoken feeling, the checkout may be most useful.
(“Am I hearing you correctly?” “Is that close?”)
 This lets the client correct you if you are either incorrect or uncomfortably close to a
truth that he or she is not yet ready to admit.
 Unspoken feelings may be seen in the client’s nonverbal expression, may be heard
in the client’s vocal tone, or may be inferred from the client’s language.

UNIT-2
EXPLORATION STAGE/INITIAL DISCLOSURE

WHAT CLIENTS BRING TO THE COUNSELLING EXPERIENCE

CLIENTS
1. VOLUNTARY CLIENTS
2. RELUCTANT CLIENTS

VOLUNTARY CLIENTS
Awareness of Tension:
• Clients voluntarily seeking counseling recognize tension, anxiety, dissonance,
confusion, or lack of closure in their lives.
Motivation:
• The awareness of these issues motivates them to seek help.
Characteristics:
• Experience tension and conflict.
• Motivation to seek help and initiate self-disclosure.
• Willingness to engage in serious thinking.
Communication Initiation:
• A simple question like "How can I help?" from the counselor is usually sufficient to
start relevant communication.

RELUCTANT CLIENTS

• Lack of Acknowledgment: These clients may experience tension but do not

acknowledge the need for help.
• Individuals abusing drugs or alcohol.
• Victims of domestic violence.
• People with aggressive and disruptive behaviors.
• Unmotivated and unsuccessful students.
• Third-Party Pressure: Often, these clients are pressured or required by a third party
to seek counseling.
• Barriers to Participation:
• Strong resistance to genuine participation.
• Reluctance to disclose relevant information.
• Avoidance of the work needed for growth.
 • Special Skills Required: Working effectively with reluctant clients requires specific
skills.

Anxiety and Resistance in Voluntary Clients

• Inherent Anxiety: Sharing personal information with a stranger induces anxiety.
• "What will this person do with the information I share?"
• "What impressions will the counselor develop if I honestly describe
my concerns? “
• Fear of the Unknown: Concerns about what will happen during the counseling
process.
• Cultural Messages:
• Belief that people should manage their own affairs.
• Seeking help seen as a sign of weakness.
• Stigma associated with counseling (e.g., only "crazy" people need
counseling).
• Reluctance to speak with counselors outside one's ethnic group.
• Minority groups' caution about discussing personal issues outside the family.
• Initial Stage Objectives:
Help the client feel comfortable with the process and less anxious about exploring their
concerns.
• Counselor's Role:
• Inviting Communication: Encourage clients to talk openly.
• Responding with Care: Show understanding and care in responses.
• Avoiding Communication Blockers: Avoid saying or doing things that could
hinder communication.

CORE CONDITION OF COUNSELLING

Initial Challenges for New Counselors

• Many beginning counselors can’t easily get clients to start talking about their
concerns.
• New counselors often struggle with how to respond when clients begin to disclose.
Purpose of Client Disclosure
• Encourage clients to describe their experiences.
• Help clients release feelings through storytelling.
• Begin to clarify the true nature of the client's problems.

Counselor's Goal:
• Aim to understand the client's experience as clearly and personally as possible.
• Avoid Premature Solutions/ Refrain from suggesting solutions too early in the
process.
• Client's Responsibility: Emphasize that it is ultimately the client's
responsibility to solve their problems.
• Negative Impacts of Premature Solutions:
• Short-circuits the counseling process.
• Demeans the client's ability to be self-directing.
• Often provides solutions that don't fit the situation.

Core conditions

1. Empathy
 2. Positive regard
3. Genuineness
4. Concreteness

[Link]

• Carl Rogers (1961): Empathy is the counselor's ability "to enter the client's
phenomenal world—to experience the client's world as if it were your own without
ever losing the 'as if' quality. “
• Bohart and Greenberg (1997): Detailed how empathy is perceived across various
psychotherapy approaches.
Categories of Empathy:
[Link] Rapport: Involves kindness, global understanding, and tolerant acceptance of
the client's feelings and frame of reference.
2. Experience Near-Understanding: Understanding what it is like to have the client's
problems and to live in the client's life situation. Includes both conscious and some
unconscious elements of the client's experience.
3. Communicative Attunement: The therapist tries to grasp what the client is trying to
communicate and experience at the moment.

Functions of Empathy in Counseling:

• Empathy helps in establishing simple acceptance and building the therapeutic
relationship.
• Empathy improves communication between the counselor and client.
• It helps in achieving a deeper understanding of what it is like to live the client's life.
• Levels of Empathy: Counselors may vary in the depth of understanding and choose
how much to reflect this understanding to the client.
• Cultural Sensitivity: Effective use of empathy requires cultural sensitivity and
knowledge of different cultures.
Counselors must adapt their counseling style to be congruent with the value systems of
culturally diverse clients.
• Desired Effects of Empathy in Initial Disclosure Stage:
• Active listening expresses caring and affirmation to the client.
• Feedback from the counselor helps clients see their own themes more
clearly, aiding self-understanding and reexamination of perceptions,
attitudes, and beliefs.
• Sets the expectation that counseling involves self-exploration and self-
discovery.
• Offering a level of empathy consistent with the client's readiness helps the
client feel safe and willing to continue.
• Effective empathy shows the counselor's special skill, fostering client
optimism about future sessions.
• Research on Empathy:
• Research shows correlations between therapist empathy and positive counseling
outcomes.

Components of Empathy
1. Perceiving Component of Empathy
• Involves actively listening for themes, issues, personal constructs and emotions.
Understanding the clients personal construct (George Kelly)
2. Communication Component of Empathy:
Counselors need to communicate their understanding to the client.
• Primary Empathy:
• Interchangeable Verbal Responses: Statements that capture
essential themes without going deeper than the client's expressed
material.
• Examples: Paraphrasing client's feelings and meanings in simple
language.
• Impact: Helps the client feel understood and encourages further
elaboration.
• Advanced Empathy:
• Additive Verbal Responses: The counselor adds perceptions implied
but not directly stated by the client.

[Link] REGARD

• Caring for the client simply because they are human and therefore worthy.
• Expression of Caring through enthusiasm for being in the client’s presence and
Devotion of time and energy to the client’s well-being.
• Impact on Clients:
• Helps clients develop and restore a sense of caring for themselves.
• Increases the client’s enthusiasm for work and growth.
• Unconditional Positive Regard:
• Rogers (1957): Counselor’s caring can be unconditional because the counselor has
no role in the client’s life outside the counseling situation.
• The counselor's respect for the client's dignity and worth remains intact regardless
of client behaviors.
• Parental Love vs. Unconditional Regard:
• Parental Love: Similar to unconditional regard but can never be fully unconditional
due to parents’ vested interest in their children’s behavior.
• Counselor's Role: The counselor, as a paid professional, does not have an ego
investment comparable to that of a parent.

Challenges with Positive Regard:

• Counselors are human and may find some clients hard to like.
• Working Through Disregard:
• Counselors must acknowledge and take responsibility for feelings of
disregard.
• Identify specific client characteristics that trigger dislike.
• Try to understand the meaning of the client's behavior without judgment to
devise strategies for change.
• Examples of Challenging Client Behaviors:
• Lying, Defensiveness, Manipulation, etc. are the Traits that often trigger dislike in
counselors.
• Difficulty working with clients who have committed severe offenses, e.g., sexual
abuse.
• Parameters Influencing Counselor's Feelings:
• Imposing "Should" Statements: Avoid imposing moral imperatives that may be
perceived as uncaring by the client.
• Anxiety: Feelings of dislike can be accompanied by anxiety due to unresolved issues
or power struggles in sessions.
 • Countertransference: Client characteristics may remind the counselor of someone
else, distorting their perception of the client.
• Self-Reflection Questions for Counselors:
• What characteristics of my client interfere with my ability to find them likable?
• What do I think my client should be doing that they are not?
• How are my "should" affecting our relationship and my openness with the client?
• What am I missing about my client as a result of my "should"?
• Am I experiencing anxiety rather than calmness with my client?
• With whom in my life might I have important unfinished business?
• Is my own unfinished business interfering with my ability to feel caring for this
client?

• Seeking Professional Assistance:

• Resource Counselor: Counselors are advised to discuss their feelings with a
professional colleague or supervisor.
• Personal Therapy: May be necessary if unresolved issues are intruding significantly
in counseling interactions.
• Effectiveness of Positive Regard:
• Counselors will experience positive regard for most clients.
• Positive regard is often not as directly expressed as empathy but becomes apparent
through spontaneous statements that acknowledge the client’s efforts for a more
satisfying life.
• Clients quickly detect the absence of caring, so it is crucial for counselors to address
such feelings promptly.

[Link]

Characteristics of transparency and authenticity: Being real, honest, and authentic in

interactions and being congruent and behaving in ways that are consistent with one's self-
concept over time.
• Expression of Genuineness:
• Behaving consistently helps the client perceive the counselor as real.
• Allows the client to see into the counselor's thoughts and feelings, reducing
concerns about hidden agendas.
• Impact on the Client:
• Helps the client feel safer and develop greater trust in the counselor.
• Enables the client to be more genuine, dropping defenses, games, and
manipulations.
• Self-Knowledge:
• Counselors must know themselves well and understand how their personality
elements are expressed.
• Never communicate dishonestly, mislead, or deceive the client.

• Disclosure:
• Sharing information is a decision based on the client's need or ability to benefit.
• Sharing present feelings or observations about the relationship should be done
cautiously.
• Disclosing personal experiences should be limited to help the client see parallels
without shifting focus away from them.
 • Describing emotions experienced in the client's presence or current relationship
observations.
• Limited sharing of past experiences that parallel the clients to reduce distance and
create mutuality.
• Avoid extensive detail about personal experiences that distract from the client’s
exploration.
• Avoid expressing judgments about others' behavior to maintain the client's
perception of genuineness.

• Challenges and Considerations:

• Clients with deep wounds to self-esteem may not handle complete honesty well.
• Some honesty may need to be developed over time rather than disclosed
immediately.
• Avoiding Manipulation:
• Behaving genuinely without manipulating or controlling the client.
• Role of Genuineness in Counseling Process:
• Helps in establishing a trusting relationship crucial for effective counseling.
• Encourages clients to engage in intensive exploration work.

[Link]

• Definition
• Promptly seeking specific feelings, thoughts, and examples of actions rather than
vague generalities and ensuring that discussions are centered around concrete and
relevant issues.
• Importance of Concreteness:
• Helps avoid excessive storytelling and ensures the conversation remains focused on
important material.
• Assists in identifying which statements are central to the client's concerns.
• Counselor's Role:
• While the client determines the content, the counselor manages the process to
make it easier for the client to talk about what matters.
• The counselor's responses influence what the client elaborates on and what is
dropped.

Challenges in Achieving Concreteness:

• Even counselors who are empathic, caring, and genuine may allow clients to avoid
important topics.
• Essential to differentiate between initial social amenities and meaningful self-
disclosure.
Techniques to Enhance Concreteness:
Direct Questions: Asking for specific examples of troublesome events (e.g., "She is always
picking on me" vs. "The teacher calls attention to me in a public way when I don't have my
homework done").
• Modeling Direct Communication: The counselor should use clear and direct
language, setting an example for the client.
Impact of Concreteness:
• More concrete and specific recreation of troublesome events in the session can lead
to new understandings and more positive feelings.
Helps ensure that valuable counseling time is not wasted on small talk or unfocused
discussion

WAYS TO IMPEDE COMMUNICATION

1. Counsellor Predisposition
2. Premature Advice Giving
3. Lecturing
4. Excessive Questioning
5. Story Telling

COUNSELLOR PREDISPOSITION
Avoidance of Emotional Content:
• Social Norms: In typical social interactions, people tend to avoid discussing
emotional content unless they share a strong relationship and are in a private
setting. For example, if a couple at a party starts arguing about money, other guests
will likely give them space to resolve their issue privately.
• Impact on Counseling: If a counselor adopts the same approach of avoiding
emotional content, it signals to the client that it is not safe to share their feelings
and thoughts. This hinders the establishment of a trusting relationship, which is
crucial since the client initially sees the counselor as a stranger.
• Establishing Trust: The primary goal in the initial sessions is to build trust. This can
be achieved by employing attitudes and behaviors such as empathy, positive regard,
and genuineness, which communicate to the client that it is safe to share emotional
content

Expert Mindset:
• Premature Problem-Solving: Many counselors, especially those new to the
profession, may feel pressured to solve the client's problems quickly due to their
perceived role as experts.
• Shortcuts to Disclosure Process: This mindset leads to adopting the client's anxiety
and attempting to provide solutions prematurely. Such an approach can shortcut the
necessary process of thorough exploration and understanding of the client's issues.

PREMATURE ADVICE GIVING

• Transactional Analysis Game:
• The dynamic often begins with the counselor offering advice ("Why don't
you...?") and the client responding defensively ("Yeah, but...").
• This pattern creates barriers in the therapeutic relationship, leading to
defensiveness in the client and exasperation in the counselor.
• Negative Impact:
• Premature advice makes the client feel inadequate and dependent, stalling
the development of self-reliance.
• Reinforces defensive behaviors and game-playing rather than promoting
genuine problem-solving.
• Appropriate Timing: Advice should be reserved for later stages in the counseling
process when the counselor has a thorough understanding of the client's
circumstances. At this point, suggestions can be discussed collaboratively as
potential options.

LECTURING
 • Disguised Advice Giving:
• Presenting long-winded advice or "sage wisdom" places the counselor in a
superior, expert position, implying the client should follow their guidance.
• This approach sends a hidden message that the client is incapable if they do
not follow the advice, fostering a power imbalance.
• Client Reactions:
• Clients often tune out and disregard both the lecture and the lecturer,
especially if they have had conflicts with authority figures in the past.
• The counselor should avoid being perceived as just another authority figure
imposing solutions.
• Indicators of Lecturing:
• Speaking more than three consecutive sentences can indicate a tendency to
lecture, which should be avoided to maintain client engagement and focus.

EXCESSIVE QUESTIONING
Problem with Excessive Questioning:
• Passivity in Clients: When counselors ask too many questions, it puts clients in a
passive role, simply responding rather than initiating or guiding the conversation.
This dynamic reinforces the counselor's control and limits the client's ability to share
important information.
• Missed Information: Excessive questioning can lead to important issues being
overlooked as the counselor's questions may not align with the client's immediate
concerns or needs. This can result in a client feeling misunderstood or frustrated.
• "Why" Questions: These can be particularly problematic as they require the client to
explain and justify behaviors, increasing anxiety and defensive responses such as
rationalization and intellectualization. They also may prompt clients to seek the
"right" answers instead of sharing their true experiences.

Alternative Approaches:
• Nonverbal Clients:
• Instead of questions, use statements that work with the client's energy: "I
can see that it is hard for you to talk comfortably with me. Perhaps it would
help to share with me what is happening in your life that creates excitement
for you. “
• Information Gathering:
• Use mutual, understanding-focused statements: "I need to understand more
clearly how things looked, sounded, and felt to you when your wife decided
to move out. Help me understand what it was like for you then. “
• Focusing on Specific Themes:
• Invite exploration and concreteness: "You have mentioned sitting alone on a
school bus a couple of times. Tell me the things you think about when this
happens."

Guidelines for Effective Questioning:

• Avoid Consecutive Questions: Never ask two questions in a row. Follow a question
with a statement that relates to the received response.
• Use General Leads: Utilize phrases like "Tell me more about..." to encourage further
disclosure without dictating the direction of the conversation.
Distinguish Between Closed and Open Questions:
  Closed Questions: These probe for specific factual information and can often be
answered with a word or two. For example, "Are you living with your husband now?
“
 Open Questions: These invite broader responses involving ideas, beliefs, or
emotions. For example, "What do you do when your husband comes home drunk?"
Open questions promote more client disclosure and are usually more effective
during the initial stages of counseling.

Balancing Questions and Statements:

• Questions should not dominate the conversation. Instead, they should be used
sparingly to guide and facilitate the client’s self-exploration and disclosure.
• Responses that are statements rather than questions help in maintaining a
spontaneous and open atmosphere, encouraging clients to share more freely and
deeply about their concerns and experiences.

STORYTELLING
Pitfalls of Storytelling:
• Clients often find it hard to believe that the counselor has been in an identical
situation. This skepticism can create a barrier to trust and rapport.
• When the counselor shifts focus to their own experiences, it disrupts the client's
exploration process, making it harder for the client to delve into their own issues.
• The assumption that the counselor experienced the same beliefs and emotions in a
similar situation can be misleading and inaccurate. Each individual's experience is
unique, and projecting one's own emotions onto the client can lead to
misunderstandings.
• Personal anecdotes can introduce irrelevant information that distracts from the
client's issues and concerns. This "noise" can dilute the focus and effectiveness of
the session.
• Storytelling can sometimes be a way for the counselor to manage their own anxiety
rather than addressing the client's needs. This can lead to a misuse of the session for
the counselor's benefit rather than the clients.

Effective Alternatives
1. Empathic Responses: Instead of sharing personal stories, counselors can express
empathy directly related to the client's experience: "That sounds really tough. It
must have been very lonely for you. “
2. Reflecting Feelings: Reflect the client's emotions to show understanding without
shifting focus: "It seems like you're feeling quite isolated and misunderstood by your
peers. “
3. Validating Experiences: Validate the client's feelings and experiences to reinforce
their importance: "It's understandable that you would feel that way given what
you're going through. “
4. Encouraging Exploration: Encourage the client to continue exploring their own
feelings and experiences: "Can you tell me more about what it was like for you in
those moments? “
5. Minimal Self-Disclosure: If self-disclosure is deemed necessary, keep it minimal and
directly relevant: "I also struggled with feeling isolated in high school, but I'm more
interested in hearing about your experience."

OPENING TECHNIQUES
1. GREETINGS

• Your active presence is a kind of social-emotional presence which speaks in unequivocal

terms your willingness to work with the client. Since you commit yourself to his/her welfare
you should both verbally and non-verbally communicate the warmth and willingness of
being with the client and working with him/her.
• Since much depends upon the reception one receives at the hand of a counsellor, the
counsellor should take the initiative to welcome the clients warmly without being affected
too much in his manners. A natural way of greeting that is expressive of genuineness and
concern is called for. Clients feel either encouraged or put out depending upon the tone of
interaction during the first five minutes or so. Every culture has its own ceremony of
receiving a guest. That ceremony which is appropriate to your culture cannot be dispensed
with in receiving a client.
• In welcoming you shake hands with the person whom you are meeting. Here who extends
the hand first is significant. The person who is pleased with the arrival of another person is
happy to extend his hand to shake hands with the newcomer. Therefore, it will always give
the feeling of being wanted for the client if you take the initiative to extend your hand and
gently shake hands with her.
• In Indian culture, we welcome a person by greeting them with a pleasant smile.

2. PHYSICAL ARRANGEMENTS

• Counseling may take place anywhere but some kind of physical setting may promote and
enhance the counseling process better than others. Benjamin (1987) and Shertzer and Stone
(1980) emphasize that among the most important factor that influences the counseling
process is the place where counseling occurs. Though there is no universal quality that a
room should have certain optimal conditions within the room where counseling is to be
rendered can provide a conducive environment to both counselor and counselee. The
optimal condition includes a room with quiet colors, lighting that is neither too flashy and
bright nor too dull and depressing clutter free with harmonious, comfortable furniture and
good ventilation. It should be free from outside disturbances and should exude a feeling of
warmth. In short it should be comfortable such that a relaxed atmosphere is provided in
which the counselee can talk in a relaxed mood.

3. ATTITUDE
One of the vital components of counseling is the attitude of the counselor. Some attitudes,
such as being closed to new experiences, can impede the counseling process. Other
attitudes, such as openness to learning, can be valuable to the counseling process. One of
the goals of Advanced Practicum is to help develop these counselor attitudes which enhance
counseling and to help Advanced Practicum students inhibit those counselor attitudes which
detract from good counseling.
The counselor attitudes of particular relevance to effective counseling fall into five
categories: -
• Openness toward self- Willingness to learn. Try new things, and to see alternatives.
• Openness toward clients – Viewing them as individuals seeking assistance, as complex
individuals who are not helpless, and as partners in the process.
• Openness toward colleagues– Viewing them as colleagues, not competitors. With
experiences and ideas that are valuable.
• Openness toward supervisors – Viewing them as colleagues with unique and relevant
experiences.
• Openness toward counseling – The counseling process is often a developing. Evolving
process wherein the client’s skills and resources are developed. The counselor does not
solve the problem, but offers alternatives and teaches/facilitates the client’s problem-
solving process

4. NON-VERBAL SKILLS
• Nonverbal communication plays a significant role in our lives, as it can improve a person’s
ability to relate, engage, and establish meaningful interactions in everyday life. A better
understanding of this type of communication may lead people to develop stronger
relationships with others. Often referred to as body language. Nonverbal communication can
take many forms and may be interpreted in multiple ways by different people, especially
across cultures. Even a lack of such nonverbal cues can be meaningful and, in itself, a form of
nonverbal communication

SOLER
Guidelines for Visibly Tuning in to Clients There are certain key nonverbal skills you can use
to visibly tune in to clients. Some of these skills can be summarized in the acronym SOLER.
Because communication skills are particularly sensitive to cultural differences, care should
be taken in adapting what follows to different cultures. What follows is only a framework.

• S: Face the client Squarely. That is, adopt a posture that indicates involvement. In North
American culture, facing another person squarely is often considered a basic posture of
involvement. It usually says, "I'm here with you; I'm available to you." Turning your body
away from another person while you talk to him or her can lessen your degree of contact
with that person. Even when people are seated in a circle, they usually try in some way to
turn toward the individuals to whom they are speaking the point is that your bodily
orientation should convey the message that you are involved with the client. If, for any
reason, facing the person squarely is too threatening, then an angled position may be more
helpful. The point is not inches and angles but the quality of your presence. Your body sends
out messages whether you like it or not. Make them congruent with what you are trying to
do.
• O: Adopt an Open posture. Crossed arms and crossed legs can be signs of lessened
involvement with or availability to others. An open posture can be a sign that you’re open to
the client and to what he or she has to say.
• L: Remember that it is possible at times to Lean toward the other. Watch two people in a
restaurant who are intimately engaged in conversation. Very often they are both leaning
forward over the table as a natural sign of their involvement. The main thing is to remember
that the upper part of your body is on a hinge. It can move toward a person and back away.
In North American culture, a slight inclination toward a person is often seen as saying, “I’m
with you, I’m interested in you and in what you have to say.” Leaning back (the severest
form of which is a slouch) can be a way of saying, “I’m not entirely with you “or “I’m bored.”
Leaning too far forward, however, or doing so too soon, may frighten a client. It can be seen
as a way of placing a demand on the other for some kind of closeness or intimacy. In a wider
sense, the word “lean” can refer to a kind of bodily flexibility or responsiveness that
enhances your communication with a client. And bodily flexibility can mirror mental
flexibility.
• E: Maintain good Eye contact. In North American culture, fairly steady eye contact is not
unnatural for people deep in conversation. It is not the same as staring. Again, watch two
people deep in conversation. You may be amazed at the amount of direct eye contact.
Maintaining good eye contact with a client is another way of saying, “I’m with you; I’m
interested; I want to hear what you have to say.” Obviously, this principle is not violated if
you occasionally look away. Indeed, you have to if you don’t want to stare. But if you catch
yourself looking away frequently, your behavior may give you a hint about some kind of
reluctance to be with this person or to get involved with him or her. Or it may say something
about your own discomfort. In other cultures, however, too much eye contact, especially
with someone in a position of authority, is out of order. I have learned much about the
cultural meaning of eye contact from my Asian students and clients.
• R: Try to be relatively Relaxed or natural in these behaviors. it means not fidgeting
nervously or engaging in distracting facial expressions. The client may wonder what’s making
you nervous. Helps put the client at ease

ATTENDING, LISTENING AND OBSERVING SKILLS

• Attending refers to helpers orienting themselves physically toward clients. The goal of
attending is for helpers to communicate to clients that they are paying attention to them so
that clients feel safe to talk openly about their thoughts and feelings. In effect, attending lays
the foundation for the implementation of the verbal helping interventions. Clients feel they
are valued and worthy of being listened to when helpers attend to them. Attending can also
encourage clients to verbalize ideas and feelings because they feel helpers want to hear
what they have to say. Furthermore, attending behaviors can reinforce clients' active
involvement in sessions.
• Attending is communicated mostly through nonverbal and para- verbal (i.e., how we say
the words) behaviors, which help convey both what helpers are trying to express and what
they do not intend to express (or might be trying to hide). For example, although a helper
might try hard to be empathic and look concerned, he or she might feel bored and irritated
with the client, which might be expressed through foot tapping or stifled yawns. Attending
orients helpers toward clients, but listening goes beyond just physically attending to clients.
• Listening refers to capturing and understanding the messages that clients communicate.
Listening involves trying to hear and understand what clients are saying
• Listening provides the raw material from which helpers develop their verbal and nonverbal
interventions, but listening should not be confused with the ability to deliver helpful
interventions. Helpers could listen without being helpful, but it would be difficult to be
helpful with-out listening. Thus, from watching sessions, one could not actually tell if helpers
were listening; however, one could infer they were listening if they were able to produce
statements that reflected what they heard.
• Observing involves paying attention to what is going on overtly with clients in terms of
nonverbal behaviors and mannerisms. Whereas listening focuses more on the words and
nuances of what the client is saying, observing focuses on trying to pick up on the behavioral
cues of the client and how the client is coming across. Observing is particularly important for
noting times when clients have negative reactions, feel ambivalence, have difficulty
expressing emotions, or are distracted or uninvolved.
Nonverbal Behaviors That Facilitate Attending
• Helpers typically communicate much of their attending and listening through nonverbal
behaviors, and helpers observe what clients may be experiencing through noting their
nonverbal behaviors. Indeed, some researchers have discussed the importance of nonverbal
behaviors in the communication of emotions. These researchers have suggested that people
communicate true emotions more through nonverbal than verbal expressions, and that
nonverbal behaviors are more reliable indicators of true emotion when there is a
discrepancy between verbal and nonverbal behaviors. In my opinion, there is not enough
empirical evidence to indicate the relative importance of verbal and nonverbal behaviors;
however, enough evidence exists to suggest that helpers should pay attention. To what they
and their clients communicate nonverbally as well as verbally.
EYE CONTACT
Eye contact is a key nonverbal behavior. Looking and gaze aversion are typically used to
initiate, maintain, or avoid communication. With a gaze, one can communicate intimacy,
interest, submission, or dominance. Eyes are used to monitor speech, provide feedback,
signal understanding, and regulate turn taking. One could say we meet people with our eyes
or that "the eyes are the windows into the soul." In contrast, gaze avoidance or breaking eye
contact often signals anxiety, discomfort, or a desire not to communicate with the other
person. In general, a person who violates the rules of eye contact will have a hard time
communicating with others.

FACIAL EXPRESSIONS
The face is perhaps the body part most involved in nonverbal communication because
people communicate so much emotion and information through facial expressions. People
pay a lot of attention to facial expressions because they give clues about the meaning of the
verbal message. The following are some common facial expressions and possible. Meanings
(remember that these are only possible meanings), according to Nirenberg and Calero
(1971):
• A frown might indicate displeasure or confusion.
• A raised eyebrow may suggest envy or disbelief.
• An eye wink might indicate intimacy or a private matter.
• Tightened jaw muscles may reflect antagonism.
• Eyes squinted might reflect antagonism.
• Upward rolling of the eyes may imply disbelief or exasperation.
• Both eyebrows raised may denote doubt or questioning.

HEADNODS
The appropriate use of head nods, especially at the end of sentences, can make clients feel
helpers are listening and following what they are saying. Indeed, verbal messages are
sometimes unnecessary because helpers communicate through head nods that they are
“with” clients and that clients should continue talking. Too few head nods can make clients
feel anxious because they might think that helpers are not paying attention; too many can
be distracting. BODY POSTURE An often-recommended body posture is for helpers to lean
toward clients and maintain an open body posture with the arms and legs uncrossed. This
leaning, open body posture often effectively conveys that the helper is paying attention,
although helpers can appear rigid if they stay in this position too long. Also, if the open,
leaning position is uncomfortable, it can be hard for helpers to attend to clients.

BODILY MOVEMENTS
Bodily movements provide information one often cannot obtain from either verbal content
or facial expression. body expressions were particularly important in addition to those of the
face and voice in helping responders recognize emotions. spontaneous hand gestures
enabled people to get their messages across more clearly. Ekman and Friesen (1969) noted
that leg and foot movements are the most likely sources of nonverbal leakage because they
are less subject to conscious awareness and voluntary inhibition. The hands and face are the
next best sources of clues for nonverbal leakage. Hence, if a helper finds him or herself
repeatedly tapping his or her foot, the helper might think about what he or she is feeling.
Gestures often communicate meaning, especially when they are used in conjunction with
verbal activity. According to McGough (1975), the following are some possible meanings
(again, remember that these are just possible meanings):
• Steepling of fingers might suggest that a person feels confident, smug, or proud.
• Touching or rubbing the nose tends to be a negative reaction.
• Hand to mouth often occurs when a person has blurted out something that should not
have been said.
• Finger wagging or pointing implies lecturing or laying blame.

Para verbal Behaviors That Facilitate Attending

• In addition to nonverbal behaviors, there are also Para verbal behaviors that accompany
interventions. In other words, the manner in which helpers speak makes a difference. We
consider here tone of voice and grammatical style.

TONE OF VOICE
Consider how you feel when someone speaks with a soft, gentle, inviting voice as opposed
to when a person speaks in a loud, brash, demanding voice. You might have strong reactions
to the two helpers based on their different speech mannerisms. Similarly, clients are more
likely to explore when helpers speak gently rather than loudly and demandingly. In addition,
it can be helpful for helpers to somewhat match the client’s pace of speech. Helpers might
use a slower pace of speech with clients who speak slowly. In contrast, helpers might use a
somewhat faster pace with clients who talk rapidly. If a client is speaking too rapidly,
however, the helper might use a slower pace to encourage the client to slow down.

GRAMMATICAL STYLE
Another way helpers communicate attending is by matching the client’s language and
grammatical style. Language must be appropriate to the cultural experience and educational
level of the client, so the helper can form a bond with the client. If a client says, “I am not
never going to make it with chicks,” it would probably be better for the helper to say
something like, “You’re concerned about finding a girlfriend,” rather than “Your inferiority
complex prevents you from establishing relationships with appropriate love objects.” The
latter statement sounds too discrepant from the client’s language. Helpers should not
compromise their integrity by using a language style that feels uncomfortable to them, but
they can modify their style to be more similar to that of their client. Each of us has a comfort
range of behaviors, and helpers need to find the place within that range to meet each client

Behaviors That Facilitate Active Listening and Observing

• Listening and observing involve verbal, nonverbal, and Para verbal channels of
communication. Furthermore, helpers observe each of these types of communication to try
to determine what the client is thinking and feeling.

VERBAL MESSAGES
Helpers can listen carefully to the words clients use to communicate thoughts, feelings, and
experiences. Helpers get into a listening stance by using attending skills (e.g., “um-hmm”)
and freeing their minds from distractions. Helpers can imagine themselves in the client’s
position. Thus, helpers listen by seeking to understand what a client is experiencing from the
client’s perspective rather than from the helper’s view point.

NONVERBAL AND PARAVERBAL MESSAGES

Not only is it important that helpers listen to clients' words, they also can learn a lot by
"listening" to clients' nonverbal behaviors. Clients who are nervous often use a lot of
adaptors, are quiet, stutter, or can- not speak coherently. Clients who are defensive or
closed often cross their arms and legs, almost as a barricade to the helper. Clients who are
ashamed might look down as they speak. Clients who are scared might speak softly, look
away, or have a closed posture
MINIMAL VERBAL BEHAVIORS
• There are two minimal verbal behaviors that helpers can use to facilitate client
exploration; minimal encouragement and approval-reassurance.
• Minimal Encouragers: Helpers encourage clients to keep talking through nonlanguage
sounds, non-words, and simple words such as “un-hmm,” “yeah,” and “wow.” Helpers use
minimal encouragers to acknowledge what the client has said, communicate attentiveness,
provide noninvasive support, monitor the flow of conversation, and encourage clients to
keep talking. Minimal encouragers are often used in conjunction with and serve the same
purpose as head nods.
Approval-reassurance: is a helpful skill that can be used occasionally (and I stress
occasionally) to provide emotional support and reassurance, indicate helpers empathize
with or understand clients, or suggest that clients’ feelings are normal and to be expected.
The key is to use approval-reassurance to foster exploration and to make clients feel safe
enough to keep talking at a deep level about their concerns. For many clients, approval-
reassurance that their problems are normal and that they are not alone in their feelings can
be empowering and help clients in deeply exploring their concerns. The following are some
examples of approval-reassurance that could be helpful depending on the situation:
• "That's really hard to handle.”
• “That’s a devastating situation.”
• “How awful!”
• “Wow! That’s an awesome opportunity!”
• “Good try!”
• “It was really terrific that you were able to express your feelings to him!
•” Yeah, I know what you’re going through.”
• “I’ve been there too

NON-VERBAL BEHAVIOUR

 Nonverbal communication means conveying information without using words. This

might involve using certain facial expressions or hand gestures to make a specific
point, or it could involve the use (or non-use) of eye contact, physical proximity, and
other nonverbal cues to get a message across.
 Each culture has its own rules for nonverbal communication, such as greeting
patterns and turn taking.
 Nonverbal behavior are actions that can indicate an individual’s attitudes or feelings
without speech. Nonverbal behavior can be apparent in facial expressions, gaze
direction, interpersonal distance, posture and postural changes, and gestures
 Types of nonverbal behaviors – Kinesics, emblems, illustrators, regulators, adaptors

EYE CONTACT
 Crucial in initiating, maintaining, or avoiding communication.
 Conveys intimacy, interest, submission, or dominance.
 Monitors speech, provides feedback, signals understanding, and regulates turn-
taking.
 Gaze aversion or breaking eye contact often signals anxiety or a desire not to
communicate.
 In typical interactions, 28% to 70% of people make eye contact, usually for 1
second.
 Too much or too little can make people uncomfortable or intruded.
  Norms for eye contact vary among cultures, with some maintaining eye contact
while listening but looking away when speaking.
 In some Native American groups, sustained eye contact is offensive. In Indian
culture, prolonged eye contact is avoided.

FACIAL EXPRESSION

 Facial expressions were likely used to communicate before language, influencing

basic emotions across cultures.
 The face is the most involved in nonverbal communication, providing clues about
the meaning of verbal messages.
 • Fear, anger, and happiness are expressed primarily through the eyes, while
happiness is expressed through the mouth.
 • Facial features used in helping, such as smiling and laughter, evolved as survival
strategies.
 • Over smiling can be seen as ingratiating or inappropriate, and excessive smiling
can be seen as uninvolved.
 • Common facial expressions include frowns, raised eyebrows, eye winks, tightened
jaw muscles, squinted eyes, upward rolling, and doubt.
 • Ekman and Friesen (1984) found that facial expressions have the same meaning
across cultures, with crying being distressed, shaking heads being defiant, and
smiling being happy.

HEAD NODES
 Use at the end of sentences to convey attentiveness.
 Communicates "with" clients, encouraging continued conversation.
 Can reduce anxiety and distraction.
 Too few can make clients feel unnoticed.

BODY POSTURE
 Body posture is a key element of nonverbal communication, conveying a wealth of
information about a person's emotions, confidence level, and even their openness
to communication.
 Posture Types in Communication

Open Posture:
• Suggests openness, receptiveness, and confidence.
• Often seen when interested in conversation or comfortable in surroundings.

Closed Posture:
• Signals defensiveness, protectiveness, or desire for distance.
• Often seen when uncomfortable, anxious, or disagreeing.

Dominant Posture:
• Projects dominance, power, or assertiveness.
• Can intimidate or command attention.

Submissive Posture:
• Indicates submission, insecurity, or lack of confidence.

BODY MOVENEMTS
  Body movements is a range of nonverbal signals that you can use to communicate
your feelings and intentions. These include your posture, facial expressions, and
hand gestures.
 Types of Body Movements:
• Gestures: Intentional movements of the hands, arms, or head used to emphasize
spoken words, illustrate points, or express emotions. [pointing, nodding,]
• Emblems: Culturally specific gestures with a direct verbal translation. [thumbs up
peace sign]
• Affecters: Movements reveal a person's emotional state. [biting lips, tapping foot]
• Regulators: Manage the flow of conversation. [head nodes]
• Adaptors: Self-directed movements that can indicate anxiety or discomfort
[playing with jewelry or scratching an itch]

SPACE
 Proxemics and Space Usage
 • Proxemics explains how people use space in interactions.
 • Middle-class Americans have four distance zones: intimate [1.5 feet less], personal
[1.5-3 feet], social [4-12 feet], and public [12 feet more].
 • Violations of these boundaries can cause discomfort.
 • Space usage varies across cultures, with American and British preferring distance.
 • Space violations can trigger conflict across cultural backgrounds.
 • Helpers should consider cultural considerations when addressing diverse space
usage.

TONE OF VOICE
 Different speech styles can impact client reactions and exploration.
 Gentle, inviting tone of voice can encourage clients to explore.
 Helpers should match the client's pace of speech to foster empathy.
 Slower pace is recommended for slow-talking clients, and faster pace for rapid-talking ones.
 Clients are more likely to explore when helpers speak gently rather than loudly and
demandingly. If a client is speaking too rapidly, however, the helper might use a slower pace
to encourage the client to slow down.

GRAMMATICAL STYLE
 Helpers should match the client's language and grammatical style to foster a bond.
 Language should be culturally appropriate and educationally appropriate to the client's
experience and level.
 Avoid discrepancies in language to maintain integrity.
 Helpers can modify their style to match the client's comfort range.
 Helpers should aim to meet each client within this comfort range.

SILENCE
 Silence is a pause where neither the helper nor the client is speaking.
 It can occur after a client's statement, within a client's statement, or after a simple
acceptance of the helper's statement.
 Silence can be used to convey empathy, warmth, and respect, and to give clients
time and space to talk.
 Some helpers may be silent due to anxiety, anger, boredom, or distraction.
 If silences go on for more than 30 seconds or if clients are uncomfortable, the helper
should consider breaking the silence and asking clients how they are feeling.

MINIMAL ENCOURAGERS
  Helpers encourage clients to keep talking through non language sounds, nonwords,
and simple words such as “um-hmm,” “yeah,” and “wow.”
 Monitor conversation flow and encourage continued conversation.
 Often used alongside head nods.
 Too few can feel distancing, too many can be distracting.
 Timing is crucial as interruptions can be distracting.

APPROVAL-REASSURANCE
 Approval-reassurance can serve as reinforcement, indicating the helper values the
client's words or actions.
 It can help clients persist in exploring difficult or painful topics.
 It's crucial for the helper to stay close to the client and understand the behavior
being approved.
 Approval-reassurance should not be used to minimize or deny feelings, as it can
hinder clients' exploration and acceptance of feelings.
 It's important to help clients identify, intensify, and express feelings rather than
minimize or deny them.
 Excessive, premature, or insincerely use of approval-reassurance can sound false
and promote helper biases.
 Helpers may use approval-reassurance to feel liked by the client, which can be
counterproductive and reflect their insecurity.
 If used judiciously and sparingly, approval-reassurance can encourage clients and
facilitate exploration of thoughts, feelings, and experiences.
 If used in a counterproductive way, helpers may need to consider their own
personal lives.

NON-VERBAL BEHAVIORS TO AVOID IN A COUNSELING

 Lack of eye contact: Signals disinterest, judgment, or boredom. Aim for natural eye
contact.
 Crossed arms and closed posture: Creates a physical barrier, making the client feel
shut out. Maintain an open posture.
 Fidgeting and distracted behaviors: Conveys lack of focus and makes the client feel
unimportant. Be mindful of body language.
 Facial expressions of disapproval or skepticism: Encourages vulnerability. Strive for
neutral expressions.
 Mirroring excessively: Builds rapport but can feel inauthentic or mocking. Focus on
active listening.
 Dominating gestures or pointing: Use gestures sparingly and create a calm space.
 Yawning or sighing: Makes the client feel their problems aren't important. Be aware
of body language.
 Checking your watch: Sends a message of time pressure and lack of investment.
 Smiling inappropriately: Feels dismissive or inauthentic when discussing serious
issues.

LISTENING AND OBSERVATION SKILLS FOR HELPING PROFESSIONALS

INTRODUCTION
 Effective helpers rely on strong listening and observation skills to understand their
clients.
 Clients communicate through verbal, nonverbal, and paraverbal channels.
Verbal Communication
1 Pay attention to Client's words
-Thoughts, feelings, and experiences
2 Active listening techniques
-attending skills (e.g., "um-hmm"), focus, and avoid distractions.
3 Empathy
-Understand client's perspective, not your own
4 Recognize different verbal styles
-introverts vs. extroverts.
5 Avoid interrupting the client's exploration.

Nonverbal and Paraverbal Communication

 Nonverbal cues provide additional insights into clients' emotions

 Examples: fidgeting (anxiety/boredom), crossed arms (defensive/relaxed), eye
contact (comfort/anxiety—cultural considerations).
 Don't assign fixed meanings to nonverbal behaviors.
 Use nonverbal cues to form hypotheses and gather more data for confirmation.
 Certain emotions (fear and anger) can be harder to read accurately.
 Be mindful of cultural differences in nonverbal communication.

Key Points for Effective Listening and Observation

[Link] context
-Verbal, nonverbal, setting, culture, client's issue
[Link]-awareness
-Be aware of your own biases and limitations.
[Link] assumptions
-Clarify unclear communication through open-ended questions.
4 Practice makes perfect
-Hone your listening and observation skills through continuous practice

SKILLS FOR EXPLORING THOUGHTS

Rationale for Exploring thoughts

 Need to hear what they think about their problems,
 What stories and how they got where they are,
 What explanations they have for their problems.
 We can help clients to change the thoughts which lead to changing their behaviors.

Exploring / Ruminating / Telling a Story

If a client is telling a story
 there is a clear beginning,
 a build up to a climax,
 and then a conclusion.
 focused on getting the other person's attention.
If the client is ruminating,
 there is a steady tone,
 often boring,
 and often a mono- tone voice,
 with a lot of repetition.
  The goal of the ruminator is to worry or justify.
 When a client is truly exploring thoughts, often pauses to check things out, voice
tone varies as the person is discovering new things
 The goal of the explorer is to think about, evaluate, consider, reflect, and see new
aspects.
 The primary skills for exploring thought are using restatements.
 They help clients feel heard, encourage them to continue talking, help to focus on
the most important aspects of their stories.
 Using Open questions for thoughts are also helpful.

Restatements
Restatements are repeating the content or meaning of what a client has said. Restatements
typically contain
 fewer but similar words as the clients,
 more concrete and clear than the client's statement,
 can be phrased either tentatively (e.g., "So you seem to be saying that maybe you
were a little bit late?") or more directly (e.g., "You were late"),
 Keep restatements short and simple Pause before restating to see if the client has
finished talking Give restatements slowly and supportively
 Focus on the client rather than on other people

Uses of Restatements
 The use of restatement goes back to Rogers (1942), (helpers need to be mirrors.)
 Explains how their concerns sound to others.
 Enable clients to think about aspects they had not considered before.
 Some clients only need an opportunity to hear what they are thinking.
 First things out of the client's mouth may sound confused
 Restating is much harder.
 Helpers not only listen but also struggle to understand enough.

How to restate
 Enable clients to focus and to talk in more depth about an issue (Goal)
 Restate what the client focuses on most,
 what the client is most involved in talking about,
 what the client seems to have questions or conflicts what is left unresolved.
 Attention to nonverbal messages (e.g., vocal quality indicates the depth)
 Client-centered approach
 If the client is talking about many things that getting in the way of studying, the
helper might give a restatement such as,
 " So, you have not been able to study lately"
Some Examples are:
 " If I'm hearing you accurately,
 " Let me see if I got what you're saying..."
 " I'm not sure I got that completely, let me try to summarize and see if I got it..."
 Helpers can draw out a key word a client has said, (divorce, music, or headache.)
 Encourages to talk more about the topic.
 It is not necessary for the restatements to be perfectly accurate.
 If your restatement is totally wrong,
 it’s not a disaster for the relationship (unless of course the helper has been
dismissive, judgmental, or critical).
Open questions for thought
 Questions are a most direct way to elicit information.
 Helpers do not want a specific answer from clients
 Want clients to explore whatever comes to mind.
 Helpers do not purposely limit responses to a " yes," "no," or one- or two-
word answer
 Open questions are phrased in the form of a question (e.g., "What are your
thoughts about that?"),
 Probes are phrased in the form of a statement (e.g., "Tell me more about
your thoughts").

How to use open questions

 Appropriate attending behaviors are important.
 Tone of voice is low and soft, Rate of speech is slow
 Helpers should be supportive, nonjudgmental, and encouraging
 Should be short and simple.
 Multiple questions can have a dampening effect
 Client might feel confused.
 Examples: ("What did you do next, and what were you thinking, and what did you
mean by that?")
 Clients might ignore important questions if there are too many of them
 Rather than interrupting, it’s better to keep quiet
 Only ask questions when the client is stuck or needs guidance.
 Helpers generally also avoid "why" questions (e.g., "Why are you not able to
study?") in the exploration stage.
 Nisbett and Wilson (1977) indicated, people rarely know why they do things.
 When someone asks why you did something, you might feel she or he is judging you
 Instead of "why" questions, helpers could use "what" or "how" questions (e.g.,
instead of "Why didn't you study for your exam?" the helper could ask, "What was
going through your mind when you were trying to study?"

Difficulties while delivering open questions

 Helpers ask the same type of open questions repeatedly (Common Problem)
 Clients become annoyed
 Interaction can become one-sided if helpers use too many open questions.

SKILLS FOR EXPLORING FEELINGS

Rationale for exploring feelings

 From a biological perspective, verbalizing feelings is also important.
 FMRI research by Lieberman et al. (2007) showed that verbalizing feelings is helpful.
 Diminish negative emotional experiences Decreases the response of the amygdala
and increases the activity in the right ventrolateral prefrontal cortex.
 Clients' expression of emotions enables helpers to know and understand them.
 People respond differently to events
 The goal is not to make the client feel "better" but rather to experience emotions
more deeply: to laugh when happy, cry when sad.
 Unaccepted feelings "leak" out, sometimes in destructive ways.
 Some people do not directly say they are angry but indirectly communicate.
 Other people get stuck because they cannot accept their feelings.
 Feelings are rarely simple or straightforward
  Clients might have several conflicting feelings about a topic.
 Negative emotions are often not expressed because of shame and fear of
disapproval.
 Clients require a supportive environment to feel safe enough to express these
feelings openly.

Reflection of feelings
 Statement that labels the client's feelings.
 The reflection may be phrased either tentatively (e.g., "I wonder if you're feeling
angry?") or more directly (e.g., "It sounds to me like you're feeling angry").
 The emphasis can be just on the feeling (e.g., "You feel upset") or on both the
feeling and the reason (e.g., "You feel upset because your teacher did not notice all
the work you have done recently”).
 Help clients identify, clarify, and experience feelings.
 Cathartic relief occurs when clients accept their feelings.

How to reflect feelings

 Reflections must be done gently with empathy.
 If the helper says, "It sounds like you're feeling..." 20 times in a row, it would take
away from the client's exploration.
 Using a metaphor can also be helpful egg: ("It's like you're in a fog".)
 Helpers should focus on one salient feeling
 Should focus on present feelings rather than past feelings
 Remember that a person can have feelings in the present about something that
happened in the past.
 Rushing quickly to the next feeling is inappropriate.
 If the client starts crying, encourage them to express these feelings.
 Pause, go slowly, and do not interrupt when the client is experiencing feelings.

Identifying feelings words

 Many beginning helpers have difficulty coming up with a variety of words to
describe the emotions expressed in a given situation.
 This includes both positive and negative emotions, but the negative emotions out
number positive emotions by about two to one, as is generally true with emotions
(Izard, 1977).

SOURCES OF REFLECTIONS
A. Client's Expression of Feeling
 Sometimes clients are aware of their feelings and express them openly.
 For example, Amanda might say, "I was really upset with my teacher.
B. Client's Verbal Content
 Another source of clues about feelings is verbal content.
 It is sometimes possible to infer the feelings from the client's words.
 Helpers can make preliminary hypotheses
C. Nonverbal Behaviors
 If the helper observes that the client is smiling and looks pleased, the helper might
say, "You seem happy about that."
 The meaning of nonverbal behaviors is not always the same
D. Projection of Helper's Feelings
 A final source for detecting client feelings is ourselves:
 How would I feel if I were in that situation?
  Helpers are not judging but are attempting to understand the client's feelings by
imagining themselves in a similar situation.
 These projections are possibilities rather than accurate representations of the
client's reality.

Difficulties while delivering reflection of feeling

 Helpers become nervous to clients' expressions of intense negative feelings, such as
sadness or anger.
 They get anxious when clients cry
 Uncertain about how to handle deep negative emotions
 Unsure about how to respond to show understanding.
 Feelings of guilt because helpers might think their interventions upset the clients or
caused the pain.
 Helpers might be afraid that if they encourage clients to express their feelings, the
clients will get stuck in the feelings and not be able to emerge from them.

Open Questions About Feelings

 Formulate a reflection to get to the salient topic and then replace the feeling word
with the open question.
 For example, if the reflection would be, "You seem worried about what your mother
might say," the helper might instead say, "How do you feel about what your mother
might say?"
 Helpers are not continually saying, "How do you feel about that?" Instead, helpers
might say, " What was that like for you?" or "Tell me about that experience."

PARAPHRASING

• Paraphrasing is a crucial skill used by therapists to restate their clients' words in a

more concise or clearer manner, without changing the meaning.
• It helps validate the client's feelings, encourages them to delve deeper into their
thoughts and emotions, and fosters a stronger therapeutic alliance.
• By paraphrasing, counselors demonstrate active listening and empathy, facilitating
effective communication and understanding between themselves and their clients.
• egg: Client: I think that she is better than me.
Counsellor: You believe that she is superior to you

STEPS INVOLVED IN PARAPHRASING

[Link] Listening: Pay close attention to what the client is saying, focusing on both verbal
and non-verbal cues.
[Link]: Understand the essence of the client's message, including their emotions,
concerns, and underlying meanings.
[Link]: Condense the client's message into its core elements, capturing the main
points while maintaining accuracy
4. Rephrasing: Use your own words to express the client's message, ensuring that the
paraphrase is clear, concise, and reflects the client's perspective accurately.
[Link]: Convey empathy and understanding through your paraphrase, reflecting the
client's feelings and experiences.
[Link] for Understanding: Confirm with the client that your paraphrase accurately captures
their thoughts and feelings. This demonstrates active listening and encourages further
exploration
[Link] Interpretation: Refrain from adding your own interpretation or judgment to the
paraphrase. Instead, focus on reflecting the client's words and emotions without distortion.
[Link]: Be flexible in your paraphrasing approach, adapting your language and style to
match the client's communication style and preferences.
[Link]: Regular practice is essential for developing proficiency in paraphrasing. Engage in
role-plays, receive feedback, and reflect on your paraphrasing skills to enhance
effectiveness.

PARAPHRASING AND REFLECTING MEANING

Reflecting meaning goes beyond simply restating the client's words. It involves capturing the
underlying emotions, thoughts, or themes behind what the client has shared. Reflecting
meaning helps deepen the therapeutic conversation by acknowledging and exploring the
significance of the client's experiences.
[Link] Understanding: Reflecting meaning ensures that the counselor accurately
grasps the underlying emotions, thoughts, and themes behind the client's words.
This deeper understanding enables the counselor to provide more meaningful
support and guidance.
[Link] Empathy: By reflecting the client's emotional experience, counselors
demonstrate empathy and validation. Clients feel understood and accepted, which
strengthens the therapeutic alliance and encourages openness and trust.
[Link] Self-Exploration: When counselors reflect meaning, they help clients
explore their own thoughts and feelings more deeply. Clients gain insight into their
experiences and motivations, leading to greater self-awareness and personal
growth.
[Link] Client-Centered Therapy: Reflecting meaning keeps the focus of the
conversation on the client's experiences and perspective. This client-centered
approach empowers clients to take an active role in their own therapy and facilitates
more meaningful and relevant interventions.
[Link] Problem Solving: By accurately reflecting the meaning behind the client's
statements, counselors can better identify underlying issues and challenges. This
understanding forms the basis for developing effective coping strategies and
problem-solving techniques tailored to the client's needs.
[Link] Therapeutic Relationship: Reflecting meaning fosters a strong
therapeutic alliance built on trust, empathy, and understanding. Clients feel heard
and respected, which encourages continued engagement in therapy and promotes
positive outcomes

PARAPHRASING AND REFLECTING FEELING

Reflection of feelings involves observing emotions, naming them, and repeating them back
to the client. It is a crucial skill in communication that involves not just understanding and
acknowledging what someone is saying but also empathizing with their emotional
experience.
[Link] Emotions: Reflecting feelings starts with recognizing the emotions being
expressed by the other person. This requires attentive listening not only to the words but
also to the tone of voice, facial expressions, and body language.
2. Verbalizing the Emotion: Once you've identified the emotion, you verbalize it in a way that
shows you understand and validate what the person is feeling. This can be done by simply
stating the emotion or paraphrasing it in your own words.
 - For example, if someone says, "I'm really anxious about this upcoming presentation," you
might reflect their feeling by saying, "It sounds like you're feeling really anxious about the
presentation."
3. Validation: Reflecting feelings also involves validating the person's emotional experience.
Validation means acknowledging that their feelings are understandable and legitimate, even
if you may not necessarily agree with their perspective.

HELPING CLIENT MANAGE RELUCTANCE AND RESISTANCE

RELUCTANCE
Reluctance refers to their hesitancy to engage in the work demanded by the tasks of the
helping process. Being slow to seek help or accept help when it is offered is an early form of
reluctance.

REASONS FOR RELUCTANCE

1. Fear of intensity: If the counselor uses high levels of tuning in, listening, sharing
empathic highlights, and probing, and if the client cooperates by exploring the
feelings, experiences, behaviors, points of view, and intentions related to his or her
problems in living, the helping process can be an intense one.
2. Lack of trust: Some clients find it very difficult to trust anyone, even a most trust
worthy helper. They have irrational fears of being betrayed. Even when
confidentiality is an explicit part of the client-helper contract, some clients are very
slow to reveal themselves.
3. Fear of disorganization: Some people fear self-disclosure because they feel that
they cannot face what they might find out about themselves. Digging into one’s
inadequacies always leads to a certain amount of disequilibrium, disorganization,
and crisis. But breakthroughs and growth often take place at crisis points.
4. Shame: Shame is a much-overlooked variable in human living. meaning that suggests
the process of painful self-exploration. Shame is not just being painfully exposed to
another; it is primarily an exposure of self to oneself. In shame experiences, particularly
sensitive and vulnerable aspects of the self are exposed, especially to one’s own eyes.
5. The cost of change: Some people are afraid to take stock of themselves because they
comfortable but unproductive patterns of living, work more diligently, suffer the pain of
loss, acquire skills needed to live more effectively, and so on.
6. A loss of hope: Some clients think that change is impossible

RESISTANCE
o Clients who resist tend to think that they are being forced to do something.
o They may even want to engage in therapy or in some therapeutic exercise, but feel
that their helpers are demanding participation rather than inviting them to
participate.
o Clients who believe that their cultural beliefs, values, and norms—whether group or
personal—are being violated by the helper can be expected to resist.
o Resistance is the client’s way of fighting back
o Involuntary clients sometimes called mandated client is an individual who is
required to attend counseling or therapy sessions due to an external mandate,
typically from a legal, occupational, or social service authority —are often resisters.
o Healthy resistance: resistance can be a healthy sign. It can mean that clients are
standing up for their rights and fighting back.

GUIDELINES FOR HELPING CLIENTS MOVE BEYOND RELUCTANCE AND RESISTANCE

 o Avoid unhelpful responses to reluctance and resistance
o Develop productive approaches to dealing with reluctance and resistance.
- Explore your own reluctance and resistance.
- See some reluctance and resistance as normal.
- Accept and work with client’s reluctance and resistance.
- Examine the quality of your intervention
- Be realistic and flexible.
- Establish a “Just society” with your client
- Do not see yourself as the only helper in your client’s life.
- Employ reluctant and resistant clients as helper.

PROBING AND SUMMARISING

PROBING
Probes are verbal and sometimes nonverbal tactics for helping clients talk more freely and
concretely about any issue at any stage of the helping process.
Probes help clients name, take notice of, explore, clarify, or further define any issue at any
point in the helping process. Probes are designed to provide clarity and to move things
forward.

Different form of probes

• Statements: One form of probe is a statement indicating the need for further clarity.
• Requests: Probes can take the form of direct requests for further information or
more clarity. Requests should not sound like commands.
• Questions: Direct questions are perhaps the most common type of probe.
- Don’t ask too many questions.
- Ask open-ended questions.

GUIDELINES FOR USING PROBES

• Use your ongoing feedback system as a way of probing
• Use probes to help clients engage as fully as possible in the therapeutic dialogue
• Use probes to help clients achieve concreteness and clarity
• Use probes to explore and clarify clients’ points of view, intentions, proposals, and
decisions
• Use probes to help clients fill in missing pieces of the picture.
• Use probes to help clients get a balanced view of problem situations and
opportunities.
• Use probes to help clients move into more beneficial stages of the helping process

SUMMARIZING
The ability to summarize and to help cli ents summarize the main points of a helping
interchange or session is a skill that can be used to provide both focus and challenge.
There are certain times when summaries prove particularly useful: at the beginning of a new
session, when the session seems to be going nowhere, and when the client needs a new
perspective.

1. At the beginning of a new session: Using summaries at the beginning of a new

session, especially when clients seem uncertain about how to begin, prevents clients
from merely repeating what. It puts clients under pressure to move on.
2. During a session: that is going nowhere Helpers can use a summary to give focus to
a session that seems to be going nowhere. One of the main reasons sessions go
 nowhere is that helpers allow clients to keep discussing the same things over and
over again instead of helping them either go more deeply into their stories, focus on
possibilities, and goals, or discuss strategies that will help clients get what they need
and want.
3. When the client needs a new perspective: Often when scattered elements are
brought together, the client sees the “bigger picture” more clearly.

RECOGNISING PATTERNS AND THEMES

Recognizing patterns and themes in counseling sessions is crucial for understanding clients'
experiences and facilitating effective therapy. Here are some key steps and considerations:
1. Active listening: Pay close attention to what the client is saying, both verbally and
non-verbally. Look for recurring words, phrases, emotions, and topics that emerge
during the session.
2. Note Emotional Cues: Emotions often indicate underlying themes. For example, if a
client frequently expresses frustration or sadness when discussing relationships, this
could suggest a theme related to interpersonal dynamics or attachment issues.
3. Identify Repetitive Issues: Clients may revisit certain issues or stories across
sessions. These repetitions can point towards core themes or unresolved conflicts
that need exploration.
4. Connect the Dots: Look for connections between different aspects of the client’s life
and experiences. Themes may transcend specific events and reveal deeper concerns
or patterns of thinking.
5. Contextualize: Consider the broader context of the client’s life, such as cultural
background, family dynamics, or significant life events. These factors can influence
the themes that emerge in therapy.
6. Use Reflective Practice: Reflect on your own observations and reactions during
sessions. Discussing your insights with a supervisor or colleague can provide
additional perspectives on the patterns you’re observing.
7. Collaborate with the Client: Discuss emerging patterns and themes with the client.
This collaboration can help validate their experiences and deepen their self-
awareness.
8. Document and Track: Keep notes of recurring themes and patterns over time.
Tracking changes and developments can provide valuable insights into the client’s
progress in therapy.
9. Stay Flexible: Remain open to unexpected themes or shifts in the client’s narrative.
Counseling is dynamic, and themes may evolve as the therapeutic relationship
deepens.
10. Seek Supervision: If you’re unsure about interpreting patterns or themes, seek
supervision or consultation with experienced colleagues. They can offer guidance
and help ensure your interpretations are grounded in therapeutic theory and
practice.

UNDERSTANDING CLIENT’S FRAME OF REFERENCE

• Understanding a client's frame of reference is essential in counseling because it
allows you to see the world through their perspective. Here are some key steps and
considerations to achieve this understanding:
1. Active Listening and Empathy: Actively listen to the client without judgment and try
to empathize with their experiences, emotions, and beliefs. This helps you connect
with their frame of reference.
 2. Explore Cultural and Social Context: Consider the client's cultural background,
family dynamics, socio-economic status, and any other relevant social factors that
shape their worldview. These factors influence how they perceive themselves and
their experiences.
3. Validate Their Experience: Acknowledge and validate the client's feelings and
experiences as real and meaningful from their perspective, even if you don't
personally share the same views or beliefs.
4. Clarify Assumptions and Beliefs: Ask open-ended questions to clarify the client's
assumptions, beliefs, values, and interpretations of events. This helps uncover their
underlying thought patterns and reasoning.
5. Reflect Back Their Narrative: Reflect back to the client what you understand about
their narrative. This shows them that you are actively trying to understand their
perspective and can help clarify any misunderstandings.
6. Respect Autonomy and Agency: Recognize and respect the client's autonomy and
agency in defining their own experiences and goals. Avoid imposing your own beliefs
or values onto them.
7. Consider Developmental History: Understand how the client's past experiences,
including childhood and significant life events, have shaped their current frame of
reference and ways of coping
8. Stay Culturally Competent: Be aware of cultural differences and biases that may
affect your understanding of the client's frame of reference. Continuously educate
yourself on cultural competence and diversity issues.
9. Adapt Communication Style: Adjust your communication style to match the client's
preferences and cultural norms. This helps create a comfortable and trusting
therapeutic environment.
10. Collaborate in Goal Setting: Work collaboratively with the client to set goals that are
meaningful and achievable within their frame of reference. This fosters a sense of
ownership and commitment to the therapeutic process.

• EXTERNAL FRAME OF REFERENCE

The concept of an external frame of reference refers to a perspective where the counselor
or therapist assesses and evaluates the client's experiences, behaviors, or emotions based
on criteria external to the client's own subjective experience or self-assessment. This
approach is used to gain a more objective understanding of the client's situation, behaviors,
and issues.
• INTERNAL FRAME OF REFERENCE
Internal frame of reference refers to the client's subjective perspective, beliefs, values, and
perceptions about themselves, their experiences, and their world. Unlike an external frame
of reference that relies on external standards or benchmarks, an internal frame of reference
focuses on how the client interprets and makes sense of their own thoughts, emotions,
behaviors, and life circumstances.

STRUCTURING

 Structuring describes any statement by the counsellor that lets the client know what
to expect of the process and outcome of counselling. It may address “the nature,
conditions, limits and goals” of counselling.
 Structuring helps to keep the conversation purposeful
 Need for structuring
• Many clients arrive at a counselor’s office having no idea what to expect of
counselling.
 • Others arrive with unreasonable or inappropriate expectations.
• Some of a counselor’s earliest statements to a client will suggest how the
client might participate and what the counsellor will contribute to the
conversation
• When clients lose momentum during counselling, they need help in
maintaining the motivation to work on their concerns or to move to a new
stage.
 Counselling trainees voice and body messages may enhance or impede structuring
 Good voice message skills include easy audibility, comfortable speech rate, firm
voice, clear articulation, and appropriate variations in emphasis.
 Trainees’ body messages should support their verbal and voice messages: for
example, by appropriate gaze, eye contact and use of gestures.
 Ineffective voice and body messages can countermand verbal messages

Too much and too little structuring

 Too little structuring
• Possibility of rambling
• Unfocused interaction that is lacking in concreteness and is unproductive
• Client will present an initial concern and then withdraw to await the
counselor’s solution
• Clients may feel anxious and confused. Counsellor too may be anxious and
confused.
• Clients may perceive that counsellor have nothing of value to offer
 Too much structuring
• Clients may feel stifled by their agendas and reluctant or unable to reveal
their own.
• Clients may perceive counsellor as to set on fitting them into their way of
working whether it suits them or not.
• If counsellor talk too much at the beginning of sessions, not only do they
make it difficult for clients to talk, but they may structure the counselling
process in too intellectual a way

Structuring at the beginning of counselling

 During the first couple of sessions, the client and counsellor establish the pattern of
how they will work together
 With adolescent and adult clients, the counsellor will usually initiate specific
discussion about confidentiality, length and frequency of counselling sessions,
projected duration of the counselling, client and counsellor responsibilities and
possible outcomes
 Such discussion assure that client has given informed consent
 Discussion of the time frame like” we will have 45 min for today “, after hearing
“Let’s plan to meet for about 6 sessions and then take stock of where you are, often
people are able to sort out concerns like yours in about that amount of time.”
 With children, action limits are usually discussed as well (for example, "You may not
break the equipment or hit the counsellor”)
 Wording of the other elements of structure must be adjusted to the client’s ability to
comprehend
 Advantage
• Reducing anxiety by clarifying roles
• Explaining the purpose of the initial session
 • Establishing the expectancy that clients will work on rather than just talk
about problems
• Providing an introductory rationale for working within the life skills
counselling model
• Communicating limitations concerning the counselling relationship such as
any restrictions on confidentiality

Structuring later in the counselling process

 It serves to reassure about confidentiality, to reaffirm or renegotiate time
parameters, to remind the client of the nature of the process and to reinforce the
appropriate roles of the participants or to move counselling forward to new stage.
 In some instance, clients do not comply with stated time parameters, arriving late
for sessions, appearing at unscheduled times when no emergency exists, or perhaps
delaying the introduction of important material until near the end of a session in
hopes of either extending their time or of escaping any authentic work on the new
agenda, there is a need to reopen a discussion of the value and appropriate use of
counselling time.
 The counsellor and client should also discuss periodically the clients progress related
to the initially planned duration of counselling and perhaps revise the plan.

LEADING

 A counsellor is typically confronted every few seconds during a counselling session

with a choice about how to respond to the content and effect of what the client has
just said
 Counselors’ potential responses include paraphrases, statements of empathy,
confrontation, interpretation and ability potential responses
 Robinson (1950) coined the term leading to describe the counsellor’s selection of a
response that anticipates the client’s readiness to benefit from a particular kind of
response.
 The concept of leading includes the proposition that that there is “a critical region,
just ahead of but not too far ahead of the client, where therapy takes place most
efficiently”.

Football analogy

 Robinson (1950) used a football analogy to describe leading. When throwing the
football, the passer anticipates where the receiver will be when the ball arrives and
throws the ball out ahead of the receiver (leads the receiver) so that the ball and the
receiver arrive at the same place at the same time. Analogously, Robinson advised
the counsellor to estimate where the client is going next and to formulate a
response that will intersect with the client’s path and further his or her progress.
 Length of lead -If a counsellor underestimates the pace of a client’s progress, he or
she forces the client to slow down and react to a statement that from the client’s
viewpoint needs no further work much like a pass receiver must slow his pace or
retrace his footsteps to catch a pass that is underthrown. If a counsellor
overestimates a client’s pace, he or she may make a statement that is beyond the
client’s ability to comprehend and internalize, and the client may become confused
and defensive like in the case of a receiver who just can’t make it to the football
because it has been overthrown
CONTINUUM OF LEAD

Robinson arrange all types of response on a continuum from least leading to most leading,
thereby creating reference points that facilitate the choice of slightly more or less leading
responses as they are needed in counselling sessions.

Least leading response Most leading response

Silence immediacy
Acceptance interpretation
Restatement confrontation
Minimal encourager ability potential response
Primary empathy advice
Advanced empathy reassurance
Affirmation introducing new idea or a new idea
Organizing lead

Leading and stages of counseling

1. Exploration stage - Minimum lead responses are excellent for relationship building
and they are low risk responses because they do not frighten the client with startling
new perspectives
2. In-depth exploration stage - Responses toward the center of the continuum can be
somewhat threatening and may produce defensive reactions if used prematurely
3. Commitment to action stage - Maximum lead responses are including use of new
information and reinforcement of selected behaviors

QUESTIONING

The use of questions in counselling

 Questions depending on a minimum, medium or maximum degree of leading
 Questions can occur at any time in the counselling process. If they are open-ended
and well-timed, they promote deeper client self-exploration
 Questions are useful in opening new aspects of the client’s situation for discussion
(such as history, strengths or prior attempts all alleviating the problem)
 Clarifying vague or conflicting comments from the client
 In focusing the client’s attention on specific thoughts, feelings or behaviors related
to an issue or problem
 Effective questioning enables clients to provide much additional information for
identify, clarify, and break problems down into their component parts
 Plants and their root system analogy for the role of questioning in initial sessions of
counselling
 Limitation
• If counsellors appear to be grilling the client and can actually prevent the
client from disclosing what he or she needs to discuss by channeling
attention onto issues that may seem pertinent to the counsellor but not the
client
• Premature questions may rush the client to define the problems too quickly
or hurry the process of identifying solutions
• Poorly formulated or badly timed questions interrupt client progress

Types of question
[Link]-ended versus closed question - Open-ended questions give clients considerable
choice in how to respond, whereas closed questions restrict choice. When working with new
clients many counsellors use open-ended questions prior to asking more focused questions
[Link] questions - Clarification questions seek information about and clarify the
counsellor’s perception of clients’ words and phrases
[Link] questions - Elaboration questions are open questions that give clients the
opportunity to expand on what they have already started talking about like ‘Would you care
to elaborate?', 'Is there anything more you wish to add?’ etc.
[Link] detail questions - Specific detail questions aim to collect concrete information
about clients 'problems and problematic skills patterns. These questions focus on how, what,
when, and where.
5.‘Show me’ questions - ‘Show me’ questions ask clients to show the counselling trainee how
they communicated. Sometimes trainees act the other person in a roleplay.
[Link] personal meaning questions - The information clients provide often has personal
or symbolic meaning for them. Questions like ‘Why is it so important for you?’
[Link] for strengths questions – Like ‘What are your assets?', 'Was there anything good
in the way you behaved?', 'What skills do you bring to this problem?’ etc.
[Link]-focused questions - Solution-focused questions ask clients to provide information
concerning the extent to which they have tried or are trying to do something about their
problems like ‘What are your options?', 'What are you planning to do?', 'How can you
change your behavior?’ etc.

Areas of information for questions

In each area, start with open ended questions and then, if appropriate, become more
specific. There is no set order
1) Brief history of problem
2) Feelings
3) Physical reactions
4) Thoughts
5) Communication/actions
6) Miscellaneous
 The trainee might ask further questions to confirm or negate hypotheses
 Throughout this process of asking questions, the trainee should take brief notes

DIFFICULTIES IMPLEMENTING THE EXPLORATION STAGE

[Link] Listening and Attending

 Instead of using only the skills, helpers need to genuinely care, feel compassion for
the client, and be present and engaged in the moment
 Factors that interfere with helpers' ability to attend and listen adequately:
• Thinking about what to say next
• Something unrelated to the session (e.g., “What's for dinner tonight?”)
• Helpers sometimes judge the merits of what clients are saying rather than
listening and understanding them
• Sympathy
 Coping strategies - self-reflection and practice
[Link] Implementation of the Skills
 Asking Too Many Closed Questions
• Reason
• Many helpers think the helping process is similar to a medical model in
which they should collect a lot of information to diagnose the problem and
 provide a solution for the client. However, in this stage, the helper's task is
to aid clients in coming to their own solutions, facilitating exploration of
thoughts and feelings so there is little need to know all the details.
• To fill time or satisfy their curiosity - When asking questions, it is important
to clarify for whom and why the question is being asked
 Disclosing Too Much
• Client issues are often similar to their own, beginning helpers want to share
their experiences with their clients
• Helpers need to learn to restrain themselves and only disclose for the
client's benefit (e.g., when it would help the client feel less isolated and
different).
 Talking Too Much and Not Allowing Silence
• Reason
• Counselor is anxious, want to impress the client, or like to talk in general
that leads to clients cannot talk, cannot be focusing on themselves and
exploring their concerns
• Not allowing silence due to fear that clients are bored, anxious, critical, or
stuck
• Coping strategies - Watch videos of themselves and reflect on their fears
about silence in sessions, asking themselves what concerns they have (e.g.,
not appearing competent, not helping the client) etc.
 Giving Too Much or Premature Advice
• Reason
• Feel pressured to provide answers, fix problems, rescue clients, or have
perfect solutions
• Help client to figure out how to solve their problems rather than someone
telling them what to do
 Discouraging Intense Expressions of Affect
• Beginning helpers sometimes feel uncomfortable when clients express
intense affect, such as despair, intense sadness, or strong anger (especially if
the anger is directed toward the helper) so they may deny or defend to their
negative feelings
• Sometimes helpers feel a need to make clients feel better immediately
because they do not want their clients to suffer.
• They mistakenly think that if clients do not talk about their feelings, the
feelings go away express their negative feelings.
• Helpers need to be aware of their tendencies to respond in these types of
situations so that they can practice other, more therapeutic ways to respond
(e.g., allowing the client to cry, responding empathically to the hostility)
• Coping strategies - watching videos of one’s own sessions to personally
observe the effects of your interventions, observing models to see how they
handle similar situations, self-reflection and personal therapy
3. Clients Circling Rather Than Exploring
 Clients go around in circles, repeating themselves rather than going deeper into
their problems
 Reason
1) Beginning helpers use too many closed questions
2) Use restatements or reflections that are focused on someone other than
the client
3) Use interventions that are too general or vague,
4) Do not inquire about other aspects of problems
[Link] to Attend to Culture
 Helpers must be mindful of not imposing their own values about open
communication on people from other cultures
 Helpers must be careful not to stereotype clients from other cultures or assume that
all people from a given culture have similar values
 Remember that there is more variation within a given culture than between cultures
 To explore cultural difference can ask about cultural differences, whether discomfort
is due to cultural differences, cultural values related to the helping process etc.
 Gender
• In general women are more comfortable expressing feelings than men,
given that men are typically socialized to hide feelings of sadness and fear,
helpers should not assume that all women will enjoy exploration and all men
will not.
 Coping strategies for enhancing cultural awareness include getting feedback and
engaging in self-reflection
[Link] “Buddies”
 Sometimes beginning helpers acting like “buddies” with clients instead of being
helpers
 The role of helper necessitates providing a connected yet clearly defined
relationship to maintain objectivity and offer maximum assistance
 Coping strategies - Getting feedback from others, self-reflecting about why you want
to be liked as a buddy, observing models of therapists acting in a professional way,
and practicing using exploration skills
[Link] Intense Negative Reactions to Clients
 Reactions are positive (e.g., supportive, warm), sometimes we have negative
reactions (e.g., dislike, anger, prejudice)
 Negative reactions may arise from aspects of either counselor or the client
 Negative reactions might be projecting negative feelings about yourself onto the
client, might have negative reactions to a client who reminds you of someone else
etc.
 Negative reactions arise from a combination of counselor’s own personal issues and
honest perceptions of the client
 Coping strategy - Getting feedback, self-reflection and practice
[Link] and Panicking
 Sometimes novice helpers become so anxious about their performance that they
feel like they are outside their bodies observing themselves, instead of being fully
present and interactive in the helping session.
 At worst, these helpers become completely frozen and cannot say anything
 These experiences can frighten helpers, who then panic and tell themselves they can
never be good helpers
 Coping strategy - Deep breathing, relaxation, mindfulness; positive self-talk; focus on
the client; self-reflection; practice
[Link] Discouraged About Your Ability to Be a Helper
 Some students say they feel like they are getting worse, rather than better, at being
able to be a helper
 They are so focused on each skill and on watching everything they do that it is hard
to perform at all
 In learning helping skills, helpers first practice individual skills (and often unlearn
habits that are not facilitative to helping) and then put all the skills together
 Coping strategies
1) Getting feedback about how others view your helping ability
 2) Self-reflection
3) positive self-talk
4) Practice

COPING STRATERGIES FOR MANAGING DIFFICULTIES IN EXPLORATION STAGE

[Link]-Reflection
 Self-awareness is crucial for helpers to become aware of their motives so that they
can get these needs met elsewhere and not act out with clients
 One excellent method for beginning self-reflection is to keep a journal and write
your reactions immediately after every training session and every session with a
client; observe what you felt, and query yourself about what those feelings were
about. Personal therapy and supervision, as noted repeatedly.
[Link] Videos and Transcribe Your Sessions
 Watch videos of sessions and pause them frequently to ask yourself, "What was I
feeling at that moment?” “What was I feeling about the client?” “What do I think
the client was feeling about me at this moment?” This method, called interpersonal
process recall.
 Transcribe sessions helps to slow down and try to understand what was happening
[Link] Models
 Watching seasoned helpers conduct sessions is an excellent way to observe skills
being used appropriately. The skills come alive when one sees them demonstrated
by experts
 Bandura (1969) found that watching models was an important step as one step in
the learning process.
 Watching many helpers to illustrate that there are numerous ways and styles of
helping
4. Focus on the Client
 Focus on client rather than themselves can listen more attentively, to facilitate
clients in exploring feelings and by immerse themselves in the client's world, many
helpers forget about their anxiety
5. Practice the Skills—Many Times and in Many Settings
 Before sessions with clients, helpers can role-play using specific helping skills.
Helpers can also role-play the mechanics of sessions, such as starting and stopping
the session, responding to silence, and dealing with anger directed toward the
helper
 By using role-plays with supportive partners (e.g., classmates), helpers are more
likely to learn the skills at a comfortable pace
 The more helpers practice and pay attention to what they do well and how they can
improve, the better and more comfortable they are likely to become in helping
sessions.
 Imagery - Helpers can imagine themselves using appropriate attending behaviors
and helping skills in different situations
[Link] Regulation Through Deep Breathing, Relaxation, and Mindfulness
 Learn mindfulness and relaxation techniques
 During sessions, helpers can manage anxiety by breathing deeply from the
diaphragm instead of taking short breaths from high in the chest. To determine
whether you breathe from the diaphragm, put your hand over your stomach. When
you breathe, you should feel your hand move in and out.
 Deep breathing serves several functions,
• it allows one to relax.
 • Taking a deep breath gives helpers a moment to think about what they want
to say
• It gives clients a chance to think and consider whether they have anything
else to say
[Link] Case Conceptualization
 Understanding why clients act as they do can go a long way to helping develop
empathy and compassion for them and then figuring out how to work with them in
the different stages
[Link] Self-Talk
 We all talk to ourselves as we do things. Some people have called this the “inner
game” because it occurs beneath the surface.
 We sometimes say positive things like “I can do this” or negative things like “I think I
am going to panic.” Positive self-talk has a positive influence on performance in
helping sessions, whereas negative self-talk has a negative influence on performance
 Helpers can practice using positive self-talk before sessions so that they have
positive sentences ready to use to coach themselves. Alternatively, helpers can write
down positive self-statements (e.g., "I know the skills,” “I am competent”) on index
cards and glance at them before or during practice sessions. which is most effective
after you have done self-reflection and come to understand yourself more
[Link] to Empathy and Use Exploration Skills
 Helpers is attempting to be present, empathic, focused on the client and use
exploration skills
 when helpers feeling lost, overwhelmed, or discouraged during a session with a
client, refocus your energy, use emotion regulation strategies, and center yourself.
Take a deep breath, pause, remind yourself to focus in the moment on the client,
forgive yourself for not being perfect, remember humility, and then try to imagine
what the client is feeling.
[Link] Your Own Style
 There is no “right” way
 Helpers have to modify the skills to fit their personal style, and then modify that
style to fit the needs of the individual client

UNIT-3
IN-DEPTH EXPLORATION/INSIGHT STAGE

Goals and methods of In-depth Exploration

To crucial goals in the in-depth exploration stage for the client:

• To get insight – Insight into his/her strengths, deficiencies, interpersonal functioning,
"baggage “from the past, feelings desires and needs.
• To begin formulating goals – Regarding those changes that he/she has the power to
make that will lead to more complete satisfaction of desires and needs.
• Not all clients need the same kind of insight.
⮚ Some may need a clearer picture of interests and ability patterns that relate to
career choice
⮚ Some may need clarification about how their behavior affect others.
⮚ Some confused clients may need help understanding internal beliefs and
perceptions that create conflict.
⮚ Others benefit from becoming aware of inner emotion and how these are expressed
and disguised
 • Insight is gained through the process of exploring significant themes, patterns,
concerns and issues.
• Insights sometimes can be an unachievable goal for – children, adolescents and
adults who are less intellectually capable.
• Every client does not possess the habit of looking inside.
• Two types of possible clients in In-depth exploration stage:
1. Those who experience emotional release(catharsis) through counselling
that leads to more satisfactory feelings and behaviors without ever
achieving a thorough understanding of the roots of their difficulties.
2. Clients who achieve insight into the nature of their difficulties but may
never formulate goals or take any action, therefore probably will not
experience much benefit as a result of the counselling experience

Feedback as the essential work in Stage 2

• Feedback helps people grow and learn about themselves and their environment
• . Through feedbacks, clients can learn more about their present behaviors, they
become clearer about their goals for change.
• People may resist feedback even though they need them for growth.
• Should be provided in a way that it can be assimilated and used for growth.
• Since feedback will be resisted, offering it is an art.
• Working in line with the principles that govern feedback will increases the chances
of assimilation and use.

Principles of giving Feedback

Eight principles govern the counsellors use of feedback.

Feedback is hard to receive.
• All feedback, even when supportive, can meet with some resistance.
• When receiving a supportive feedback people often have mixed emotions: -
appreciate the good words; yet feel uncomfortable in the spotlight of attention.
• When receiving critical feedback; the feedback identifies behavior that an observer
has found to be inappropriate and is even harder to accept.
• Clients feels that his/her own judgement is being questioned; which is
uncomfortable especially if one is already feeling uncertain or guilty about it.
Feedback that does not fit a person’s self-image will be harder to receive than
feedback that is consistent with self-image.
Client
• Low grades
• Failed an exam
• Lonely
• Not having established many new friendships
• No girlfriend
Counsellor
• Encourages by providing feedback
• “You are bright and attractive to others based on your experience in high school”.
• When provided such feedback the client becomes more insistent that he is failure
would never reach his goal.
• The client reluctant to accept factual feedback of a hopeful nature since success is
not part of self-image right now.
Feedback is never fully internalized at the time it is received.
 • Elements consistent with the self-concept are quickly acknowledged yet others are
rejected or discounted.
• Still others are reviewed many times before they are recognized as valid and
incorporated into revised self-concept.
• “Even when we want feedback, we resist it.”
Feedback is easier to receive if it comes from a trusted source.
• If the client sees most of the counsellors’ observations, perceptions and judgements
as valid he/she will work hard to accept new feedback that may initially seem
incongruent with self.
• Trust is also a function of client’s assessment of credibility.
• Trust develops in the context of genuine, caring relationship in which the counsellor
shows respect for the client.
Feedback is easier to receive when the giver offers it with a calm presence.
• In the calm presence the counsellor helps the client feel confident about the
feedback.
• When the counsellor is anxious angry or embarrassed the client will feel insecure
and will block assimilation.
• The counsellor may have difficulty with giving feedback when they project
themselves in the role of the client (imagining themselves in the client’s situation)
and would think, “I would not want to receive the kind of feedback I'm about to
give.”
Feedback is more effective when it is communicated clearly and specifically.
• Counsellor should fully formulate the information and should be very comfortable
about giving it, in order to clearly communicate it.
• When the counsellor is not clear 🡪 client will not be able to perceive what is not
stated.
• When counsellor feels uncomfortable 🡪 client is deprived of the counsellor’s
accurate insight.
• Specific feedback will promote effective exploration.
• The first feedback encourages discussion of specific hurtful exchanges between
husband and wife.
Feedback can only be absorbed in small doses.
• It is important not to overwhelm the client.
• The counsellor may feel the urge to present the client with a litany of shortcomings
when he/she is feeling frustrated with the progress of the counselling.
• when the client is stuck or resistance to change
• slow progress makes them feel they are losing control of the situation.
• “Although most people have many areas that would profit from change, they cannot
work on all of them at one time. "Ivey
Feedback is presented for client consideration not as indisputable truth.
• For example, the case of a boy who repeatedly gets involved in fights with other
boys on the playground. These incidents occur when other boys call him names or
make remarks about his mother. The other children have learned that he responds
excessively to their taunting and have made a game of antagonizing him
• Although the first feedback might generate insight for the boy to consider this
hypothesis, he may have trouble acknowledging it if he is sensitive about having a
single mother with a live-in boyfriend.
• The hypothesis might be easier to contemplate if stated less bluntly and offered for
consideration This second statement, while still pursuing the hypotheses that the
client is ashamed of his family, avoids a negative label and asks for the client's
perceptions.
Modes of providing feedback

[Link] EMPATHY
[Link]
[Link]
[Link]/REFRAMING
[Link] PLAYING
[Link]-DISCLOSURE

[Link] EMPATHY

• Empathy - “The counsellor’s ability to enter the client’s phenomenal world - to

experience the clients world as if it were your own without ever losing the ‘as if’
quality.” (Roger,1961)
• Primary empathy -the responses that indicate the counsellor has understood those
themes that are readily apparent. Communicated through non-verbal
communication means and interchangeable responses.
• In the in-depth exploration stage this is characterized by a deeper level of openness
in the client. i.e. an increased readiness to explore significant themes and to become
aware of the less obvious meanings behind those themes.
• The counsellor uses statements, whose purpose is to evoke the feeling and meaning
that already resides in the client even though the client maybe barely aware of the
existence.
• CLIENT: My past caught up to me and really floored me. I've been trying to keep my
past in the past.
• COUNSELOR 1: It's hard to talk about the past.
• COUNSELOR 2: Keeping the past bottled up hasn't worked. As difficult as it is to talk
about it, you knew you had to do it.
• The first counsellor used a primary empathy of the idea that it is difficult to talk
about the past. some purposes are served by this. The client learns that the
counsellor understands that the process is emotionally sensitive. The client is also
prompted to think again about how difficult it might to be to talk and could possibly
sense enough caring in the counsellor to go on. The client feels some understanding
from the counsellor but has a lot of choices about how to continue, which is
appropriate early in the counselling process.
• The second counsellor used an advanced empathy response. While recognizing the
client’s caution, the counsellor sensed the client’s intended message that it is time
to get some of the past out on the table, however difficult it may be.

ROLEPLAYING

Steps in Roleplaying
• Explain how role playing might help.
• The client decides (with help) who plays which role, instructs the counsellor on the
characteristics of the person he or she is playing, and decides how to play his or her
own role.
• Details about the setting should be clarified by the client to achieve as much
authenticity as possible.
• It may be useful to have several 'rehearsals" to get all the details right and to portray
personalities accurately. The rehearsals themselves deepen the client's
 understandings of the parties involved, while at the same time they inform the
counsellor.
• When the role playing is completed, the client and counsellor discuss what has
occurred.

Tasks of counsellor during role playing

• The counsellor has to play his or her own role accurately
• Has to pay close attention to the client's behavior and emotions, and to pay close
attention to his or her own inner experiencing.
• The counsellor has a rich supply of information from the experience to offer as
feedback to the client. The information can come from within him or herself and be
offered as immediacy communication ("As I played your wife, I wanted to hear your
ideas but was feeling talked down to and was hurt that you did not see me as an
equal to you") or from observations of the client (As I asserted my ideas, your
muscles seemed to freeze.”)

Uses of role playing

• Helps the client clarify emotions, desires, beliefs about the other person as well that
of others.
• Helps understand the impact of his/her behavior
• The newly formed insights serve as the bias for developing action strategies in the
third stage.

IMMEDIACY

"Immediacy refers to the current interaction of the therapist and the client in the
relationship" (Patterson, 1974).
• An immediacy response is a communication that provides feedback to the client
about the therapist's inner experience of the relationship at a given moment.
• Three kinds of immediacy responses (Egan, 1998): -
1. those that review the overall relationship with the client
2. those that explore changes in the client's demeanor as different issues arise in the
counselling
3. those that are self- involving statements reflecting the counsellor’s affective
responses to the client in the present moment.
• Immediacy responses dealing with the overall relationship provide opportunities for
the client and counsellor to explore whether they are working effectively together as
well as ways in which their relationship resembles or differs from the client's
relationships outside of the counselling.
• According to Patterson (1974), "Concern with immediacy is significant because the
client's behavior and functioning in the therapy relationship are indicative of his/her
functioning in other interpersonal relationships “
For example, the client exhibits unusual dependency in the counselling relationship,
then it is likely that she or he may do the same with significant others.
• Helping the client to recognize, understand, and manage the dependency in the
counselling relationship should generalize to the client's other relationships as well.
• Hence through immediacy, the discussion of the relationship affords opportunities
for the counsellor to identify effective relationship skills, to help the client examine
his or her own relationship skills, and to draw attention to comparisons between the
counselling relationship and the client's (often deficient) relationships with
significant others outside counselling.
• COUNSELOR: Tom, for the last five minutes or so I have not been feeling
comfortable about what is happening. To me it seems as though we are circling
around the theme of you and your father without really getting into it. (Immediacy
response indicating that progress in this session and related to this issue is
different from the usual tone of the counselling)
• CLIENT (Pause): I think you are right. So what?
• COUNSELOR: For the last two sessions I have felt as though we have circled without
focusing. Today I decided I want to say something.
(Immediacy response indicating that the blocking has been going on for a while and
may signify something important.)
• CLIENT: If that's how you have felt, why didn't you say something sooner
• COUNSELOR: I haven't been sure whether you would be open to hearing that
message from me.
(Immediacy response expressing concern that the client may not have been ready to
go further.)
• CLIENT: You must see me as pretty defensive
• COUNSELOR: All of us, including me, are defensive in some way. I can be excellent at
intellectualizing.
(Immediacy response that acknowledges counsellor's human fallibility, giving client
permission to be fallible [capable of making mistake] as well.)
COUNSELOR: Right now, I am feeling very cautious. Part of me wants to explore how
things are between you and your boyfriend, and part of me is holding back... I wonder if
you may be having a similar experience.
(Immediacy statement identifying the counsellor’s feelings.)
CLIENT: (Pause followed by slow speech.) Yes. This whole thing is so screwed up for me
that sometimes I would just rather not think about it
COUNSELOR: I get from that that you would feel more comfortable if we talked about
something else.
(Immediacy statement focusing on whether trust in the relationship is strong enough
for the client to proceed.)
CLIENT: (Still slowly.) It would be safer but I still need help sorting this all out.
COUNSELOR: I have a sense of how loaded this area is for you.... Would it help you if I
just listen while you talk? (Immediacy statement proposing a way to alleviate stress in
the relationship at the moment.)
• Sometimes when the counsellor sense that the relationship is tense, signals client
discomfort with material being discussed. A self-involving statement identifying the
counsellor’s feeling in the moment can often help the client to acknowledge
discomfort and make a more conscious decision about how to proceed.

How immediacy responses help?

🡪Useful tool in situations in which the client and counsellor are of different race, gender,
ethnic background, sexual orientation, or another characteristic. (The client may fear
that the counsellor will lack the experience to truly understand his or her life situation,
and open discussion of client-counsellor differences will often clear the air and ease
communication).
🡪Immediacy responses can provide opportunities for the counsellor to react to changes
in client participation in the therapy-for example, changes in spontaneity or perhaps a
sense that the counselling has "bogged down”.
• Immediacy involves revealing the therapists’ feelings in response to the client.
• There is always the possibility that the client will reject the perceptions as incorrect
or that the client will respond defensively
 • Considerable social competence is required to formulate statements that are potent
enough to achieve an impact and yet considerate and careful of the client's feelings.

CONFRONTATION

• Confrontation as used in counselling is defined as a counselling intervention that

describes a client's discrepancies, contradictions, and omissions. Confrontation is
done for and with the client, not to and against the client.
• The counsellor does not confront to satisfy his or her own needs, to vent feelings of
frustration with the counselling, or to punish the client. Instead, the counsellor holds
a sincere belief that the client will experience growth by paying attention to some
discrepancy or incongruence he or she has revealed.
• Egan (1998) proposes that the word challenges may more correctly describe the
intent.
• The first step in the confrontation process is the identification of mixed messages,
conflict, and incongruity in the client's statements and behaviors that require further
attention through observation, questioning, and listening (Ivey, 1994)
• These observations are then fed back to the client in a clear, concise, nonjudgmental
manner.

Discrepancies between the Client's Perceptions and Accurate Information

• People act on the basis of what they believe to be true, and when their beliefs are
inaccurate, they act in ineffective ways.
• Helping a client correct misconception can lead to more rewarding behavior.
• For example, an adolescent female may express the belief that washing with soap
and water after intercourse will eliminate the possibility of pregnancy.
• She is acting with serious misinformation, helping her understand reality more
accurately may help her take more appropriate preventive actions.
• Her counsellor may choose to confront her as follows: "Rina, it sounds as though you
believe washing with soap and water will make sure you don't get pregnant. (Rina
nods affirmatively with an anxious look) There are several ways to prevent
pregnancy if you want to, but washing with soap and water is not one of them.
Would you find it helpful for us to discuss the possible ways?"
Discrepancies between Client Expectations and Likely Possibilities

• Counselors help clients think rationally and sensibly about what is happening to
them.
• A counselor who listens carefully will often hear statements that reflect irrational
thinking - for instance, "I must be accepted and loved by everyone or I cannot be
happy”.
• Such thinking is said to be irrational because common experience tells us that no
one is loved by everyone they meet, and yet many people are able to achieve
happiness.

Discrepancies between Verbal and Body Messages

• Perls (1969) has indicated that, although it is relatively easy for people to use words
to cover up internal truths, body messages provide more accurate information about
what is happening within.
• For example, a female client was speaking in a slow, labored, drawn-out fashion.
The counsellor asked the woman whether talking about the particular theme was all
 right for her. Although she said yes, the client crossed her arms and pressed them to
her stomach. The counsellor called her attention to her closed posture. "You say that
you are comfortable with this, but your arms are crossed in close to your body and
you look tense." This comment led to some important exploration of the reasons
why the theme was hard for her to talk about.

• Sometimes, too, clients will try to hide their feelings about what they are saying by
effecting a contradictory physical message. Perhaps the most frequent example of
this is smiling while discussing or describing some very distressing event. The true
emotion may be fear, anger, or embarrassment but the smile is presumed by the
client to make the message more acceptable.
• Providing a client with feedback about body messages or discrepancies between
verbal statements and body messages can lead to more honest communication.

Discrepancies between Behaviors and Stated Goals

• Perhaps one of the most usual manifestations of a discrepancy between behaviors

and stated goals is seen in persons who seek to be accepted by others but whose
behaviors make such acceptance very unlikely.
• On the elementary school playground, this pattern is observed in the child whose
goal is to gain the positive attention (friendship) of his peers. He seeks attention by
tormenting his or her peers and consequently ends up without any friends.
• Discrepancies between behaviors and stated goals are also seen in academic
settings when students say they want to pass their courses but do not study.

Contradiction between Statements and Actions

• Consider the case of an adult female client who was trying to cope with a separation
initiated by her husband. She described herself as a good wife and expressed intense
agitation and confusion about why her husband wanted a divorce. In a later session
she told of an affair she had shortly after her marriage.
• By presenting two pieces of information together in the same sentence, the
counsellor provided the client with feedback about the incongruence of her
statement that she was a good wife and her actions as seen by her husband: "You
see yourself as a good wife, and yet you also had an affair shortly after you were
married."
• This led to exploration about her concept of being a good wife, her standards of
sexuality, and what the affair had meant to her husband, who had found out about
it.

Mixed Messages

• One of the common kinds of mixed message is conditional love: "I love you when
you do what I want.” Such messages are commonly delivered to children by parents
and by one spouse to another.
• The sender of the message is usually not aware that demands are being
communicated along with the love statements and become confused when the
receiver of the message does not feel loved.
• Confrontation with the demanding or negative part of the message creates fertile
ground for further counselling work.
Omissions

• Sometimes clients present information about their life experiences leaving out
details that may be uncomfortable to discuss and that are crucial to resolving the
problem.
• One example might be a mother who notes on her counselling intake form that she
has three children but who only discusses two in the counselling.
• An example of passive-aggressive behavior: - a young man whose father had been
pressing him to excel as a pitcher in baseball. A fleeting smile revealed the client's
satisfaction when he told of pitching a ball to his dad so hard he broke Dad's hand.
The client had omitted any verbal reference to his anger at his dad or to his
satisfaction at the punishment he had meted out, but that anger became an
important part of his counselling.

• Sometimes, as in the first case, the omission may be discovered through records,
statements of significant others, or clients’ journals presented to the counsellor.
• In other instances, there will be clues in the client's statements or behaviors (such
as the smile) that the counsellor observes and explores.
• If an apparent omission comes from a report of another person, it is important for
the counsellor to recognize that the statement may include a bias of the observer.

Working with Client Defenses

• Directly confronting a client's defenses is probably the riskiest kind of confrontation,

as such a clear approach has the high possibility of raising the client's resistance.
• It is important to recognize that a client's defenses may be longtime friends, often
they have helped the client tolerate the stresses and pains of life over a long period
(Clark, 1991).
• However, a person's defenses may also help him or her avoid the solution of
problems and often result in self- defeat and misery. Even so, the client will resist
giving up defenses.
• The task of the counsellor is to work with rather than to attack the client's
resistances (Polster & Polster, 1973). Rather than demand that resistances be given
up.

• Because resistance is often accompanied by physical responses of tight muscles,

constricted breathing, rigid posture, failed eye contact, and other signs of
discomfort, drawing the client's attention to the physical manifestation can be
helpful.
• This can be done by describing their activity, asking the client what the resisting
muscles would say if they could talk, slightly exaggerating their behavior, or using
one's own body to show the client what he or she is doing.
• To be effective with these interventions, the counsellor will learn from experience
with the client which kinds of approaches are most acceptable.
• Example: "Could it be that you act so angrily so you won't feel so controlled?"

Guidelines for Constructive Confrontation

• When a counsellor confronts a client, even with the noblest of motives, the client is
not sure of the counsellor’s intent. He or she may be an ally in the sense of wanting
 to encourage the client but may well come across as an enemy of the client's
resistances.
✔ Remember that confrontation is not the only mode of giving feed- back to a client.
Use it sparingly
✔ If you are feeling angry toward your client, that's your problem. You won't help by
punishing. If you are angry, you are probably reacting to one of your client's
resistances. You can use your anger as a source of information to recognize your
client's defense. If you have trouble resolving your anger, seek supervision or
consultation with a trusted colleague
✔ Be very clear about your reasons for confronting. If you have a plan for what you are
trying to accomplish with the client, it is much more likely that the confrontation is
based on the client's needs and not your own.
✔ Confrontation should be a feedback experience and that it should not contain
implied disapproval or manipulation.
✔ Use direct and simple language. Vague language may mean that you are unclear
about what client material you want to confront, your motives for confronting, or
whether the client is ready to hear what you want to say

INTRPRETATION

• Interpretation is also a form of additive responding the purpose of which is "to

explain rather than merely describe a client's behavior and to change a client's
frame of reference in a therapeutic direction “. (Clark, 1995)
• Interpretation is often barely distinguishable from advanced empathy responses
(Martin, 1989, Patterson, 1974).
• With advanced empathy, the counsellor stays with the client's frame of reference,
regardless of how much she or he may extend the client's story through adding what
is implied, with interpretation, the counsellor introduces a new way of thinking
about or ac- counting for the client's experience from the counsellor’s frame of
reference (theoretical frame of reference).
• Some therapists prefer to use the term Reframing instead of interpretation, because
it directly describes the introduction of a new "frame" for viewing the client's
concern and may avoid some of the association with "depth" therapy carried by the
term interpretation.
• When interpreting, the counsellor presents the client with hypotheses about
relationships, meanings, or behaviors that emerge from his or her theoretical
understandings of human personality.
• The frequency with which a counsellor uses interpretation and the nature of those
interpretations will depend on the theory or theories to which the counsellor
adheres.
🡪Person-centered counsellors regard the client's frame of reference as the only one that
matters and generally see interpretive responses as errors.
🡪In the psychoanalytic approach, interpretation is seen as the process through which clients
gain new insight into their symptoms and dynamics, and it is thus seen as necessary to the
change process.

SELF-DISCLOSURE

• The term refers to intentional verbal disclosure.

• Disclosures showing involvement: - showing counsellors involvement can humanize
counselling so that clients feel they relate to real people.
 • Three areas for disclosing involvement are responding to specific client disclosures,
responding to clients as people, and responding to clients' vulnerability.

Responding to specific disclosures:

• I am delighted.
• That is great.
• That is terrible.
• I am really sorry to hear that.
Responding to clients as people:
• I admire your courage.
• I appreciate your honesty.
Responding to clients’vulnerability:
• I am available if you get really low.
• I am very concerned about what you are going through.

• Possible positive consequences of such disclosure include providing new insights and
perspectives, demonstrating a useful skill, equalizing and humanizing the helping
relationship, normalizing clients’ difficulties, giving encouragement, and
reassurance.
• Negative consequences include🡪 Boundaries may get blurred as they burden clients
with their problems and shift the focus of the counselling conversation to
themselves.
🡪They may come across as weak and unstable when clients who feel vulnerable
want helpers who have ‘got their act together’.
• Counsellors who show involvement can help clients feel that they genuinely care.
• Counsellors need to be careful about being too gushing and nice. Clients want
detached involvement rather than involvement with psychological hooks attached.
• Sharing personal experiences may help clients feel that the counsellor understands
what they are going through.
• Counsellor has many choices in sharing personal experiences. Included among these
are whether to mention them or not, whether to restrict themselves to past
experiences or discuss current experiences, how honest to be, whether to go
beyond disclosing facts to disclosing feelings
• Below are some guidelines for appropriate sharing of personal experiences.
[Link] about oneself. Do not disclose the experience of third parties whom one knows.
2. Talk about past experiences.
3. Be to the point. Personal disclosures should follow similar client disclosures.
[Link] slowing down or defocusing the counselling session through lack of relevance or
talking too much.
[Link] sensitive to clients’ reactions. Have sufficient awareness to realize when disclosures
might be helpful to the client and when they might be unwelcome or a burden.
6. Share personal experiences sparingly. Be careful not to switch the focus of counselling
from clients to oneself.
[Link] sensitive to counsellor–client differences.
[Link] differ regarding appropriateness of counsellor self-disclosure.
9. Beware of counter-transference. Counter-transference refers to negative and positive
feelings towards clients based on unresolved areas in counsellors or counselling trainees’
lives.

SKILLS FOR FOSTERING AWARENESS

CHALLENGES
• Challenges are used to help clients recognize maladaptive feelings, motives, and desires of
which they are not aware or unwilling to change
• A challenge points out maladaptive thoughts, discrepancies, or contradictions of which the
client is unaware, unwilling, or unable to change.
• If a client is sad but cannot bring himself to feel the sadness, he may end up feeling stuck
and blocked emotionally. Similarly, if a client is angry at others but unable to admit it, she
might make a lot of sarcastic comments and inadvertently wound others because her anger
“leaks” out.
• Furthermore, clients might be invested in not being aware of their inappropriate
behaviors. They may blame other people rather than take responsibility for their actions.
• Challenges can also help clients become aware of ambivalent feelings. Most of us have
ambivalent feelings but cannot allow ourselves to feel both sides of issues because of beliefs
about how we “ought” to be.
• Challenges can be used to unearth thoughts and feelings so that clients begin to
experience and take responsibility for thoughts and feelings
• Challenges also enable clients to admit to having different or deeper feelings than they
were previously able to acknowledge.
• These interventions can also be used to help clients become aware of their defenses.
Defenses exist for a reason-they help us cope, the helper’s goal is to help clients become
aware of their defenses and make choices about when and how much to use them. By
providing a safe place to examine defenses, helpers can work with clients to distinguish
situations in which defenses are needed to protect the client and when it is safe to let go of
unnecessary defenses.
• Even though the goal of challenges is to raise awareness sometimes challenges help clients
gain insight.
• Sometimes simply hearing a challenge can led clients to want to understand themselves at
a deeper level.

TYPES OF CHALLENGES
• CHALLENGES OF DISCREPANCIES
• CHALLENGES OF THOUGHTS
• CHALLENGING THROUGH CHAIR WORK
• HUMOR AS A TYPE OF CHALLENGE
• SILENCE AS A TYPE OF CHALLENGE
• CHALLENGING CLIENTS TO TAKE RESPONSIBILITY
• USING NONVERBAL BEHAVIORS TO CHALLENGE
• CHALLENGING THROUGH QUESTIONS

CHALLENGES OF DISCREPANCIES
• Discrepancies and contradictions are important because they are often signs of unresolved
issues, ambivalence (mixed feelings), or suppressed (or repressed) feelings.
• Often these discrepancies come up because clients have not been able to deal effectively
with feelings as they arise.
• With challenges of discrepancies, helpers should consider way to understanding the cause
of the discrepancy and making changes.
• Helpers can focus on several types of discrepancies:
• Between two verbal statements (e.g., “You say there’s no problem, but then you say
you’re annoyed with him”).
• Between words and actions (e.g., “You say you want to get good grades, but you spend
most of your time partying and sleeping”).
• Between two behaviors (e.g., “You’re smiling, but your teeth are clenched”),
• Between two feelings (e.g., “You feel angry at your sister, but you also feel pleased that
now everyone will see what kind of person she really is”),
• Between values and behaviors (e.g., “You say you believe in respecting others’ choices, but
then you try to convince them that they are wrong about abortion”),
• Between one’s perception of self and experience (e.g., “You say no one likes you, but
earlier you described an instance in which someone invited you to have lunch”),
• Between one’s ideal and real self (e.g., “You want to meet your mother’s high standards,
but you feel like you’re just average”),
• Between the helper’s and the client’s opinions (e.g., “You say you are not working hard,
but I think you are doing a great job”)
• Between values and feelings (e.g., “You would like to be a good charitable person who
volunteers for everything, but you feel angry about having to help out”).
• A major task for helpers challenging discrepancies is to do so in such a way that clients can
hear them and feel supported rather than attacked.
• With challenges, helpers indicate that some aspect of a client’s life is incongruent or
problematic and imply that a client should change to feel, think, or act differently, and so the
helper needs to be careful about how the challenge is phrased and presented.
• Challenges should be done carefully, gently, respectfully, tentatively, thoughtfully, and
with empathy.
• Furthermore, it is important that helpers not make judgments when they challenge. A
challenge should not be a criticism but an encouragement to examine oneself more deeply.
• The goal is to work collaboratively with clients in raising awareness.

CHALLENGES OF THOUGHTS
Cognitive theorists suggest that irrational thinking keeps people from coping effectively and
makes them unhappy.
 Humans often have irrational thoughts that perpetuate their behaviors and negative
feelings.
 Examples: “I MUST always be perfect.” “I SHOULD have known better than to fall in
love with him” “I MUST be loved by everyone.”
 Helpers challenge this by:
 Acknowledging these irrational thoughts e.g. “To me, it sounds like you expect to be
perfect.”
 Challenging irrational beliefs: e.g. “Is it realistic that someone can be perfect? Who is
perfect?”
 Ellis noted that most clients make the assumption that events cause emotions, but
he strongly argued that it is the irrational beliefs that lead to negative emotions.
 Beck and his colleagues developed a cognitive theory that is slightly different from
Ellis’s theory. They postulated that automatic thoughts and dysfunctional
interpretations are the major source of problems for clients and that clients
misconstrue events on the basis of faulty logic and beliefs in the cognitive triad of
the self, world, and future.
 He recommended that helpers work collaboratively with clients as scientists to
uncover faulty logic and examine its Impact.
 Helpers ask a series of questions to help clients arrive at logical conclusions. When
asking such questions, it is important to remember that helpers attack the beliefs,
not the person.
 Beck suggested as helpers can challenge these irrational thoughts to help clients
recognize their faulty thinking and change it.
CHALLENGING THROUGH CHAIR WORK
• Chair work can be particularly useful for challenging clients to become aware of conflicting
feelings (e.g., love-hate) or unfinished business (e.g., feeling unresolved about a relationship
ending).
• A role-playing exercise that helps you experience both sides of a conversation and be
aware of hidden perceptions.
• This technique originally comes from gestalt therapy and more recently has been used in
process-experiential therapy and emotion-focused therapy to help clients become aware of
and integrate feelings. Sometimes doing and acting out feeling is easier and has more impact
than talking about feeling.

TWO-CHAIR WORK
• A two-chair technique can be used when the client expresses a major conflict between two
opposing sides (e.g., “I wish I could, but I’m scared”; “I’d like to, but I stop myself”).
• These conflicts often arise due to internalized “should,” which come from early
experiences of being told what to do. People begin to live according to these not thought
through and determined for themselves how to live their lives based on their own feelings.
• one side, called the top dog in gestalt therapy because it is the controlling and dominant
voice, engages in a lot of criticism (the “should”), whereas the other side, called the
underdog in gestalt therapy because it is usually the passive voice, whines, and acts helpless.
• Because of the conflict, the person feels stuck, Immobilized, and angry, all of which are
often outside of awareness. By having both sides speak fully and express their feelings as
well as listen to the other side talk, the client comes to allow both sides to emerge and exist
equally and thus can integrate them both into a more complete whole.
• The helper identifies a conflict split in what the client says, Importantly, the helper first
determines that the client has enough ego strength (resiliency) to be able to participate in
the chair work given the potential intensity of this kind of work.
• The helper asks the client if she or he would like to try an exercise to deepen the
conflicting feelings so that they can try to understand them more. More education may be
needed given that chair work can seem awkward to some people, but it is important for the
helper not to be apologetic or unsure about whether chair work is a useful exercise.
• If the client agrees, the helper pulls up another chair and invites the client to move to the
new chair and talk directly to the other side of the sell. It is important for the helper to be
positioned equidistant from both chairs and be aligned equally with both sides, given that
the ultimate hope is for both sides to express themselves openly and negotiate.
Alternatively, the helper could ask the client which side she or he feels most in touch with or
which side feels more alive and ask the client to start with that side. The helper directs the
client to say what the chosen side would say to the other side.
• The helper then asks the client to move to the other chair and express what it feels like to
hear what the other side said. Again, the helper encourages the client to be direct and clear
about his or her reactions, perhaps asking the client to repeat if the client did not state the
feelings strongly. If the client starts to talk to the helper instead of the other chair, the
helper gently encourages the client to talk directly to the chair.
• The helper again asks the client to switch chairs and respond. The switching continues with
the helper encouraging each side to fully express the underling feelings and needs (With
both sides fully expressing themselves, the client can come to accept and negotiate the
conflicting views. Typically, the critic softens, the passive side becomes stronger, and the
struggle is resolved.
• It is important to process the experience with the client. The helper can ask how it felt to
engage in the exercise.
EMPTY-CHAIR WORK
• Another version of this technique involves empty-chair work for clients with unfinished
business, often feelings of anger, sadness, resentment, and hurt toward a significant other
that the client has carried around since childhood.
• In this case, the helper works with the client to imagine what she or he wants to say to the
person, talk to the person as if the person were sitting in an empty chair and then imagine
how the other person might respond. The helper guides the client in expressing difficult
feelings when talking to the significant other and coaches the client to express other
possible feelings when talking from the side of the significant other. The same steps apply as
above for two-chair work, such that the client goes back and forth between self and other.

HUMOR AS A TYPE OF CHALLENGE

• Sometimes challenges can be softened by using humor, as long as the client feels that the
helper is laughing with rather than at him or her. Helping clients laugh at themselves can
help them think about their problems in a different way
• If clients can start laughing, they can sometimes begin to see things in a different light. Of
course, as with other types of challenges, helpers need to have established a relationship
with clients and use the humor to raise awareness rather than to make fun of the client.

SILENCE AS A TYPE OF CHALLENGE

• In contrast to the use of silence to provide empathy and warmth silence can also be used
to challenge. In this use of silence, Helper’s challenge clients to take responsibility for what
they want to say. Rather than rushing in and taking care of the client, helpers wait and
encourage the client to say something.
• E.g. Giving a client a moment to examine what they have/haven’t said
• Silence sometimes increases discomfort and forces clients to rely on their inner resources
and examine their thoughts.

CHALLENGING CLIENTS TO TAKE RESPONSIBILITY

• Encouraging personal responsibility through “I” language
• E.g. “Everyone is frustrated by her” vs. “I am really frustrated with her”
• Another way to challenge clients is to urge them to take appropriate responsibility for their
behavior. One way of identifying whether clients are owning responsibility is to listen to the
language they use.
• Simply asking the client to say “I” and make the statement for himself or herself can raise
the client’s awareness and encourage him or her to take responsibility and differentiate
from other people.
• Once they change their language, clients can be asked to talk about how it feels to use
different phrases. Once again, helpers should use such interventions gently and infrequently
so that clients do not feel blamed and shamed.

USING NONVERBAL BEHAVIORS TO CHALLENGE

• Helpers can also point out a nonverbal behavior that may reflect a discrepancy or
underlying feelings that the client is denying.
• If we assume that sometimes feelings leak out through nonverbal behaviors, we might be
able to encourage clients to examine what might be going on.
• Clients might thus be encouraged to become aware of what their bodies might be saying
to them. Of course, this intervention needs to be done cautiously and for the benefit of the
client.
• E.g. Helper: “I notice your arms are tightly crossed while you say you are fine. If your arms
could talk, what would they say?
CHALLENGING THROUGH QUESTIONS
• The helper might also challenge by simply saying, “Really?” “Oh yeah?” or “Hmmm?”
These interventions question the client in a gentle challenging manner and encourage the
client to think about what he or she is thinking.

SKILLS FOR FACILITATING INSIGHT

Insight in this context refers to:
• Seeing things from a new perspective
• Making new connections
• Or having a deeper understanding of why things are the way they are
• Helpers help clients develop their own insights because discovered insights are typically
better than those that are imposed.
• The skills that helpers use to facilitate insight are open questions and probes for insight,
interpretations, and disclosures of insight.

OPEN QUESTIONS
• Open questions and probes for insight, which are questions or probes that invite clients to
think about deeper meanings for their thoughts, feelings, or behaviors, can be used for this
purpose. These questions and probes gently guide the client to explore and become curious
about possible explanations.
• These open questions and probes might be phrased in the following ways:
• "What are your thoughts about what is going on there? “
• "What do you make of your feelings about the ending of the relationship? “
• "What connection do you make between your feelings and the event?"
• The helper is collaboratively inquiring and helping the client to think about insight. Helpers
do not ask too many questions at one time, do give clients time to respond, and vary
questions with other skills so that they do not sound repetitive.
• Whereas open questions are phrased in the form of a question (e.g., "What are your
thoughts about that?"), probes are phrased in the form of a statement or directive (e.g.,
"Tell me more about your thoughts"). The phrasing is different, but the intent for both is to
facilitate exploration.
• Open questions and probes for insight are ideal as a first step into the interpretive process
because they allow helpers to find out what clients think and give clients a chance to
integrate what they have learned in the exploration stage, interspersed with open questions
and probes, helpers can use a few interpretations and disclosures of insight.

INTERPRETATIONS
• Interpretations are interventions that go beyond what a client has overtly stated or
recognized and present a new meaning, reason, or explanation for behaviors, thoughts, or
feelings so clients can see problems in a new way.
• Interpretations can work in the following ways:
• Make connections between seemingly isolated statements or events.
• Point out themes or patterns in a client’s behaviors, thoughts, or feelings.
• Explicate defenses, resistance, or transference.
• Offer a new framework or explanation to understand behaviors, thoughts, feelings, or
problems.
• There are several sources of data that helpers can use for developing interpretations:
• Verbal content of clients’ speech: What has the client told me? What do they spend most
of their time talking about, and what do they tend to avoid discussing?
• Past experiences: What about their past might be in play here? What significant
experiences have they discussed or referenced? Are there any possible themes or
connections to those events?
• Inter- personal patterns: How do they describe their interactions with others? What
interpersonal patterns do I see? Are they aware of how they contribute to these
interactions? • Developmental stages: How do they describe their interactions with others?
What interpersonal patterns do I see? Are they aware of how they contribute to these
interactions? • Existential concerns/Spiritual issues: Are there any existential/spiritual issues
here? How do they define meaning in life? How do they approach loss
• Unconscious activities: Interpretations can be developed through indications of
unconscious activities, most typically observable through dreams, fantasies, and slips of the
tongue.

DISCLOSURES OF INSIGHT
• Much like other disclosures, this skill involves sharing insight you gained as a helper in a
comparable life situation.
• In sharing personal insights you’ve had, you should share with the instinct that the client
will benefit from hearing about it.
• Disclosing insight helps normalize the fact that we can all get stuck in our own
understanding of our lives.
• A disclosure of insight reveals an understanding the helper has learned about himself or
herself and is used to facilitate the client’s understanding of his or her thoughts, feelings,
behaviors, and issues.
• Instead of using challenges or interpretations, helpers share insights that they have
learned about themselves in the hope of encouraging clients to think about themselves at a
deeper level. Remember, though, that the intention is to facilitate client insight rather than
to further the helper’s understanding of himself or herself insight that might help the client
and uses his or her experience to presented this in a more tentative way than an
interpretation.
• Helpers disclose their experiences to help clients attain realizations of which they had not
been aware. This type of disclosure is useful when clients are stuck or are a hard time
achieving deep levels of self-understanding on their own.
• A reason for using disclosures of insight is to enable clients to hear things in a less
threatening way than might happen with therapist challenges or interpretations. Rather
than asserting an interpretation that may offend the client, helpers disclose personal insights
and ask whether these insights might fit for the client, thus possibly facilitating new and
deeper insight.
• Disclosures should not be used, however, to discuss or solve the helper's problems.
• When helpers disclose, it is best to choose something that occurred in the past and that
has been resolved, resulted in a new perspective, can be helpful to the client, and does not
make the helper feel vulnerable.
• If they have not had a similar experience that led to a new understanding, they should use
a different skill rather than making up something or using a hypothetical.
• If a disclosure does not work, it is probably best to refrain from making further disclosures.
Several things could have happened.
• In such instances, the helper can collect more evidence to determine whether the helper’s
projection, the client’s lack of readiness, or the client’s need for distance is at issue. If lack of
readiness is the problem, the helper can try other skills (e.g., reflection of feelings or
challenge).
 UNIT-4
COMMITMENT TO ACTION

INTRODUCTION

⚫ The action stage is based on behavioral theory, centers on helping clients make
desired changes in their life.
⚫ It emphasizes number of themes like empathy, collaboration with the client
throughout therapy, cultural considerations and a focus on what the individual client
needs.
⚫ That is, after clients have explored and gained insight, they are ready for the action
stage, during which helper collaborate with the client to explore the idea of change,
explore options for change, and help them figure out how to make changes.
⚫ Changes can be in thoughts, feelings or behaviors.
⚫ Action stage also involves exploring feelings and values, priorities, barriers and
support in relation to change.
⚫ Helps in decision making and think about action
⚫ Helpers are more like coaches rather than experts giving advice.

WHY ACTION STAGE?

⚫ There are two major reasons. They are:

⚫ 1. Most clients seeks help to seek better or to change, and it is important to help the
clients to attain their goals. Also, it makes the client feel better when they get to
have some ideas about the change.
⚫ 2. Taking action is crucial for consolidating the new thinking patterns learned in the
insight stage. Action helps to understands the insight.

GOALS OF STAGE 3 OR ACTION STAGE

⚫ The main goals of the helpers or the counselors are as follows:

1. Explore new possible behaviors,
2. Assist clients in deciding on actions,
3. Facilitate the development of skills for action,
4. Provide feedback about attempted changes,
5. Assist clients in evaluating and modifying action plans,
6. Encourage clients in processing feelings about action.
Also, the helper needs to remember to be empathetic and follow the pace according to the
clients.

PROCESS OF GOAL SETTING

According to Patterson and Welfel (2004), the counselor uses selective reflection,
confrontation and ability potential response in order to specify goals more clearly.
1. SELECTIVE REFLECTION: When a counselor uses self-reflection, the focus will be still
in affective messages the client is sending, but the counselor responds to the
messages selectively which are the essence of advanced empathy. Here counselor
and client only respond to one part of the effect, that is why it is called as selective
reflection. A counselor who tries to impose readiness-for-change feelings on a client
is likely to fail and retard the client’s progress. This method is used to focus on
action plan.
 2. ABILITY-POTENTIAL RESPONSE: According to Hackney and Cormier (1996) an ability
potential response is one in which the counselor suggests to the client that he/she
has the ability or potential to engage in a specified form of activity”. It may be used
when the goals have been decided but the action plans to reach those goals are still
on consideration. The aim of the counselor through this technique is to make the
client aware about their capabilities or expands options for the problem. Here
counselor respects the clients’ free choices and assists them in effective problem
solving. Also, the counselor affirms with the clients which help the client to affirm
with their own resources to reach the goals, also helps the clients to perceive about
their negative traits.
3. CONFRONTATION: it is one of the controversial modes of counseling. It is used as a
counseling intervention that describes a client’s discrepancies, contradictions and
omission .it is done for and with the client, not against the client. In other words,
counselor does not confront to satisfy his/her own needs, to vent feeling of
frustration with counseling or to punish the client. Rather the counselor holds a
belief that the client will experience growth by understanding the discrepancy.
⚫ Although confrontation and self –reflection further mobilize the client’s readiness
for change, whereas ability potential response structure the goal setting through
discussion of what the client as the likely outcome of the possible alternatives and
evaluation of the degree of difficulty and desirability of each outcome.

SKILLS TO IMPLEMENT ACTION STAGE

1. Open questions for action,

2. Giving information,
3. Feedback about the clients,
4. Process advisement and
5. Direct guidance.
 Also, helpers continue to use exploration skills throughout the action stage. If the
clients get stuck, insight skills such as challenge, interpretation, self-disclosure and
immediacy are used to uncover obstacles to action.
 Helpers also needed to be attentive to observing client’s reactions to see how they
are responding and to make sure that clients are actively involved in the process.

[Link] QUESTIONS FOR ACTION

⚫ They are questions aimed specifically at helping clients explore actions.
⚫ PURPOSE: To stimulate the client’s thinking about action.
⚫ E.g. “What kinds of things have you tried?” or “How did it work when you tried
that?”
⚫ TYPICAL INTENTION: To promote insight and the possible client reaction is clear
feelings and recounting affective exploration.

Usage of open questions

⚫ They are particularly useful for gently guiding clients through the action stage.
⚫ It is a primary tool through which helpers or counselors find to whether the clients
are change or how they respond to action ideas.
⚫ Thus, helpers encourage clients to solve problems with their support, communicate
respect that clients have self-healing capacity, and minimize the likelihood of
imposing helper’s values on client.
⚫ Helpers can also teach client a process of thinking through problems and possible
solutions.
Guidelines
⚫ The helper is collaboratively inquiring and helping the client figure out about action.
⚫ Helper should be careful not to ask too many questions at one time, make sure to
give the clients enough time to respond, vary questions so that they do not sound
repetitive and make sure that questions are open rather than closed.

[Link] INFORMATION

⚫ DEFINITION: It can be defined as providing specific data, facts, resources, answers to

questions, or opinions to the clients.
⚫ PURPOSE: Information is important to educate the clients about options for actions.
⚫ TYPICAL INTENTION: To give information and to promote change.
⚫ POSSIBLE CLIENT’S REACTION: Educated, new ways to behave, hopeful and no
reactions

Guidelines
⚫ Before giving information, helpers may find it useful to ask what information or what
misinformation the client possess.
⚫ Thus, rather than assuming client’s need information, helpers can assess client's
knowledge base.
⚫ Can also enquire about strategies used by the client.
⚫ The following guidelines must be followed by the helpers
⚫ 1. Empathetic
⚫ 2. Gentle and
⚫ 3. Sensitive
⚫ Goal: educate the clients when they are ready to learn.
⚫ Don'ts: helpers should not provide too much of information and provide small
amount of information and crucial points.
⚫ STEPS:
⚫ Needs to identify the motive of the client to ask for the information.
⚫ After analyzing the motive, the helper can address the motives directly.

[Link] ABOUT THE CLIENTS

⚫ DEFINITION: It can be defined as the helper providing information to the client

about his/her behaviors/impact on others.
⚫ PURPOSE: Allows the helper to let clients know how they come across to the
helpers.
⚫ E.g. “you maintained good eye contact during the role-play, but your voice sounded
hesitant when you told your partner that you were leaving the relationship.”
⚫ TYPICAL INTENTION: To give information, promote change
⚫ POSSIBLE CLIENT’S REACTION: New ways to behave, responsibility, misunderstood.
⚫ DESIERED CLIENT REACTION: Cognitive-behavioral exploration, affective exploration,
therapeutic changes.

Rationale for giving feedback

⚫ According to Brammer and MacDonald (1996): effective feedback can increase
client’s self-awareness.
 ⚫ E.g. if the helper comments that a client always ends her sentences with a question
and thus sounds tentative when she speaks, this might lead the client to become
aware of how she talks and try to change his/her behavior.
⚫ Researches shows that clients prefer positive feedback and think it is more accurate
rather than negative feedback (Claiborn, Goodyear and Horner,2002).
⚫ Positive feedback enhances relationship credibility.
⚫ In addition, negative feedback must be given, by preceding with positive feedback.
⚫ For beginner helpers can often occur MUM Effect: - a tendency to withhold bad
news or minimizing unpleasant news.

Guidelines
⚫ Give feedbacks with cautious and clear understanding.
⚫ Make the statements descriptive.
⚫ Emphasis strengths before weaknesses.
⚫ Give feedback about things clients can change rather than physical characteristics or
life circumstances that cannot be changed.
⚫ Give feedback in close proximity in terms of time to occurrence of the behavior.
⚫ Feedback should be given with lot of empathy and support.
⚫ Helpers should provide feedback with gentleness and tentatively.

[Link] ADVISEMENT

⚫ DEFINITION: Helper directives for what the client should do within the session.
⚫ TYPICAL INTENTION: To promote change
⚫ POSSIBLE CLIENT’S REACTION: Educate, unstuck, new ways to behave, hopeful,
confused, misunderstood, no reaction.
⚫ DESIRED CLIENT BEHAVIOURS: Agreement, therapeutic changes. (behavioral
rehearsal or role-play)
⚫ It is used to direct the process of sessions, particularly in doing therapeutic exercises
within sessions.

Guidelines
⚫ The helper must form a good rapport in such a way the client will be agreeable in
trying things in sessions.
⚫ The helper needs to convey the idea that these exercises will help in order to
change.
⚫ Signs of the client that the helpers need to be aware while doing process advisement
are:
⚫ 1. Passive resistance: hesitation, no responding, changing the topic).
⚫ 2. Active resistance: arguing or “Yes…. but” usage.
⚫ These signs occur due to the helper has presented the process advisement poorly,
the client is reluctant to try it or the helper may present it in an apologetic manner.
⚫ If the client is very reluctant to do an activity the helper can use exploration
techniques to understand the reason for these reluctances.

[Link] GUIDANCE

⚫ DEFINTION: Helper’s suggestion, directives or advise for the client to implement

outside the session.
⚫ TYPICAL INTENTION: To promote change.
 ⚫ POSSIBLE CLIENT REACTION: Educate, unstuck, new ways to behave, hopeful,
confused, misunderstood, no reaction.
⚫ DESIRED CLIENT BEHAVIOURS: Agreement, therapeutic changes.
⚫ It is occasionally useful to give some advice to clients about the best strategies.

Rationale
⚫ Direct guidance is rationale because the opinions of the helper is based on solid
knowledge and experience and are given after extensive client insight and
exploration.
⚫ Helpers would have a good idea about what might be helpful.
⚫ If an individual is at crisis situation, they require more explicit guidance.
⚫ E. g. when a client is suicidal, they often have “tunnel vision” that prevents them
from seeing options other than death. In such situations the helpers need to
intervened and try to ensure that the clients do not harm themselves.
⚫ Other than in extreme cases (child abuse, suicidal cases), the helper does not take
over and manage what clients do.

Guidelines
⚫ Before giving direct guidance, it is important for the helpers to think about and
become aware of their intentions.
⚫ Helpers should not give direct guidance until they have assessed the client’s
motivation.
⚫ Helpers can be specific about which small steps could be done and when it is done,
they should reinforce.
⚫ Helpers can give written assignments to the client and observe the clients’ reactions.
⚫ Helpers need to distinguish between direct request and expression of dependent
feelings. In that case if the helper is not able to find the difference, they can first
deal with feeling then the request.
⚫ Clients often have negative reactions if helpers ignore their request. In such cases, it
may be better to openly addressing the clients’ feelings.

Cautions
⚫ Do not force the client.
⚫ Helpers needs to know the limits of how much they can offer.
⚫ It can foster dependency by shifting the responsibility for solutions from client to
helper.
⚫ If helpers use too much guidance, it can lead to tension, resistance or rebellion.
⚫ Direct guidance can cause problems in therapeutic relationship, if it is not done
collaboratively.

CONCLUSION
⚫ Rather than learning and practicing single skills such as in exploration and insight
stage, here in action stage we combine these skills into a series of steps for four
action tasks.
⚫ They are:
1. Relaxation
2. Behavior change
3. Behavior rehearsal
4. Decision making.
⚫ Thus, we practice the steps for each of the task rather than focusing as specifically
on the individual skills
INTEGRATING ACTION SKILLS
Rather than learning and practicing single skills as we did in the exploration and insight
stages, we combine the skills (open questions and probes for action, information, feedback,
process advisement, direct guidance and disclosure of strategies) into a series of steps for
four action tasks.

 Relaxation
 Behavioral Change
 Behavioral Rehearsal
 Decision Making

RELAXATION
• Relaxation is particularly important for clients who have problems with stress and anxiety.
An extensive amount of data shows that relaxing one's muscles reduces anxiety (Jacobson,
1929; Lang, Melamed, & Hart, 1970; Paul, 1969) and that it is useful to teach clients to relax
when they get anxious (Bernstein & Borkovec, 1973; Goldfried & Trier, 1974).
• When people are relaxed, they are more open and able to handle information, so
relaxation is a good thing for helpers to teach before trying to implement other behavioral
interventions.
• Examples of markers for helpers to do relaxation are when clients have a fear of flying, are
extremely anxious about taking tests or speaking in public, have anxiety in social situations,
or seem especially tense during the session. In contrast, helpers should be cautious about
offering to do relaxation with clients who are paranoid, fear losing control, or have
delusions. Essentially, the helper is first going to teach relaxation and then help the client
figure out how to implement it outside of the session.

STEPS

STEP 1: IDENTIFY AND DESCRIBE SPECIFIC SITUATIONS OF STRESS AND ANXIETY

Through exploration, clients often identify stress and anxiety as a major problem. Helpers
can also observe when clients seem particularly tense (e.g., they might speak rapidly, act
fidgety, or panic). Helpers may then ask whether the client would like to learn relaxation
techniques to calm down in the immediate moment and to be able to calm themselves
down outside of sessions in times of stress. The explanation is that if a person is
physiologically relaxed, this state is incompatible with anxiety, and relaxation is a good
coping strategy.

STEP 2: TEACH RELAXATION

Benson's (1975) extensive research has found two main components of effective relaxation:
(a) the repetition of any word, sound, prayer, thought, phrase, or muscular activity and (b)
the passive return to repeating when other thoughts intrude. Following Benson's
suggestions (modified somewhat here), helpers can teach clients to relax by going through
the following steps, using a calm voice and speaking slowly:
1. "Get as comfortable as possible in your seat. Remove everything from your lap and put
your feet firmly on the floor. Close your eyes. Imagine sand being poured into your head and
filling your body so that your whole body begins to feel heavy."
2. "Relax your body starting from your toes up through your head. Shrug your shoulders and
release the tension. Now focus on your breath. Breathe in... breathe out. As you breathe in,
imagine taking in fresh, clean, restoring air. As you breathe out, imagine getting rid of bad
air."
3. "Pick a word (e.g., one, peace), sound (e.g., om), prayer (e.g., the Lord's Prayer), thought,
or phrase (e.g., the river runs through it). Pick something that fits with your beliefs and feels
comfortable to you. Repeat that phrase each time you breathe out."
4. "Let all your other thoughts go. When you find yourself thinking about something else,
don't worry, just passively let it go and return to repeating."
5. "Do this for 3 to 5 minutes and then sit quietly for a minute."

Another method is deep muscle relaxation (Jacobson, 1929), wherein the helper teaches the
client to systematically concentrate on one muscle at a time and tense it for 30 seconds and
then relax. The helper goes systematically through the major muscle groups of the body,
perhaps starting at the feet and tensing and then relaxing opposing muscles (e.g., bend feet
toward self, bend feet away from self). Going through the whole body takes 20 to 30
minutes. After practicing relaxation systematically several times, many people can begin to
induce it when needed.

STEP 3: IMAGINE APPLYING RELAXATION IN A SPECIFIC SITUATION

If the relaxation was used because the client was anxious talking about something outside of
the session, the helper can now help the client Imagine the situation while staying relaxed
(using a method similar to guided imagery or systematic desensitization). The helper can ask
the client to close her or his eyes and then gently lead her or him through the steps of the
situation described in Step 1.

STEP 4: ASSIGN RELAXATION PRACTICE

If it seems useful, helpers can suggest that clients practice deep breathing, relaxation, or
mindfulness 5 to 10 minutes, once or twice a day (e.g., in morning before breakfast and in
the late afternoon) in a quiet place with no distraction. A good explanation for practicing is
that the client will then be able to induce relaxation in new situations more quickly.

STEP 5: FOLLOW-UP
In subsequent sessions, helpers can ask about the client's experience practicing the
relaxation. If the client was able to easily do the exercise, the helper could encourage the
client to continue practicing. They could also talk about and rehearse trying to implement
relaxation during difficult situations (e.g., flying, examinations). If the client was not able to
or chose not to do the relaxation exercises, the helper can nonjudgmentally ask about what
was going on. The helper and client can then work to modify the exercise or might choose to
drop the idea of this exercise

BEHAVIOURAL CHANGE
• During the exploration and insight stages, many clients identify specific behaviors that
need to be changed. They might report doing too much of some behaviors (e.g., eating too
much, drinking too much alcohol or coffee, nail biting, playing too many computer games),
not enough of other behaviors (e.g., exercise, teeth brushing, keeping the apartment clean),
and inappropriate or unconstructive behaviors (e.g. poor social skills, poor study skills,
procrastination).
• The foci in earlier stages were on exploring the context more generally with brief mention
of the specific problem, whereas in the action stage our attention turns to a clearer, fuller
description of the problem in and of itself. This model of behavior change is ideal for
problems that are intrapersonal and under the person's control (e.g., procrastination,
exercise); interpersonal problems (e.g., assertiveness) are more appropriate for behavioral
rehearsal.
STEPS
STEP 1: CLARIFY THE SPECIFIC PROBLEM
In this step, we need to make sure that we understand the problem and that it is specific
enough to work with behaviorally. It is important to choose a specific, observable problem
(e.g., studying more) rather than something nonbehavioral, vague, or amorphous (e.g.,
feeling better). In addition, it is best to focus on one problem at a time because dealing with
several problems simultaneously can be confusing and diffuse change efforts. If the client
has multiple problems, the helper could work with the client to list all the problems, order
them, and then choose the most important one, making sure that it is one that using a
behavioral approach.

STEP 2: EXPLORE THE IDEA OF ACTION FOR THIS PROBLEM

Rather than assume clients are eager to change, it is important to allow them to explore the
idea of changing. Although clients might be unhappy with the way things are, they are often
scared by what things might be like if they change (e.g., it is better to live with the misery
you know than to risk the unknown).

STEP 3: ASSESS PREVIOUS CHANGE ATTEMPTS AND RESOURCES

When the helper has established that the client wants to change, she or he can work with
the client to assess what attempts, if any, the client has already made. Finding out about
previous attempts can avoid encouraging actions that have not worked in the past, indicate
that the helper respects the client's change efforts, and lets the client know the helper is
aware that the client has been attempting to solve problems. After all, clients have usually
had lengthy experiences with their problems and have undoubtedly tried, and have many
feelings about, various alternatives. Instead of being the experts. helpers thus act as
consultants, collaboratively working with clients to determine what they have tried and how
these strategies have worked

STEP 4: CLARIFY OR RECONCEPTUALIZE THE PROBLEM

Now that the client has explored the problem thoroughly, the helper might ask the client
how she or he now feels about the original problem or goal. The client may well change the
problem description. example, rather than wanting to slow down her eating all the time,
Chris decided he wanted to eat more slowly during Saturday night dinners with her husband.

STEP 5: GENERATE OPTIONS TOGETHER

One of the biggest benefits for clients of working with helpers is that they can come up with
options together for working on change. Through collaboration, two people (or even better,
a group) can usually generate more ideas than can one person alone. The goal in this step is
to generate as many ideas as possible to enable clients to see that there are many
alternatives.

STEP 6: CHOOSE AN OPTION OR OPTIONS

Once a number of options have been generated, the aim of the helper is to help the client
think through the options and need to select ideas that are specific, realistic, within visibility,
and consistent with their values. It might be easiest to start by asking the client to cross off
any options that are totally bad (from the list that the helper wrote). Alternatively, helpers
can ask the client to choose the three or four most likely options and then work with the
client to evaluate the good and bad aspects of cache of these options. Helpers can also ask
about clients' values to determine whether any of the options violate these values.

STEP 7: DETERMINE REINFORCERS

In this step, if reinforcers have not come up naturally, helpers work with clients to identify
realistic reinforcers, things that they can use to reward themselves for changing, given that
change is more likely to happen with reinforcers. Importantly, reinforcers are individual,
such that what works for one person (e.g., the helper) might not work for another (e.g., the
client).

STEP 8: PROBLEM SOLVE ABOUT IMPLEMENTING ACTIONS

Once the target behavior is identified, baseline information has been gathered, realistic
goals set, options generated and chosen, and rein- forcers identified, the helper works with
the client to figure out how to implement the changes: how and when the client will try the
new behavior, what they expect will happen, and how they will cope with adversities that
inevitably arise. Essentially, they work together to do problem solving.

STEP 9: ASSIGN HOMEWORK

Helpers often assign homework so that the client can implement tasks that they have
collaboratively developed in the session. For example, after discussing study skills, a helper
might make a contract with a client to study at least 30 minutes a night at his desk (where he
does nothing. else but study), after which he can reinforce himself by getting a soda and
calling his girlfriend. Helpers might also warn clients to "go slow" to prevent too much
enthusiastic initial behavior that often results in not being able to sustain the change. Many
people enthusiastically say they will make an extreme change (e.g., exercise 3 hours a day)
but then get discouraged when they discover how difficult it is to carry out this change. It is
better to take too small a step than to overestimate what one can do.
STEP 10: CHECK ON PROGRESS AND MODIFY ASSIGNMENTS
Problems almost always arise when clients try to implement actions outside sessions.
Changing is often more difficult than anticipated and unanticipated obstacles. On the basis
of experiences clients have had trying out homework in the real world, helpers can work
with clients in subsequent sessions to modify homework assignments

BEHAVIOURAL REHEARSAL
• Behavioral rehearsal is used to teach clients skills for responding in more adaptive ways to
specific life situations (Goldfried & Davison, 1994). Helpers teach clients new behaviors
through role-playing how they could behave differently in specific situations. Although
behavioral rehearsal can be used for many concerns (e.g., rehearsing for a Job interview,
practicing for a public speech), It focus here on problems with assertiveness (i.e., standing up
for oneself) because these are so prevalent.
• According to Alberti and Emmons (2001), the goal of assertiveness training is to teach
clients to stand up for their rights without infringing on the rights of others. The assumption
here is that open and direct communication is most likely to lead to good relationships

STEPS
STEP 1: ASSESS THE BEHAVIOR IN A SPECIFIC SITUATION
The helper asks the client to describe a specific example of when the lack of assertiveness
occurred (e.g., a client did not tell a roommate that she did not like her borrowing her
clothes without asking, a client got angry and blew up at a colleague for not doing his share
of the work). It is best to ask the client to choose a specific example (e.g., the last time it
happened) because behavioral rehearsal works best with specific situations.

STEP 2: DETERMINE BEHAVIORAL GOALS

Helpers work with clients to determine specific, realistic goals for how they would like to
behave differently (e.g. make one comment during class discussion, calmly tell son to take
out the garbage, ask neighbor to turn down the music) given that clients are more likely to
make changes when they have clear, doable goals. To goals, helpers and clients can generate
different possible behaviors and determine which behaviors would feel comfortable to
clients.

STEP 3: GENERATE AND EVALUATE POSSIBILITIES

Similar to the step in behavior change, the goal here is to generate various possible ways of
dealing with the situation, trying to help the client think creatively about options (e.g., what
have others tried in the past, what might specific situation. Once several options have been
generated, the helper can work with the client to explore the feasibility and desirability of
the different options, hopefully leading the client to choose the best options.

STEP 4: PROVIDE A MODEL

Once the target behavior is determined, helpers can provide a model of how clients could
implement the new behaviors by playing the part of the client. For example, the helper
could ask the client to be the instructor, and then the helper would show how she would ask
an instructor for an extension of a deadline because of a documented illness.

STEP 5: ROLE-PLAY AND PROVIDE FEEDBACK AND COACHING

Helpers then can ask clients to be themselves again, with the helper being the other person,
and try the chosen behavior in a role-play of the problematic situation. During the role-play,
the helper again observes the client's behavior carefully and provides honest positive
feedback after the role-play ("You did a really good job of using eye contact and of stating
your needs"). Even if the positive feedback is about something minor, clients need to feel
that they are doing something well and making some progress. Helpers then can give
corrective feedback about one or two specific things (it is important not to overwhelm the
client with too much feedback at one point).

STEPS 6 AND 7: ASSIGN HOMEWORK AND MODIFY ON THE BASIS OF EXPERIENCES

DECISION MAKING
• Clients often have major life decisions to make: which job to take, whether to go to
graduate school, whether it is best to buy a house or rent an apartment, or whether or not
to get married to a specific person. In decision making, helpers work with clients to help
them articulate their options, explore their values, and evaluate the options according to
their values (Carkhuff, 1973; Hill, 1975).
• As they do with the other three behavioral tasks, clients reveal during the exploration and
insight stages that they need to make a decision about something (e.g. choosing between
graduate programs, deciding where to go on vacation, deciding between two people for a
dating partner choosing between three nursery schools for a child),
• Sometimes clients easily make the decision by exploring, and sometimes they are to make
a decision after simply listing the pros and cons of each possibility, but other times clients
still feel blocked. At this point, the helper can ask if the client would like to try an exercise to
help make the decision.

STEPS
STEP 1: ARTICULATE THE OPTIONS
The helper first asks the client to describe and explore various options. This step often
involves work on generating options (similar to steps in behavior change and behavioral
rehearsal). It sometimes takes a fair amount of exploration for all the options to emerge, and
clients sometimes add or modify options as they go through the steps so helpers may need
to go back and add to this list.

STEP 2: VALUES CLARIFICATION

Next, the helper asks the client to generate no more than 10 relevant values, desires, needs,
or things that influence the choice and are relevant to making the decision. Once again, the
client may need help in generating values because these are often not things we are aware
of.

STEP 3: WEIGHT THE RELATIVE IMPORTANCE OF THE VALUES

The helper then asks the client to weight the importance of each value, desire, and need (1
not important, 10 extremely important). Each weight is used only once so that the client is
forced to figure out priorities, and it helps to suggest that the least important receives a
weighting of 1 and the most important a weighting of 10, with some numbers left unused if
fewer than 10 values are listed.

STEP 4: RATE THE OPTIONS

The goal in this step is to evaluate all the options based on the values using a scale of -3 to
+3 the helper asks the client to rate the various options on each of the values and to discuss
the reasons for the ratings.

STEP 5: EVALUATE THE RESULTS AND REVISE THE WEIGHTINGS

The goal here is to look at the results and see how they fit for the client. A key is to pay
attention to the client's reaction upon learning the results. If the client is happy, the task is
done. But if the client seems disappointed, this indicates that something is wrong in the grid
and we want to discover the problem. It might be necessary to modify the options or add
more options, to revise the values, or to change the ratings, all based on extensive
exploration. It might also be helpful to use behavioral rehearsal or a two-chair technique to
the client think through the various options and obstacles.

STEP 6: FOLLOW-UP
It is for helpers to come back in subsequent sessions and check in with clients about their
feelings.

TERMINATION
Termination is the term most commonly used to describe the process of finalizing or ending
a counseling experience. Yet that word conjures up images of abrupt endings or even death,
so we wish that a better phrase could be identified to describe counseling endings and
transitions. Perhaps the words finale or commencement, or even the euphemism new
beginnings, would better capture the termination process.

 The client has grown in the ways he or she wanted, and often in unexpected but
desirable ways
 In the process of solving the current problem, the client has deepened his or her
self-understanding and broadened his or her coping skills, thus, other difficulties
that arise will not seem so overwhelming.
 The client is better able to transfer learning from this situation to other problems.
 A positive termination process can provide another important kind of learning for
the client it can struct them on how to leave relationships with a sense of "mastery
and fulfillment
CLIENT RESPONSE TO TERMINATION
Research by Mack and Gelso (1987) suggests that clients experience positive feelings about
termination, such as calmness, health, and satisfaction, more commonly than negative
feelings. Still, sometimes termination can be an emotional experience even when it is clear
that the client has acquired what he or she wanted from counseling This can be especially
true when a high level of intimacy has been established or when the client's problem are
related to dependency, intimacy problems, or traumatic loss of loved ones In these
circumstances, the experience of separation may be a reminder of past experiences
(Goodyear, 1981, fickney Cormier, 1996, Weinberg, 1954). To the client, the counselor may
have become an anchor and a source of security in a life of stress The experience of being
cared for and prized by the counselor, the feelings of relief and restoration of hope, and the
discovery of new sources of personal strength and new capacities may all create summing
attachment bonds (Loewenstein, 1979, Weiss, 1975), Letting go under these conditions can
cause the client to feel a sense of loss

COUNSELOR RESPONSE TO TERMINATION

Just as clients often experience a tangle of feelings around the end of a counseling
relationship, counselors themselves can have emotional reactions to termination. As
counselors, we invest much time, emotional and intellectual energy, and dedication to
helping our clients. After all, the lifeblood of the counseling profession is based on building a
warm connection with those we serve. As a byproduct of this relationship process,
counselors do indeed develop emotions and thoughts regarding their clients. Consequently,
when the counseling relationship ends, there is an adjustment period for counselors too.
Goodyear (1981, p. 348) suggests eight conditions under which letting go may be especially
hard for the counselor:
1. When termination signals the end of the significant relationship
2. When termination arouses the counselor's anxieties about the client's ability to function
independently
3. When termination arouses guilt in the counselor about not having been more effective
with the client
4. When the counselor's professional self-concept is threatened by a client who leaves
abruptly and angrily
5. When termination signals the end of a learning experience for the counselor
6. When termination signals the end of a particularly exciting experience of living vicariously
through the adventures of a client
7. When termination becomes a symbolic recapitulation of other farewells in the counselor's
life
8. When termination arouses in the counselor conflicts about his or her own individuation

FORMATS FOR ENDING COUNSELLING

FIXED ENDING
The counselling trainee and client may have a contract that they work Advantages of fixed
termination include lessening the chance of dependency and motivating clients to use
counselling to best effect. Potential disadvantages include restricting coverage of problems
and insufficient thoroughness in training

OPEN ENDING WHEN GOALS ARE ATTAINED

counselling concludes when counselling trainees and clients agree that clients have made
sufficient progress in attaining their main goals. Such goals include managing specific
problems better and developing improved skills to address current and future problems. An
advantage of open endings is that of flexibility, such as when counsellors and clients uncover
deeper or different issues to address than the ones for which clients originally came for
counselling.

FADED ENDING
Here the withdrawal of counselling assistance is gradual. For example, instead of meeting
weekly, the final sessions could be at fortnightly or monthly intervals. Faded endings have
much to recommend them when clients are learning mind skills and communication/action
skills since they provide more time to ensure that clients have adequately internalized their
changed skills.

ENDING WITH BOOSTER SESSION(S)

Booster sessions, say after three months, are not to teach new skills, but to check clients’
progress in consolidating skills, to motivate them, and help them work through difficulties in
taking away and using trained skills in their home environments.

SCHEDULING FOLLOW-UP CONTACT AFTER ENDING

Counselling trainees can schedule follow-up phone calls or postal and email correspondence
with clients. This performs some of the same functions as booster sessions, enabling trainees
to obtain feedback on how successful counselling was in assisting clients to maintain their
skills. Then, where necessary, they can take appropriate action

COUSELLING ENDINGS
1. PREMATURE ENDING
2. PROLONGED ENDING

[Link]-MATURE ENDING
 Clients can and do leave counselling before counselling trainees think they are ready
to do so.
 Sometimes clients just do not come to their next appointment with or without
warning
 Beck and his colleagues cite as reasons for premature ending rapid relief of
symptoms, negative reactions to the therapist, and lack of sustained improvement
or relapse during treatment
 Mismatch between the kind of counselling relationship that counsellors offer and
the kind that clients expect
 Trainees who clumsily handle clients’ doubts about and resistances to counselling
increase the likelihood of premature termination.
 Prematurely include pressure from significant others, laziness, defensiveness, lack of
money and fear of being trapped by counsellors or by trainees unwilling to ‘let go’ or
who have their own agendas such as mixing religious proselytizing with counselling
 Written by someone who was not at the event
 Counselling sometimes ends prematurely because trainees are insufficiently
invested in their clients.
 Burnout, personality clashes and finding certain clients unattractive or uncongenial.
 Lack of immediate result

DRYDEN AND FELTHAM (1992) ASSERT THAT COUNSELLORS SHOULD RESPECT THE RIGHT
OF CLIENTS WHO WISH TO END ABRUPTLY TO DO SO, AND AVOID TRYING TO PERSUADE
OR COERCE THEM TO CHANGE THEIR MINDS.
PROLONGED ENDING
Some cases it takes much time end a counselling section

REASONS
some trainees insufficiently prepare clients throughout counselling to face the fact of its
termination, thus making it harder to end counselling when the time comes. Sometimes
trainees waste time and allow the counselling process to drift rather than stay sufficiently
focused on appropriate tasks There are also many ‘shadow’ reasons why counselling
trainees may consciously or unconsciously prolong counselling. Such reasons include
appreciative and admiring clients who feed the trainee’s narcissism, trainees being erotically
attracted to clients, and financial considerations attached to extending counselling Becoming
friends rather than engaging in a professional relationship

CONSOLIDATING SKILLS WHEN ENDING COUNSELLING (ATTAINING NECESSARY SKILLS TO

FINISH COUNSELING SESSIONS EFFECTIVELY)

MAKE TRANSITION STATEMENTS

During counseling, counselor might mention that the process is temporary, such as by
discussing the benefits of homework assignments to build self-help skills for after counseling
ends. These comments can motivate clients to maximize their sessions and the time
between them. Trainees can also bring up the topic of ending counseling with clear
transition statements indicating that the process is concluding.

PREVENT AND RETRIEVE LAPSES

Two issues that become important after ending counselling are how clients can deal with
difficult situations on their own and how they can get back on track if they have a lapse.
During counselling, clients will often have anticipated and coped with difficult situations in
their outside lives. Where necessary, in the ending phase, they can identify future difficult or
high-risk situations where they might fail to use their improved skills and consequently
become discouraged. Counselling trainees and clients can then conduct role-play rehearsals
in how to deal with these difficult situations. Clients can learn the distinction between lapses
and relapses. counselors can help them to develop retrieval skills so that if they make a
mistake or have a lapse they can revert to using their improved skills rather than relapse.
Self-denigration and engaging in black-and-white thinking can lead them to relapses

REVIEW PROGRESS AND SUMMARIZE LEARNINGS

Clients can become not only their own counsellors, but their own trainers in the final
session, counselling trainees and clients may review the client’s progress to date and discuss
ways of maintaining and improving clients’ skills after termination. They should also inform
clients that learning can continue after the end of counselling encourage clients to persist
with their changed thinking and behavior by continuing to point out associations between
attaining wished-for outcomes in real life during the ending phase, trainees and clients may
use summaries to review the skills taught during counselling.

EXPLORE ARRANGEMENTS FOR CONTINUING SUPPORT

 Further contact with the counsellor
 Referral for further individual counselling (for another counselor)
 Further reading and audiovisual material
 Example ‘we only have a few more sessions left. Perhaps we should not only discuss
an agenda for this session, but think about how best we can spend our remaining
 time together.’ our next session is the final session. Would it be all right with you if
we spent some time discussing how to help you retain and build on your improved
skills for managing your problem?’ ‘Perhaps the agenda for this final session should
mainly be how to help you use the skills you’ve learned here for afterwards. For
instance, we can review how much you’ve changed, where there is still room for
improvement, how you might go about it, and plan how to deal with any difficult
situations you anticipate.’

FURTHER ENDING COUNSELING TASKS AND SKILLS

DEAL WITH FEELINGS

When using the life skills counselling model, most counselling contacts are short to medium
term. Because collaborative working relationships are very important, the relationship is not
the central feature of counselling and there is less likelihood of clients feeling angry, sad,
anxious and abandoned than when ending longer-term relationship-oriented counselling
Clients’ feelings when ending counselling fall into two main categories: feelings about how
they are going to fare without counsellors and feelings toward counsellors and the
counselling process. Counselling trainees can facilitate open discussion of clients’ feelings
about the future. Looking at how best to maintain skills also addresses the issue of clients’
lingering doubts. Other clients will feel confident that they can cope now on their own,
which is hopefully a sign of work well done. Clients may also wish to share feelings about the
counselling process. Nevertheless, trainees should allow clients the opportunity to share
feelings about their contact with them. Trainees may humanize terminating by sharing some
of their feelings with clients: for instance, ‘I enjoyed working with you’, or ‘I admire the
courage with which you face your situation’, or ‘I’m delighted with your progress.’

ETHICAL CONSIDERATION
• Professionalism in Goodbyes: It's important for counseling trainees to conclude
counseling relationships in a businesslike yet friendly manner, maintaining a professional
tone rather than a personal one. This ensures that the client feels respected and the
therapeutic gains are maintained.
• Ethical Responsibilities: There are ethical dilemmas regarding the post counseling phase.
Trainees must balance providing adequate support without fostering dependency; while also
ensuring they fulfill their professional obligations to the client.
• Addressing Unresolved Issues: Trainees should tactfully address any additional problems
they believe the client might have, guiding them towards further assistance if necessary.
• Boundaries Between Personal and Professional: Maintaining clear boundaries between
personal and professional relationships is crucial. Mixing these can lead to ethical breaches
and potentially complicate future counseling interactions with the client.
• Guidance and Supervision: Trainees are advised to rely on ethical codes, their own
judgment, advice from supervisors and colleagues, and their assessment of the client's best
interests when considering any personal relationships post counseling

EVALUATE ONE’S COUNSELLING SKILLS

When counseling ends, trainees can assess their performance in several ways:
1. Gather feedback from clients.
2. Assess client progress and compliance with assignments.
3. Review session notes.
4. Analyze recordings of sessions (if available).
It's important to evaluate soon after counseling to avoid forgetting details. Trainees should
reflect on their effectiveness in helping clients and their use of counseling skills. A balanced
assessment, avoiding extremes, will help improve future counseling practices.

CREATIVE TERMINATION ACTIVITIES

ONE-WAY TRIP FOR TRAUMA

Clients can take their trauma-related materials, like writings and drawings, and either tear
them up, color over them, or fold them. They then place these materials into a box, tape it
shut, and decorate it. This symbolizes that their past trauma doesn't control their future. The
process can end with a "new beginning" celebration to mark the start of a new chapter in
their lives.

STICKER CHART/MEMORY BOOK:

For younger clients, use artistic interventions like sticker charts or memory books.
Throughout counseling, clients place stickers or draw pictures on a chart to illustrate their
journey. As termination approaches, they review and add more stickers to signify
achievements. Alternatively, create a memory book with pictures, words, stickers, and
decorations to help them remember their counseling experience. In the "Aloha lei" activity,
explain that "aloha" means both hello and goodbye. Clients write coping skills or memorable
experiences on paper flowers, which are then threaded onto a string to make a lei. Family
members can add their own flowers. The lei is given to the client as a parting gift,
symbolizing the end of counseling and the start of a new beginning

ACTIVITY
Ane, a 28-year-old marketing professional, sought counseling six months ago due to feelings
of anxiety and low self-esteem, which were affecting her work performance and personal
relationships. Over the sessions, she has worked on building self-confidence, developing
coping mechanisms for anxiety, and improving her communication skills. Jane's progress has
been significant. She reports feeling more confident at work, managing her anxiety
effectively, and having healthier relationships with her colleagues and friends. She feels
ready to move forward without regular counseling sessions.

HOW YOU TERMINATE THE SESSION?

1. Acknowledging Progress: "Jane, as we approach the end of our counseling journey, I want
to acknowledge the tremendous progress you've made. You've worked hard on developing
your self-confidence and managing your anxiety, and it's clear to see how much you've
grown."
2. Reviewing Goals and Achievements: "Let's take a moment to review the goals you set
when we started and how far you've come. Initially, you wanted to feel more confident at
work and improve your communication skills. Can you share how you've seen these changes
in your life?" For younger clients, use artistic interventions like sticker charts or memory
books. Throughout counseling, clients place stickers or draw pictures on a chart to illustrate
their journey. As termination approaches, they review and add more stickers to signify
achievements. Alternatively, create a memory book with pictures, words, stickers, and
decorations to help them remember their counseling experience.
3. Discussing Coping Strategies: "You've developed some effective coping mechanisms for
anxiety. As you move forward, which of these strategies do you find most helpful, and how
do you plan to continue using them?" In the "Aloha lei" activity, explain that "aloha" means
both hello and goodbye. Clients write coping skills or memorable experiences on paper
flowers, which are then threaded onto a string to make a lei. Family members can add their
own flowers. The lei is given to the client as a parting gift, symbolizing the end of counseling
and the start of a new beginning.
4. Planning for the Future: "It's important to think about how you'll maintain your progress.
What steps will you take if you encounter challenges or feel your anxiety returning? Do you
have a support system in place?"
5. Providing Resources: "I want to ensure you have resources available if you need them.
Here are some tools and contacts you can use if you feel you need additional support in the
future."
6. Encouraging Independence: "Remember, Jane, you've developed a lot of skills and
resilience over these past months. Trust in your ability to handle challenges as they come.
You've got this."
7. Expressing Confidence and Support: "I'm confident in your ability to continue thriving. It's
been a privilege to work with you, and I'm here if you ever feel the need to return for
additional support."
8. Formalizing the Termination: "Today marks our last scheduled session. How are you
feeling about ending our sessions, and is there anything else you'd like to discuss before we
conclude?"

UNIT 6
MAJOR THEORIES OF COUNSELLING

PERSON CENTERED COUNSELLING

PERSON CENTRED APPROACH TO COUNSELLING
According to Sigmund Freud’s psychoanalytical theory, people are governed by powerful
forces originating in the unconscious, and it is these forces which compel them to act in
certain ways. Freud stressed on the concepts of drives, instincts, impulses and urges as
motivating factors in human behavior. Freud’s theory focused on sexual and aggressive
tendencies as the primary forces driving human behavior. In sharp contrast to this, the
human potential movement, by contrast, defined human nature as inherently good. From its
perspective, human behavior is motivated by a drive to achieve one’s fullest potential. Carl
Rogers developed person centered approach to counselling based on the premise of
humanistic theory. Humanistic approach believes in the uniqueness and goodness of each
individual. Humanists believe that human beings are capable of thinking rationally, can make
their choices wisely and are also aware of the consequences of their actions. 26 In all of
Rogers’s writings, the emphasis has been on the importance of each person being an
architect of his or her own destiny. Carl Rogers firmly believed that every individual has
sufficient innate resources to deal effectively with the problems in life. Even though
sometimes these innate resources are obscured, forgotten or even denied, they are
nevertheless, always present with the potential for development and growth. Rogers’
insistence on the uniqueness of the individual, and individual’s innate tendency towards
growth and wholeness, seemed to represent a more optimistic and positive view point of
humans in contrast to the totally deterministic view of Psychoanalytic theory of Freud.
Rogers emphasized that just as the plants need the right conditions to grow, so do the
human beings require the right conditions to grow and develop. The following saying (refer
to the box below) sums up many of his deeper beliefs about human growth:
 If I keep from meddling with people, they take care of themselves,
 If I keep from commanding people, they behave themselves,
 If I keep from preaching at people, they improve themselves,
 If I keep from imposing on people, they become themselves

BASIC CONCEPTS OF ROGERS PERSON CENTERED APPROACH

Person centered therapy, which is also known as client centered, non-directive, or Rogerian
therapy, is an approach to counseling and psychotherapy, that places much of the
responsibility for treatment process on the client, with the therapist taking a nondirective
role.
Person centered therapy has two primary goals, viz., (I) increased self-esteem and (ii) greater
openness to experience. Some of the related changes that this form of therapy seeks to
foster in clients include the following:
• closer agreement between the client’s idealized and actual selves
• better self-understanding
• lower levels of defensiveness, guilt, and insecurity
• more positive and comfortable relationships with others
• increased capacity to experience and express feelings at the moment they occur.

Self
The human organism’s “phenomenal field” includes all experiences available at a given
moment, both conscious and unconscious (Rogers, 1959). As development occurs, a portion
of this field becomes differentiated and this becomes the person’s “self”. The “self” is a
central construct in this theory. It develops through interactions with others and involves
awareness of being and functioning. The self-concept is “the organized set of characteristics
that the individual perceives as peculiar to himself/herself”. It is based largely on the social
evaluations that the individual has experienced.

Self-Actualizing Tendency
A distinctly psychological form of the actualizing tendency related to this “self” is the “self-
actualizing tendency”. Self-actualization, a term derived from the human potential
movement, is an important concept underlying person-centered therapy. It refers to the
tendency of all human beings to move forward, grow, and reach their fullest potential. The
person-centered approach states that all psychological difficulties are caused by blockages to
this actualizing tendency and consequently the task of counselling is to release this
motivating drive.
Individuals appear to have two motivational systems, their organismic actualizing tendency
and their conscious self. The actualizing tendency is responsible for every aspect of human
endeavor and achievement. The actualizing tendency is present from birth onwards. It
describes the holistic development of all aspects of the person, including the spiritual,
emotional, physical and creative dimensions. When humans move toward self-actualization,
they are also pro social. That is, they tend to be concerned for others and behave in honest,
dependable, and constructive ways. The concept of self-actualization focuses on human
strengths rather than human deficiencies. According to Rogers, self-actualization can be
blocked by an unhealthy self-concept (negative or unrealistic attitudes about oneself).
It involves the actualization of that portion of experience symbolized in the self (Rogers,
1959). It can be seen as a push to experience oneself in a way that is consistent with one’s
conscious view of what one is. Connected to the development of the self-concept and self-
actualization are secondary needs which all have been learned in childhood as one grows up
interacting with caregivers and parents. That is, for healthy growth and development of the
person, the individual needs positive regard from others and this need for positive self-
regard, if is present in the child’s life as he grows up, he develops a healthy personality a
positive outlook and a positive self-regard. These in turn make the person behave in a way
that is in congruence with his self-regard and positive self-concept.

Self-Concept
In the person-centered therapy, it is essential to comprehend some basic concepts of self in
understanding the client’s personality. Self-concept has at least three major qualities of
interest to counsellors which are given below.
1) it is learned,
2) it is organized, and
3) it is dynamic.

Self-concept is learned.
It is of course well known that, no one is born with a self-concept. It gradually emerges in
the early months of life and is shaped and reshaped through repeated perceived
experiences, particularly with significant others. The fact that self-concept is learned has
some important implications. These are enumerated below.
• Because self-concept does not appear to be instinctive, but is a social product developed
through experience, it possesses relatively boundless potential for development and
actualization.
• Individuals perceive different aspects of themselves at different times with varying degrees
of clarity. Therefore, inner focusing is a valuable tool for counseling.
• Any experience which is inconsistent with one’s self concept may be perceived as a threat,
and the more of these experiences there are, the more rigidly self-concept is organized to
maintain and protect itself. When a person is unable to get rid of perceived inconsistencies,
emotional problems arise.

Self-Concept is organized.
Most researchers agree that self-concept has a generally stable quality that is characterized
by orderliness and harmony. Each person maintains countless perceptions regarding one’s
personal existence, and each perception is orchestrated with all the others. It is this
generally stable and organized quality of self-concept that gives consistency to the
personality. This organized quality of self-concept has corollaries as given below.
• Self-concept requires consistency, stability, and tends to resist change. If self-concept
changed readily, the individual would lack a consistent and dependable personality.
• At the heart of self-concept is the self as doer, the “I,” which is distinct from the self as
object, the various “Me’s.” This allows the person to reflect on past events, analyze present
perceptions, and shape future experiences.
• Perceived success and failure impact on the self-concept. Failure in a highly regarded area
lowers evaluations in all other areas as well. Success in a prized area raises evaluations in
other seemingly unrelated areas.

Self-Concept is dynamic.
To understand the active nature of self-concept, it helps to imagine it as a compass, the
pointer of which shows consistently the North direction. Similarly, self-concept is a
continuously active system that dependably points to the person’s true perceived existence.
This guidance system
a) shapes the ways a person views oneself, others, and the world,
b) it also serves to direct action and enables each person to take a consistent “stance” in life.
Rather than viewing self-concept as the cause of behavior, it is better to consider it as
providing consistency in personality and direction for behavior. The continuity of self-
concept can be seen as given below.
• Self-concept development is a continuous process. In the healthy personality there is
constant assimilation of new ideas and expulsion of old ideas throughout life.
• Self-concept continuously guards itself against loss of self-esteem, for it is this loss that
produces feelings of anxiety.
• Self-concept is perceptual or subjective frame of reference, the actualizing tendency and
experiences of the client.

Perceptual or Subjective Frame of Reference

Behavior is generally viewed from either external or internal frame of reference. External
frame of reference means that an individual’s behavior is seen in terms of the point of view
of an outsider. On the other hand, the internal frame of reference means that the behavior
of the individual is seen in terms of one’s own subjective perceptual frame of reference. This
emphasis on the subjective, perceptual view of clients has led to the term ‘client centered.’

According to Carl Rogers an individual has an innate tendency toward actualization, which
means that the individual has an inherent tendency to move in directions that can be
roughly described as growth, health, adjustment, socialization, self-realization,
independence, and autonomy so as to maintain or enhance the organism. The person
expresses himself (herself) in varied ways in his or her interactions with the self and the
environment and others. Rogers thinks that the person’s life is an active and not a passive
process, one of growth and development.

Recognizing the Dignity and Worth of Individual

According to Rogers’ theory, one must believe in the dignity and worth of individuals as both
independent and self-directing. Every individual has an internal frame of reference, that is a
subjective reality that attempts at emphasizing objective reality too.
Genuineness, respect, warm acceptance, and accurate empathy if shown by the counselor to
the client and registered fairly early, there is a far better chance that the personality changes
will not only occur, but will be steadied and maintained.

The Experiential Field

The individual may not be aware of much of his experience, until his attention is drawn to
that experience. However, this experience is available to conscious awareness. The total
range of experience at any given moment may be called the ‘experiential’, ‘perceptual’ or
‘phenomenal field’.

DEVELOPMENT OF SELF CONCEPT

Rogers believed that people will move towards autonomy and self-direction if given the right
conditions and opportunities. The concept of ‘Self’ is important and refers to the ‘I’ or the
‘me’ part of each person. According to Rogers, personality development can be viewed in
terms of self-concept development, which in turn depends on the individual’s interaction
with other people and the environment.
From a very early age children seek to please their parents or care takers who are, after all,
the most important people in the world to them. Each person’s self-concept is acquired in
this way, and is continually reinforced throughout life as a result of ongoing interaction with
others. The small child sees herself reflected in the attitudes expressed by parents and other
important people. And when very little love and a great deal of criticism are received, a
negative self-concept is bound to follow.
Clients in counselling often refer to their ‘real’ selves. They often do so with regret and
sadness, especially when they have never before been given the opportunity to identify and
express their authentic needs and feelings.

Need for Positive Regard

A need for positive regard from others is a learned need development in early infancy. On
many occasions the young person’s behavior and experiencing of his behavior will coincide
with positive regard from others and hence meet his need for positive regard. For instance,
smiling at parents may reflect a pleasurable experiencing as well as generating positive
regard.
However, on other occasions, the young person may feel that he is experiencing conflicts
with his need for positive regard from significant others. Rogers gives the example of the
child who experiences satisfaction at hitting his baby brother, but who experiences the
words and actions of his parents saying ‘You are bad, the behavior is bad, and you are not
loved or lovable when you behave this way’.
As a consequence, the child does not acknowledge the pleasurable values of hitting his baby
brother and place a negative value on the experience because of the attitudes held by his
parents and his need for positive regard.

Conditions of Worth
This refers to when a person alters the true self in order to receive positive regard from
others. These people are incongruent with their true selves. E.g. a person becoming a doctor
to please parents not because he wants to be one. People learn to alter the self’s values at a
young age if unconditional positive regard is not received. Individuals differ in the degree to
which they internalize conditions of worth depending on the emotional quality of their
environment and the extent of their need for positive regard.
For some, their positive self-concepts will allow them to perceive their experiences
accurately while those who had negative self-concept develop negative notions. Some
common examples of conditions of worth are:
‘Achievement is very important and I am less of a person if I do not achieve’.
‘Making money is very important and, if I do not make much money, then I am a failure’.
‘Sexual fantasies and behaviors are mostly bad and I should not like myself for having them’.
Thus, conditions of worth entail not only internalized evaluations of how individuals should
be, but also internalized evaluations about how they should feel about themselves if they
perceive that they are not the way they should be.

ROLE OF SELF CONCEPT IN SUSTAINING MALADJUSTMENT

For the counsellor, the emphasis is not on how clients become the way they are, but what is
causing them currently to perpetuate behavior which does not meet their real needs. Rogers
observed that when experiences occur in the life of an individual there are four possible
outcomes as given below.
I) First, the experiences may be ignored.
ii) Second, they may be accurately perceived, and because they are consistent with the self-
concept, they may be reinforced.
iii) Third, their perception may be distorted in such a way as to resolve the conflict between
self-concept and experiencing. For instance, a student with a low academic self-concept may
receive some positive feedback about an essay and perceive ‘The teacher did not read it
properly,’ or ‘The teacher must have low standards.
iv) Fourth, they may be denied or not perceived at all. For example, a woman may have had
her self-concept deeply influenced by a strict moral upbringing and thus be unable to
perceive her cravings for sexual satisfaction.

Individuals have two valuing processes, viz., (I) their own organismic valuing process and (ii)
an internalized process based on conditions of worth.
The low functioning person is out of touch with his own valuing process for large areas of his
experiencing. In these areas his self-concept is based on conditions of worth which cause
him to distort and deny much of his experiencing. On the other hand, the high functioning
person has fewer conditions of worth and thus is able to perceive most of his experiences
accurately.

Incongruence between Self Concept and Experience

When experiences are accurately symbolized and included in the self-concept, there is a
state of congruence between self-concept and experience. But, when experience is denied
and distorted, there exists a state of incongruence between self-concept and experience.
This state of incongruence may exist where experiences are positive as well as where they
are negative. Clients tend to have low self-concepts and frequently deny and distort positive
feedback from outside as well as inhibit positive feelings from within.

Breakdown and Disorganization

The self-concept of a very low functioning person blocks his accurate perception of
experiences. If, however, a situation develops, in which a significant experience occurs
suddenly, the process of defense may be unable to operate successfully. Thus, anxiety may
be experienced to the extent to which the self-concept is threatened. Also, as the process of
defense was unsuccessful, the experience is symbolized in awareness. That is, the individual
is brought face to face with more of his denied experiences than he can handle. This in turn
leads to an ensuring state of disorganization and the possibility of a psychotic breakdown.

IMPORTANCE OF SELF CONCEPT

The self-concept is a unique complex of many different self-conceptions which constitute an
individual’s way of describing and distinguishing himself. For instance, the shape of one’s
nose may be felt as important by one person while another may not be aware of it. The self-
concept may be described in statements such as ‘I am a good carpenter,’ ‘I like Ice-cream’
and ‘Meeting new people makes me nervous’.

Congruence-Incongruence
When self-conceptions match the person’s experiences in reality, there is congruence
between self-conception and experience. When self-conceptions are different in varying
degrees from the reality of a person’s experiences there is a state of incongruence.

Conditions of Work
Incongruence implies that a self-conception is based on a condition of worth rather than on
the organism’s own valuing process. For example, an incongruent self-conception for a
particular individual may be ‘I want to be a doctor’, whereas a congruent self-conception for
that individual may be ‘I want to be an artist’. Being a doctor may be based on values
internalized from parents, whereas being an artist represents the organism’s own valuing
process.

Subception and Defense

Experiences may be denied or distorted by the process of subception. Subception means a
perceptual defense that involves unconsciously applying strategies to prevent a troubling
stimulus from entering consciousness. This defends existing self-conceptions by preventing
the person from perceiving incongruence and hence possibly changing both self-conceptions
and behavior.

Level of Self-Regard
Another way of expressing ‘level of self-regard’ is the degree to which the individuals prize
themselves’. Rogers state that when individual’s self-concept is such that no self-experience
can be discriminated as more or less worthy of positive regard than any other, then he is
experiencing unconditional positive self-regard. ‘Level of self-acceptance’ is a further way of
stating level of self-regard.

Real and Ideal Self

Real self-conceptions represent perceptions of how I am; ideal self-conceptions represent
conceptions of how I would most like to be. Both real and ideal self-conceptions forms parts
of an individual’s self-concept complex.

CONDITIONS FACILITATING AND DEVELOPING POSITIVE SELF CONCEPT

The adequacy of the self-concepts of parents affects the way in which they relate to their
children. The level of self-acceptance or self-regard of parents may be related to their
degree of acceptance of the behavior of their children. Rogers observes that parents are
able to feel unconditional positive regard for a child only to the extent that they experience
unconditional self-regard. Furthermore, the greater the degree of unconditional positive
regard that parents show toward the child, the fewer the conditions of worth in the child
and the higher the level of its psychological adjustment. High functioning parents create the
conditions for the development of high functioning children. By ‘unconditional positive
regard’, Rogers means prizing a child even though the parent may not value equally all of his
behavior.

GOALS OF COUNSELLING
Person centered goals are the same for clients, for counsellors and for everyone. Rogers also
made a later statement on the qualities of the ‘person of tomorrow’ who can live in a vastly
changed world. He considers that a ‘paradigm shift’ is taking place from old to new ways of
conceptualizing the person.

The Fully Functioning (Mature) Person

Through person centered counselling the therapist aims to make a person fully functioning
person or a mature person. Such a person will have the following qualities.
• Open to experience and able to perceive realistically Person-Centered Theory of
Counselling • Rational and not defensive
• Engaged in existential process of living
• Trusts in organismic valuing process
• Construes experience in extensional manner
• Accepts responsibility for being different from others
• Accepts responsibility for own behavior
• Relates creatively to the environment
• Accepts other as unique individuals
• Prizes himself
• Prizes others
• Relates openly and freely on the basis of immediate experiencing
• Communicates rich self-awareness when desired.

The Person of Tomorrow

The person of tomorrow will develop the qualities given below as a result of person-
centered counselling. Qualities
• Openness to the world, both inner and outer
• Desire for authenticity
• Skepticism regarding science and technology
• Desire for wholeness as a human being
• The wish for intimacy
• Process persons
• Caring for others
• Attitude of closeness towards nature
• Anti-institutional
• Trust of the authority within
• Material things unimportant
• A yearning for the spiritual.

THE CORE CONDITIONS FOR EFFECTIVE COUNSELLING

Rogers identified certain core conditions which he believed to be necessary if clients are to
make progress in counselling. These conditions describe counsellor qualities and attitudes
which will facilitate change and growth within the client. Among the most important of
these attitudes is the counsellor’s ability to understand the client’s feelings. Another is
respect for the client, while a third is described as counsellor congruence or genuineness.
Rogers Core Conditions
 Empathy
 Unconditional Positive Regard
 Genuineness

Empathy
The word empathy describes the counsellor’s ability to understand the client at a deep level.
It involves an awareness of what it that the client is actually experiencing. Rogers refers to
the internal frame of reference to denote the client’s unique experience of personal
problems. The task for the counsellor is to get inside the client’s frame of reference. If this is
not achieved, then no real point of contact is made between counsellor and client. Rogers
uses the term external frame of reference to describe this lack of understanding and
contact. When a counsellor perceives the client from an external frame of reference, there is
a little chance that the client’s view be clearly heard. In order to stay within the client’s
internal frame of reference, it is necessary for the counsellor to listen carefully to what is
being conveyed (both verbally and non-verbally) at every stage of counselling. The
counsellor needs to imagine and appreciate what it is like to actually be the client, and this
appreciation of the client’s experience then needs to be conveyed to him.

Unconditional Positive Regard

The need for positive regard is to present in all human beings from infancy onwards. This
need is so imperative that small children will do almost anything in order to achieve it.
People need love, acceptance, respect and warmth from others. But on fortunately these
attitudes and feelings are often only given conditionally. Parents may say, or imply, that their
love is given on condition that certain criteria are met, and when this happens it is
impossible for children to feel valued for themselves alone. Rogers believed that counsellors
should convey unconditional positive regard or warmth towards clients if they are to feel
understood and accepted. This means that clients are valued without any conditions
attached, even when they experience themselves as negative, bad, frightened or abnormal.
38 Acceptance implies a non-judgmental approach by counsellors, and it also caring in a
non-possessive way. When attitudes of warmth and acceptance are present in counselling,
clients are likely to accept themselves, and become more confident in their own abilities to
cope. However, acceptance of clients does not mean that counsellors must like to approve
of everything they do. The values and views held by clients may differ quite dramatically
from those held by individual counsellors, but even in these circumstances clients deserve
(and should receive) respect and positive regard from the people in whom they confide.
Congruence or Genuineness
The words genuineness and congruence describe another quality which Rogers believed
counsellors should possess. This quality is one of sincerity, authenticity and honesty within
the counselling relationship. In order to be congruent with clients, counsellors need to be
themselves, without any pretense or façade. This means, of course, that counsellors need to
know themselves first. In the absence of self-knowledge, it would be totally impossible to
develop attitudes of openness and honesty in relation to clients. A very important aspect of
counsellor genuineness is that it acts as a model for clients who may find difficult to be open
and genuine themselves.

THE COUNSELLING RELATIONSHIP

The person-centered counselling relationship is based on respect for the client, on the
establishment of an empathic bond, and on willingness on the counsellor’s part to be open
and genuine with the client. In addition to these qualities, however, there is also an
emphasis on facilitating each client’s growth or self-actualization. Self-actualization can only
be achieved when the core conditions described above are present in the relationship. The
counselling skills are necessary for the development of a therapeutic relationship between
counsellor and client.
• Active listening
• Responding to clients through reflection of feeling and content
• Paraphrasing and summarizing
• Asking open questions
• Responding appropriately to silence and client non-verbal communication.

CLIENTS WHO BENEFIT FROM PERSON CENTERED COUNSELLING

The person-centered approach has wide application within the helping professions, the
voluntary sector, human relations training.
Group work, education and institutional settings where the goals are to foster good inter
personal skills and respect for others.
In the context of therapy and counselling, the person centered approached is suitable for
use with clients in the first stages of crisis. Later on, however, clients to crisis may need a
more directive approach to help them cope with the practical and long-term aspects of their
problems.
Person-centered counselling has significant advantages over some of the other models. This
is because it encourages clients to consider and identify their own feelings and needs,
something which many women (especially those who have spent lifetime earnings for
others) may never have been able to do before.
Clients who have been bereaved should also benefit from the person-centered approach,
since one of the things which bereaved people appear to need most of all is validation of
their individual responses to loss.
People with relationship difficulties should derive some advantage from working with a
counsellor who gives them respect, understanding and openness which they may not have
experienced in everyday life.
The principles of the person-centered approach have been applied to a variety of
therapeutic situations including marriage counselling and family therapy.
Many support groups work by extending the core conditions to its members. Alcoholics
Anonymous is a case in point, and is a good example of the therapeutic effects of respect,
understanding and openness for people who want to change.
Telephone counselling is another therapeutic medium through which Rogerian attitudes can
be extended to clients, especially those clients who are in deep crisis.
LIMITATIONS OF PERSON-CENTERED COUNSELLING
Person-centered counselling is an approach which is suitable for most clients, though some
with deeply repressed traumas and conflicts may benefit from a more psychodynamic
perspective. However, the core conditions which Rogers described would certainly work
effectively if combined with appropriate skills from the psychodynamic model.
People with depression, addiction, phobias or eating disorders are also likely to derive more
help from other models.
Clients with alcohol problems may need more support than the kind which can be offered
through individual counselling. Even when the core conditions are present in a one-to-one
therapeutic situation, they may not be enough to sustain change for clients with some
addictive problems.
Another important factor to remember here is that deeply distressed and addicted clients
(providing they are committed to change) may respond more positively in the presence of
others with similar problems. Clients with respective thoughts and obsessions will probably
gain more from cognitive behavioral approach to counselling, and there is no doubt that
certain clients benefit from a more directive and structured approach generally.
Cultural difference can also influence the way clients perceive those who help them, and
person-centered counsellors may sometimes be seen as passive or lacking in initiative by
people who value advice or other more directive forms of intervention

GESTALT COUNSELLING

INTRODUCTION
Gestalt counseling is a humanistic approach to therapy that focuses on the individual's
experience in the present moment, the therapist-client relationship, and the environmental
and social contexts of a person’s life. Developed by Fritz Perls, Laura Perls, and Paul
Goodman in the 1940s and 1950s, Gestalt therapy emphasizes personal responsibility and
awareness of one's experiences and emotions.
• Holistic Approach: Gestalt counselling emphasizes the interconnectedness of the
individual's thoughts, emotions, and behaviors, treating the person as a whole.
• Origins and Development: Gestalt counselling was developed in the 1940s by Fritz Perls,
drawing on existential and phenomenological perspectives to provide a unique humanistic
approach.
• Emphasis on Awareness: The approach focuses on enhancing clients' awareness of their
present experience, encouraging them to be fully engaged in the 'here and now'.

Major proponents
Fritz Perls Full
Name: Friedrich (Fritz) Salomon Perls
Birth and Death: July 8, 1893 – March 14, 1970
Contributions:
 Co-founded Gestalt therapy in the 1940s and 1950s.
 Emphasized the importance of present moment awareness and personal
responsibility.
 Focused on the concept of the "here and now," encouraging clients to explore their
immediate thoughts and feelings.
 Authored several influential books, including "Gestalt Therapy: Excitement and
Growth in the Human Personality" (co-authored with Paul Goodman and Ralph
Hefferline).

Laura Perls
Full Name: Lore (Laura) Posner Perls
Birth and Death: August 15, 1905 – July 13, 1990
Contributions:
 Co-founded Gestalt therapy alongside her husband, Fritz Perls.
 Played a crucial role in the theoretical development and practical application of
Gestalt therapy.
 Emphasized the holistic approach to therapy, integrating body and mind.
 Actively involved in training and supervising new therapists, significantly shaping the
Gestalt therapy community.

Paul Goodman
Full Name: Paul Goodman
Birth and Death: September 9, 1911 – August 2, 1972
Contributions:
 Co-authored "Gestalt Therapy: Excitement and Growth in the Human Personality."
 Brought a strong intellectual and philosophical foundation to Gestalt therapy.
 His writings emphasized social criticism and the importance of individual experience
in the therapeutic process.
 Integrated his background in sociology, literature, and psychology to enrich the
theoretical underpinnings of Gestalt therapy.

Historical Background
Perls' Influential Background: Perls was influenced by psychoanalysis, Gestalt psychology,
and existential philosophy, shaping his innovative approach.
Emphasis on Experiential Learning: Perls believed clients should actively engage in the
therapeutic process, rather than passively receive advice.
Gestalt Therapy's Evolution: Perls' initial approach evolved over time, with later Gestalt
therapists expanding on his core principles.

Nature Of People
The Concept of Balance: Gestalt counseling emphasizes the importance of achieving a
harmonious balance between an individual's physiological and psychological needs.
 The balance can be threatened by events outside oneself as well as internal
conflicts.
 The organism functions as a whole organism are disrupted with an imbalance,
regardless of the source and nature of the threat to the balance.
 Disruption in one area (e.g., marriage) affects other areas (e.g., job performance).
Similarly, success in one aspect (e.g., sports) influences other relationships (e.g.,
friendships).

Polarities within Personality

Diverse Elements
Individuals develop different personality elements that may have conflicting desires (e.g.,
the "fighting self" vs. the "loving self").
Understanding Polarities
Recognizing and addressing these internal polarities is crucial for understanding the person
and helping them work towards a more unified set of motives.

Growth
Is seen as a sequence of occurrences proceeds from
Experience -with a life situation
Sensing- taking in the qualities of the situation through the senses
Excitement- becoming involved with the event
Gestalt formation- integrating experience into one’s stored perspectives of the world
Neurosis - An interruption of the growth process
Defensiveness - A process that pulls energy away from living effectively
Unfinished businesses: Things that are in our awareness but incomplete are called
“unfinished business.” Because of our natural tendency to make gestalts, unfinished
business can be a significant drain of energy, as well as a block on future development
(O’Leary, 2013).

Importance of Authenticity
• Authentic Awareness: Gestalt counseling emphasizes the importance of clients being fully
present and aware of their immediate experiences, enabling genuine self-understanding.
• Accepting Experiences: The approach encourages clients to embrace and integrate all
aspects of their experiences, including emotions and behaviors, for personal growth.
• Moving Towards Authenticity: Gestalt counseling empowers clients to take responsibility
for their actions and make meaningful changes, fostering a more authentic and fulfilling way
of being.

The Counseling Process Purpose: encourage personal growth

• Encouraging Personal Growth: Gestalt counseling fosters clients' self-awareness and
empowers them to take responsibility for their own growth and development. The purpose
itself is to encourage personal growth.
• Addressing Defensiveness: The approach helps clients recognize and overcome defensive
behaviors that may hinder their progress, enabling them to engage more authentically in the
therapeutic process.
• Sequence of Experiments: Gestalt counseling utilizes a structured sequence of experiential
exercises to guide clients through self-exploration and facilitate meaningful personal
insights.

The Gestalt Counselor

 In Gestalt counseling, the counselor doesn’t interpret behavior.
 The counselor needs diagnostic skills to recognize client’s defensive strategies.
 The counselor must be able to recognize the client's defensive attempts to hide, to
make observations that cause a client to look into him or herself.

Basic Structure of a Gestalt Counseling

Session:
Session Dynamics:
 Interactive Process: Continuous back-and-forth dialogue between counselor and
client.
 Real-Time Engagement: Focus on the present moment, addressing issues as they
emerge during the session.
Session Pace:
 Emerging Themes: As the counselor works with a client, recurring themes emerge
that reveal the client's characteristic coping mechanisms, especially in interactions
with others. Sessions evolve based on these themes from the client's experiences
and interactions.
 Calling out “phoniness”: The counselor highlights the client's defensive behaviors,
often labelled as 'phoniness,' and encourages a shift towards authentic behavior that
 accurately reflects their internal state, despite the difficulty of achieving such
authenticity
 As the client addresses unfinished business and gains a deeper understanding of
their authentic self, they become capable of establishing effective contact with
others and participating more fully in daily life.
 This growth process is contagious; success in life situations bolsters the client's
confidence to engage openly rather than hide.
 Eventually, the client's inclination to reach out surpasses their tendency to hide,
creating a self-sustaining momentum that reduces the need for further counseling.

Counselor-Counselee Relationship
 Addressing Unfinished Business: Helping clients resolve past conflicts that affect
current relationships and behaviors.
 Projection: Clients may project their unresolved issues onto the counselor, which is
used therapeutically.
 Frustration Technique: The counselor may deliberately frustrate the client's
attempts to retreat into defensiveness, promoting awareness and growth.
 Identifying Defenses: Recognizing and addressing the client's defensive behaviors to
move towards authenticity.

Techniques and Methods

A number of techniques or experiments are used by Gestalt counselors focus on bringing
"then and there" experience into the "here and now" and to bring the client into clearer
touch with him or herself.

Confrontation
 The confrontation technique in Gestalt therapy is used to help clients become aware
of discrepancies, inconsistencies, or incongruities in their thoughts, feelings, and
behaviors.
 The aim is to bring these inconsistencies to the client's attention in a direct but
supportive manner, encouraging them to explore and resolve these conflicts.
 This technique is not about creating conflict or being adversarial, but rather about
helping the client gain deeper self-awareness and insight.

Re-enacting
 The client is asked to reenact an experience or event which occurred in the past and
is concerning to the client.
 Instead of talking about what has occurred, the client reexperiences the occurrence
and the effect is recreated
 New understandings often lead to new behaviors or new acceptance of oneself or
others.
 This process of re-experiencing the earlier phases of life through these reenactments
is referred to as ‘finishing unfinished businesses.

Role playing techniques

 Role-playing is a dynamic and interactive technique used in Gestalt therapy to help
clients gain deeper insight into their feelings, thoughts, and behaviors by acting out
scenarios or taking on different roles.
 This technique allows clients to explore various perspectives, practice new
behaviors, and resolve conflicts in a safe and supportive environment. Role-playing
 can be particularly effective for understanding interpersonal dynamics, expressing
emotions, and developing problem-solving skills.

Empty chair
 The empty chair technique is a widely used intervention in Gestalt therapy. It
involves the client engaging in a dialogue with an imagined person or part of
themselves, represented by an empty chair.
 This technique helps clients to externalize and address unresolved issues, conflicts,
or emotions, promoting self-awareness and healing.

Exaggeration
 The client is asked to exaggerate a view that has been expressed and that the
counselor sees as defensive.
 As the affected content become exaggerated the client comes to see the inaccuracy
and may take back part of the original defensive statement

“I take responsibility” game

 The client is asked to repeat a questionable statement and follow it with the words
 “I take responsibility of what I have said” If the client in a retrospect has doubts
about the original statement, they must alter it in order to feel able to take
responsibility for it.

Comparison with Other Counseling Models

 Focus on the Present: Gestalt counselling emphasizes the 'here and now', while
person centered and psychoanalytic approaches focus more on the past and future.
 Role of the Therapist: Gestalt counselling views the therapist as a collaborative
partner, unlike the more directive role in psychoanalytic therapy or the non-directive
approach in person-centered counselling.
 Emphasis on Experiential Learning: Gestalt counselling actively engages clients in the
therapeutic process through techniques like role-playing, whereas person-centered
and psychoanalytic approaches rely more on verbal exploration.

Benefits of Gestalt Counseling

 Personal Growth: Gestalt counselling empowers clients to take responsibility for
their actions, fostering authentic self-awareness and enabling meaningful change.
 Enhanced Self-Awareness: The approach encourages clients to be fully present and
engaged in the 'here and now', promoting deeper self-understanding.
 Improved Coping Mechanisms: Gestalt counselling helps clients recognize and
resolve internal conflicts, enabling them to develop healthier coping strategies.

Challenges and Considerations

• Resistance and Defensiveness: Clients may resist the experiential and confrontational
techniques used in Gestalt counseling, requiring therapists to address defensive behaviors
with sensitivity.
• Misconceptions about the Therapist's Role: Some clients may misunderstand the
collaborative, non-directive nature of the Gestalt approach, expecting more guidance from
the therapist.
• Challenges with Emotional Intensity: The focus on immediate experience can evoke strong
emotions in clients, which therapists must navigate carefully to maintain a safe and
productive therapeutic environment.
PSYCHOANALYTIC COUNSELLING

INTRODUCTION
Psychodynamic therapy (or Psychoanalytic Psychotherapy as it is sometimes called) is a
general name for therapeutic approaches which try to get the patient to bring to the surface
their true feelings, so that they can experience them and understand them. Like
psychoanalysis, Psychoanalytic Psychotherapy uses the basic assumption that everyone has
an unconscious mind (this is sometimes called the subconscious), and that feelings held in
the unconscious mind are often too painful to be faced. Thus, we come up with defenses to
protect us knowing about these painful feelings. An example of one of these defenses is
called denial, which you may have already come across.
Psychodynamic therapy assumes that these defenses have gone wrong and are causing
more harm than good that is why you have needed to seek help. It tries to unravel them, as
once again, it is assumed that once you are aware of what is really going on in your mind the
feelings will not be as painful.
Psychodynamic psychotherapy takes as its roots the work of Freud (who most people have
heard of) and Melanie Klien (who developed the work with children) and Jung (who was a
pupil of Freud’s yet broke away to develop his own theories).
Psychodynamics takes the approach that our past affects our present. Those who forget
history are doomed to repeat it, and this is the same for an individual. Though we may
repress very early experiences (thus we do not remember them), the theory is that the “Id”
never forgets the experiences. As a child if we had been rewarded with sweets, even today
when matured and grown up we reach out for the tub of ice cream whenever we are
depressed and we want cheering up.

PSYCHODYNAMIC / PSYCHOANALYSIS

Freud and Psychoanalysis

Sigmund Freud, a Viennese neurologist (1856-1939), is clearly one of the most influential
writers of the twentieth century, admired for his wit, intellect, and willingness to revise and
improve his theories as his clinical experience grew. Freud began his practice at a time when
there were fewer effective from of treatment in most fields of medicine. Effective treatment
generally depends on an understanding of the causes of a disorder, and at that time,
although accurate diagnoses could sometimes be made, little was known about the causes
of disease, whether physical or mental. A disorder that was particularly common during the
late 1800s was hysteria, the presence of physical problems in the absence of any physical
causes. Like other well-trained neurologists of his time, Freud originally used hypnosis to
help his hysterical patients lose their symptoms. Then a friend, Joseph Breuer, told Freud
that while under hypnosis one of his patients had recalled and understood the emotional
experience that had led to the development of her symptoms, and that her symptoms had
then disappeared. For a time, Freud and Breuer used this method of recapturing memories
with some success.
However, because some patients were not easy to hypnotize and sometimes the positive
effects did not last long. Freud began to develop his method of psychoanalysis, in which the
patient recaptures forgotten memories without the use of hypnosis. Freud’s
psychoanalytical method made him enormously influential among European clinicians. By
the time he visited the United States in 1909, his reputation had already spread across the
Atlantic.

Freud’s Theory of Personality

Freud’s theory of personality may seem complicated because they incorporate many
interlocking factors, but two basic assumptions viz., psychic determinism and the conscious
unconscious dimension underlie the theory
The principle of psychic determinism states that all behavior, whether overt (e.g. a muscle
movement) or covert (e.g., a thought), is caused or determined by prior mental events. The
outside world and the private psychic life of the individual combine to determine all aspects
of behavior. As a clinical practitioner, Freud sought to modify unwanted behavior by
identifying and eliminating its psychic determinants.
Freud assumed that mental events such as thoughts and fantasies varied in the ease with
which they come to the individual’s awareness. For example, aspects of mental life that are
currently in awareness are the conscious. Mental contents that are not currently at the level
of awareness but can reach that level fairly easily are the preconscious. Mental contents that
can be brought to awareness only with great difficulty are the unconscious. Freud was
interested mainly in how these unconscious mental contents could influence overt behavior.
Freud was especially intrigued by thoughts and fantasies that seen to go underground but
then reappear at the conscious level. He asserted that the level of intra psychic conflict we a
major factor in determining our awareness of particular mental events. According to Freud,
the classic example of intra psychic conflict is when a young boy desires to take his father’s
place in relation to his mother, but at the same time feel love and affection for his father.
Freud believed that the greater the degree of intra psychic conflict, the greater the
likelihood that the mental events connected with it would remain unconscious. The more
massive the unconscious conflict, the greater the person’s mental events that may remain in
the unconscious. The central hypothesis of Freudian psychoanalysis is that human behavior
is determined in large part by unconscious motives (Freud, 1961). Our personality and our
actions, argued Freud, were in large part determined by thoughts and feelings contained in
the unconscious. Repressed content of the unconscious inadvertently slips through into our
words or deeds, resulting in what is commonly called as the ‘Freudian slip’. If most activities
are governed by the unconscious, the individual may have limited responsibility for his or
her actions.
Psychoanalytic / psychodynamic practitioners who use this approach tend to view
psychological distress as being related to unconscious mental processes (Jacobs, 1998).
Freud’s contribution in regard to the mental processes, the unconscious, defense
mechanisms etc., have all been developed and expanded by others who were Freud’s
students or disciples. Some have followed his basic assumptions, and others have developed
more independent approaches. The term “psychodynamic” offers a wider perspective, which
encompasses the different analytical approaches. As Jacobs (1998) suggested,
psychodynamic implies that the psyche (mind/emotions/ spirit/self) is active, not static.
These internal mental processes are dynamic forces that influence our relations with others.
The structural concept of Freud’s theory of personality consisted of the id, ego, and
superego. The id consists of everything present at birth, including instincts. The ego is the
executive of the personality, because it controls the gateways to action, selects the features
of the environment to which it will respond, and decides which needs will be satisfied and in
which order. The superego is the internalized representative of the traditional values, ideals,
and moral standards of society and the super ego strives for perfection.
Under the pressure of excessive anxiety, the ego is forced to take extreme measures to
relieve the pressure. These measures are called defense mechanisms, because they defend
the ego against anxiety. The principal defenses are repression, projection, reaction
formation, intellectualization, denial, rationalization, displacement, and regression. These
defense mechanisms have crept into contemporary therapy as denial and regression. Hence,
someone is in denial because they are unable to accept a tragic event as having occurred
and keep on stating that it had not occurred. Or to take another example, a child regresses
to a previous developmental stage as a way of dealing with a tragic death.
In general, Psychodynamics, also known as dynamic psychology, is the study of
interrelationship of various parts of the mind, personality, or psyche as they relate to
mental, emotional, or motivational forces especially at the unconscious level. The mental
forces involved in Psychodynamics are often divided into two parts
a) Interaction of emotional forces: the interaction of the emotional and motivational forces
that affect behavior and mental states, especially on a subconscious level;
b) Inner forces affecting behavior: the study of the emotional and motivational forces that
affect behavior and states of mind;
Freud proposed that psychological energy was constant (hence, emotional changes
consisted only in displacements) and that it ended to rest (point attractor) through discharge
(catharsis). In mate selection psychology, psychodynamics is defined as the study of the
forces, motives and energy generated by the deepest of human needs.

Origin of Psychodynamics
The original concept of “psychodynamics” was developed by Sigmund Freud. Freud
suggested that psychological processes are flows of psychological energy in a complex brain,
establishing “psychodynamics” on the basis of psychological energy, which he referred to as
the libido.
In general, psychodynamics studies the transformations and exchanges of “psychic energy”
within the personality. A focus in psychodynamics is the connection between the energetics
of emotional states in the id, ego and superego as they relate to early childhood
developments and processes.
At the heart of psychological processes, according to Freud, is the ego, which is envisioned
as battling with three forces, viz., the id, the superego and the outside world. Hence, the
basic psychodynamic model focuses on the dynamic interactions between the id, ego and
superego. Psychodynamics, subsequently, attempts to explain or interpret behavior or
mental states in terms of innate emotional forces or processes.

History of Psychodynamics
Psychodynamics was initially developed by Sigmund Freud, Carl Jung, Alfred Adler and
Melanie Klein. By the mid-1940s and into the 1950s, the general application of the
“psychodynamics theory” had been well established.
In his 1988 book “Introduction to psychodynamics – a New Synthesis”, psychiatrist Mardi J.
Horowitz states that his own interest and fascination with psychodynamics began during the
1950s, when he heard Ralph Greenson, a popular local psychoanalyst who spoke to the
public on topics such as “People who hate”, and also his speeches on the radio at UCLA. In
his radio discussion, according to Horowitz, he ‘vividly described neurotic behavior and
unconscious mental processes and linked psychodynamics theory directly to everyday life.
In the 1950s, American psychiatrist Eric Berne built on Freud’s psychodynamic model,
particularly that of the “ego states”, to develop a psychology of human interactions called
transactional analysis which, according to physician James R. Allen, is a “Cognitive behavioral
approach to treatment and that it is a very effective way of dealing with internal models of
self and others as well as other psychodynamic issues.” The theory was popularized in the
1964 book “Games people Play”.

MEANING OF PSYCHODYNAMICS
1) Psychodynamics is the systematic study and theory of the psychological forces that
underlie human behavior, emphasizing the interplay between unconscious and conscious
motivation.
2) The psychology of mental or emotional forces or processes developing especially in early
childhood and their effects on behavior and mental states.
3) Explanation or interpretation, as of behavior or mental states, in terms of mental or
emotional forces or processes.
4) Motivational forces acting especially at the unconscious level.

Definition of Psychodynamics
According to the American psychologist Calvin S. Hall, from his 1954 “Primer in Freudian
psychology”, the definition of psychodynamics is as given below:
“A dynamic psychology is one that studies the transformations and exchanges of energy
within the personality.”
This was Freud’s greatest achievement and as one of the greatest achievements in modern
science, it is certainly crucial in the history of psychology.
In 1930s, Freud’s daughter Anna Freud began to apply Freud’s psychodynamic theories of
the “ego” to the study of parent child attachment and especially deprivation and in doing so
developed ego psychology.

Freudian Psychodynamics
According to Freud, the ego is seen as battling with three forces, the id, the super ego and
the outside world. In his writings about the “engines of human behavior”, Freud used the
German word “Id” a word that can be translated into English as either instinct or drive.

Jungian Psychodynamics
A Swiss psychiatrist Carl Jung’s in his first book, published in the year 1907, entitled,
“Psychology of dementia praecox”, upheld the Freudian psychodynamic view point,
although with some reservation.
Carl Jung’s contribution in psychodynamics psychology includes the following:
1) The psyche tends toward wholeness.
2) The self is composed of the ego, the personal unconscious, the collective unconscious,
and the archetypes.
3) Archetypes are composed of dynamic tensions and arise spontaneously in the individual
and collective psyche. Archetypes are autonomous energies common to the human species.
They give the psyche its dynamic properties and help organize it.
4) The transcendent function: the emergence of the third resolves the split between
dynamic polar tensions within the archetypal structure.
5) The recognition of the spiritual dimension of the human psyche.
6) Recognition of the multiplicity of psyche and psychic life.
Psychodynamic therapy is a general name for therapeutic approaches which try to get the
patient to bring to the surface their true feelings, so that they can experience them and
understand them. Like psychoanalysis, psychodynamic psychotherapy uses the basic
assumption that everyone has an unconscious mind, and that feeling held in the unconscious
mind are often too painful to be faced. Thus, we come up with defenses to protect us from
becoming aware of these painful feelings.
Psychodynamic therapy assumes that these defenses have gone wrong and are causing
more harm than good that is why you have needed to seek help. It tries to unravel them, as
once again. It is assumed that once you are aware of what is really going on in your mind
feeding will not be as painful.

Meaning of Psychodynamic Counseling

Psychodynamic counseling is based on acceptance, empathy and understanding, with an
emphasis on developing a good working alliance that fosters trust. The counselor takes
account of the real world of the client, including the impact of trauma, cultural difference,
sexual orientation, disability and social context.
Psychodynamic counseling places more emphasis on the influence of past experience on the
development of current behavior, mediated in part through unconscious processes. It is
influenced by object relations theory, that is, by the idea that previous relationships leave
lasting traces which affect self-esteem and may result in maladaptive patterns of behavior.
Psychodynamic counseling skills and theory can be valuable in many working and social
environments. The insight and understanding about human functions gained from
psychoanalytic theory can enhance the life of the counselor as well as the client and can be
put to a variety of good uses.

Meaning of Psychodynamic Theory

Psychodynamic psychotherapy is derived from psychoanalysis and is based on a number of
key analytical concepts. These include Freud’s ideas about psychosexual development,
defense mechanisms. Free association as the method of recall, and the therapeutic
techniques of interpretation, including that of transference, defenses and dreams. Such
therapy usually involves once-weekly 50-minute sessions, the length of treatment varying
between 3 months and 2 years. The long-term aim of such therapy is twofold: symptom
relief and personality change.
Psychodynamic psychotherapy is classically indicated in the treatment of unresolved
conflicts in early life, as might be found in non-psychotic and personality disorders, but to
date there is a lack of convincing evidence concerning its superiority over other forms of
treatment.
Psychodynamic theory is based on the premise that human behavior and relationships are
shaped by conscious and unconscious influences.
Psychodynamic therapies, which are sometimes used to treat depressed persons, focus on
resolving the patient’s conflicted feelings. These therapies are often reserved until the
depressive symptoms are significantly improved.
Psychodynamic counseling places more emphasis on the influence of past experience on the
development of current behavior, mediated in part through unconscious processes. It is
influenced by object relations theory, that is, by the idea that previous relationships leave
lasting traces which affect self-esteem and may result in maladaptive patterns of behavior.

Psychological Counseling
Counseling is as old as society itself. In everyday life, we find, counseling goes on at many
levels in a family set up, parents counsel their children, in society doctors counsel patients,
lawyers their clients, and teachers their students. There is no limit to the problems on which
counseling can be offered nor to the persons who can render this help. Counseling is the
core of the guidance program and is considered to be its most intimate and vital part.

Definition of Professional Counseling

What counseling is, especially the Professional counseling, in its present form, which is a
recent development. Educational institutions, industries and business establishments are
becoming increasingly interpersonal in their relationships. It is believed, where no counsel is,
the people fall. But in the multitude of counselors, there is safety. No wonder, counseling is
being recognized as an important technique of guidance. Counseling has been understood
and defined in a number of ways:
The Webster’s dictionary defines counseling as “consultation, mutual interchange of
opinions, deliberating together.”
Wren says, “Counseling is a dynamic and purposeful relationship between two people who
approach a mutually defined problem with mutual consideration of each other to the end
that the younger or less mature, or more troubled of the two is aided to a self-determined
resolution of his problem.”
Pepinsky and Pepinsky feel that, “Counseling relationship refers to the interaction which
 occurs between two individuals called “the counsellor” and the “client”,
 takes place within a professional setting, and
 is initiated and maintained as a means of facilitating changes in the behavior of the
client.
The counseling relationship develops from the interaction between two individuals, one a
professionally trained worker and the other a person who seeks his services.”
Hahn and MacLean define counseling as “a process which takes place in a one-to-one
relationship between an individual beset by problems with which he cannot cope alone and
a professional worker whose training and experience have qualified him to help others reach
solutions to various types of personal difficulties.”
An analysis of the above viewpoints will reveal the major elements of counseling: Counseling
involves two individuals, that is, one seeking help and the other, a professional, trained
person, who can help the first.
There should be a relationship of mutual respect between the two individuals. The counselor
should be friendly and co-operative and the counselee should have trust and confidence in
the counselor.
The aim of counseling is to a help a student’s form a decision, make a choice or find a
direction at some important fork in the road such as that of planning a life career, a
programme in college or university, or a campaign to obtain employment.
It helps the counselee acquire independence and develop a sense of responsibility. It helps
him explore and utilize his potentialities and actualize himself.
It is more than advice giving. The progress comes through the thinking that a person with a
problem does for himself rather than through solutions suggested by the counselors.
It involves something more than the solution to an immediate problem. Its function is to
produce changes in the individual that will enable him to extricate himself from his
immediate difficulties. It concerns itself with attitudes as well as action.
Emotional rather than purely intellectual attitudes are the raw material of the counseling
have their place in the counseling process. But it is the emotionalized feelings which are
most important.

Counseling and Psychotherapy

Differences between Psychotherapy and Counseling
Psychotherapy has roots in Freudian psychodynamics, so that a medical aspect to the
training was involved in the past, which lends it an air of respectability.
The training period for psychotherapy is long, and involved working with real clients under
supervision. The courses in counseling have training shorter and less intensive.
Also, psychotherapy requires a long period of self-analysis.
Psychotherapy focuses on in-depth consideration of past issues.
As compared to psychotherapy, counseling courses are short, cheaper and more accessible
courses and they are very inclusive. Working mothers, part time workers, the unemployed
etc. can normally find some way to take some form of counseling course.
Psychotherapy involves working in greater depth than counseling, that clients see their
therapist more frequently and for a long period of time. By contrast counseling takes place
over a shorter period of time.
Counseling is seen to be about short-term help, and psychotherapy about longer term. The
focus in psychotherapy is on the past causes of the issues whereas the focus of counseling is
in regard to the present issues.
Psychotherapy is concerned with some type of deeper personality change; but counseling is
concerned with helping individuals develop their full coping potential in regards to some
particular issue.
The setting of the treatment in counseling session often takes place in a number of non-
medical settings such as an office or small therapy center, or even in the therapists flat.
Whereas Psychotherapy is often thought of as taking place in a more medical setting,
perhaps a clinic or hospital.
Psychotherapy is better for those who find it difficult to open up,
Counseling, according to Morgan-Ayers, is a process in which the therapist is there as a ‘tour
guide’ for the client, refocusing them in a process that they are otherwise quite good at
exploring themselves.

Similarities between Psychotherapy and Counseling

The aims of both are similar.
Both can be seen as an attempt to allow the person to build up resources to live in more
healthy, meaningful and satisfying ways, and to develop self-awareness.
Also, a high degree of respect for the autonomy of the client is a basic principle in both
counseling and Psychotherapy.
Both counseling and psychotherapy involve clear contracts between the therapist and the
client as to what the aims are and the roles involved.
Both counseling and psychotherapy require the therapist to have highly developed skills.
Counseling and psychotherapy are different. Although the psychotherapist uses counseling
as one of the techniques of treatment, psychotherapy is usually concerned with individuals
whose behavior is neurotic. While it deals with repressed individuals, counseling is
concerned with normal anxieties. Psychotherapy operates in a medical setting, whereas
counseling operates in an educational environment. The psychotherapist uses play therapy,
psychodrama, and socio-drama as techniques.
In counseling, such techniques are used as can be employed in educational institutions and
individual establishments. Psychotherapy is deeper in scope, whereas counseling has wider
implications. A counselor cannot be a psychotherapist, but a psychotherapist being better
and specially qualified can be a counselor.

Classification of Counseling
Generally, categorization of counseling is based on the nature and character of situation, age
group, community, society, etc.
There are so many classifications of counseling like students counseling, educational
counseling, interpersonal and intra personal counseling, adolescent counseling, social
counseling, marriage counseling, pre-marital counseling, counseling related to any kind of
behavior, habits and attitudes, career counseling, counseling related to social problems,
industrial counseling, management counseling, counseling of life-threatening factors…etc.
So, the subject of counseling is like big ocean. No definite definition and a single tested
approach can be applied for all cases. It is heterogeneous in nature. Every case is different,
but approach can be common in most of the cases. Reasons are not same for the same
cases. Why? Man is a social animal with variable natures, attitudes, aptitudes, aspirations
reactions, different responsive nature. It is different from person to person. So, no single
approach and solutions can be offered. Every case has to be studied separately and to be
dealt carefully with deeper and committed insight
Counseling can thus be classified according to the nature of the problem, the complexity of
treatment, and the competence of the counselor. Some writers classify counseling in terms
of several factors. Lloyd Jones and Smith, for example, describe various levels of counseling
with respect to the depth of the problem, length of contact, degree of need, and the skill of
the counselor.
At the surface level is the counseling offered when the student wishes only some item of
information. The counseling given may be casual; it is brief, and it may be superficial in that
it is not extensive or intensive. The need for help is important even though slight, and the
relationship maintained through the brief contact should not be less than that maintained
during the long counseling session.
Counseling at the next level requires a more prolonged contact because the counselee needs
more of complicated information. He may, for example, wish assistance in planning a
programme of study for a two or a four-year period. As the problems become complicated
and as an intensive study of the case is required, and more specialized help is needed,
counseling at deeper levels becomes necessary.
When the student is seriously disturbed, therapeutic counseling may be needed. Williamson
feels that counseling is needed not only for helping individuals to gain insight into their
emotional conflicts but also for helping them with problems stemming from lack of
information, such as information about vocational aptitudes and interests or about work
opportunities, so that they may conduct their future adjustments in such a way that a
‘minimum of maladaptive repressions’ occurs.

Goals of Counseling
Counseling goals may be simply classified in terms of counselor goals and the client goals or
the immediate intermediate or long-range goals of therapy. Regardless of how one chooses
to classify the goals, counseling, like all other meaningful activities, must be goal driven,
have a purpose, or seek an objective. Broadly speaking counseling goals may be separated
into following categories:
Developmental goals wherein client is assisted in meeting his/her anticipated human growth
and development.
● Preventive goals
● Enhancement goals
● Remedial goals
● Exploratory goals
● Reinforcement goals
● Cognitive goals
● Psychological goals
● Physiological goals

Principles of Counseling
Relationship between the counselor and counseling is based on prevalent amount of trust,
confidence and openness. Here the counselor will be helping the client to find his existent
potentialities.
 Respect: This is a very important principle of counseling. The counsellor must
respect the client and whatever he or she is expressing with concern, respect and
understanding.
 Transparency and understanding in communication: The Counsellor must be
transparent and must not say something while thinking the opposite. Every attempt
should be made by the counsellor to understand whatever is being expressed by the
client with genuine interest and concern.
 Knowing the counsellor understanding him from his situation: This is yet another
important principle. In this the counsellor is expected to know the client completely
in terms of the facts gathered during interview and also view him and his problems
from the situation that the client faces.
  Availability: After giving an appointment at a particular time, the counsellor should
never miss the appointment. In case there is an emergency and the appointment
cannot be kept up, the counsellor must inform the client ahead in advance and
apologies for the cancellation.
 Privacy: Whatever is being told by the client has to be considered as completely
private and at no time this information should be conveyed to anyone without the
clear permission from the client.
 Positive approach and recognizing client’s potentiality: The counsellor must have a
positive approach towards the client and his or her problems and should recognize
the potentialities that the client has.
Focusing on follow up specifications.
Trustworthy and no misrepresentation/ black mail.
Constant /regular consultation is essential.

Steps in Counseling
The action of transition of theories into action is referred to as counseling process. A process
usually specified by a sequence of interaction of steps. Hackney and Cormier (1996)
identified the stages as follows:
● Relation establishment.
● Problem identification and exploration.
● Planning for problem solving.
● Solution application and termination.

THE SITUATION IN WHICH COUNSELING IS REQUIRED

The following are some of the situations in which counseling is needed:
1) When the student needs not only reliable information but an interested interpretation of
such information as meets his own personal difficulties.
2) When the student needs a wise, sympathetic listener with broader experience than his
own, to whom he can recount his difficulties and from whom he may gain suggestions
regarding his own proposed plan of action.
3) When the counselor has access to facilities for helping in the solution of a students’
problem.
4) When the student is unaware that he has a certain problem but, for his best
development, must be aroused to a consciousness of that problem.
5) When the student is aware of a problem and of the strain and difficulty it is causing, but is
unable to define and understand it, and is unable to cope with it independently. The
Psychoanalytical context, then, reducing tension becomes a major goal of counseling.
Because personality conflict is present all people, nearly everyone can benefit from
professional counseling. In as much the Psychoanalytical approach requires insights that in
turn rely on openness and self-disclosure.
Psychoanalytic theory usually views the client as a person in need of assistance in
restructuring his / her personality. The counselor in the role of expert will facilitate or direct
this restructuring. The client will be encouraged to talk freely, to disclose unpleasant,
difficult, or embarrassing thoughts.
The counselor will provide interpretation as appropriate, attempting to increase client
insights. This in turn may lead the client to work through the unconscious and eventually
achieve the ability to cope realistically with the demands of the client’s world and society as
a whole. In this process, among the techniques the psychoanalytic counselor may employ
projective tests, play therapy, dream analysis and free association, all of which require
special training for the counselor, usually available only at the doctoral level.
COGNITIVE BEHAVIOURAL APPROACH TO COUNSELLING

DEFINITION
The modern roots of Cognitive Behavioral Counseling can be traced to the development of
behavior therapy in the early 20th century, the development of cognitive therapy in the
1960s, and the subsequent merging of the two.
Behavior therapy, one of the earliest of the psychotherapies, is based on the clinical
application of extensively researched theories of behavior, such as learning theory. It was
during the period of 1950 to 1970 that behavioral therapy became widely utilized, with
researchers in the United States, the United Kingdom and South Africa who were inspired by
the behaviorist learning theory of Ivan Pavlov, John B. Watson and Clark L. Hull. The wide
use and acceptance of behaviorist model can be attributed to its success in treating anxiety
disorders, and in being cost and time effective and often replicable, objective and “science-
like”.
However, early behavioral approaches were unable to effectively treat common disorders
such as depression. Behaviorism was also losing in popularity due to the so-called “cognitive
revolution”. The therapeutic approaches of Albert Ellis and Aaron T. Beck gained popularity
among behavior therapists, despite the earlier behaviorist rejection of “mentalistic”
concepts like thoughts and cognitions.
Behaviorist approaches did not directly investigate the role of cognition and cognitive
processes, such as thinking, problem solving, appraisal of situations by each individual etc.,
in the development or maintenance of emotional disorders, although their role was
gradually recognized as being of utmost importance.
In a sense, the present blending of behavioral and cognitive methods was stimulated by the
limitations of both psychodynamics and radical behaviorism. This blending was also
facilitated by the presence of several theoretical models that incorporated cognitive
variables along with the scientific and experimental rigor so precious to behaviorists.
This paved way for Cognitive therapy which is based on the clinical application of the more
recent, but now also extensive research into the prominent role of cognitions in the
development of emotional disorders. However, focusing only on cognitions, and with the
isolation of behaviors was seen as unfeasible and impractical.
The merging of these two schools of Behavior and Cognitive Therapy led to the formation of
the school of Cognitive-Behavioral Therapy (CBT) or Cognitive Behavioral Counseling. The
theoretical structure and basic method for CBT were outlined by Aaron Beck in a classic
series of papers published in the 1960s.
It is variously used to refer to behavior therapy, cognitive therapy, and to therapy based on
the pragmatic combination of principles of behavioral and cognitive theories. New Cognitive
Behavioral Counseling interventions are keeping pace with developments in the academic
discipline of psychology in areas such as attention, perception, reasoning, decision making.
Cognitive behavior counseling is an action-oriented form of counseling that assumes that
maladaptive or faulty thinking patterns cause maladaptive behavior and “negative”
emotions. The treatment focuses on changing the individual’s thoughts (cognitive patterns)
in order to change their behavior and emotional state.
The cognitive component in the cognitive-behavioral counseling refers to how people think
about and create meaning about situations, symptoms and events in their lives and develop
beliefs about themselves, others and the world.
During times of mental distress, people think differently about themselves and what
happens to them. Thoughts can become extreme and unhelpful. This can worsen how a
person feels. They may then behave in a way that prolongs their distress.
Cognitive behavioral counseling uses techniques to help people become more aware of how
they reason, and the kinds of automatic thought that spring to mind and give meaning to
things. The practitioners help each person identify and change their extreme thinking and
unhelpful thoughts and subsequently, behavior. In doing this, the result is often a major
improvement in how a person feels and lives.
It is a way of talking about:
• how one thinks about oneself, the world and other people
• how what one does affects one’s thoughts and feelings.
Unlike some of the other counseling approaches, it focuses on the ‘here and now’ problems
and difficulties. Instead of focusing on the causes of distress or symptoms in the past, it
looks for ways to improve one’s state of mind now.
Cognitive Behavioral Counseling helps in making the client recognize that one’s thoughts,
emotions, physical responses and actions, do not exist in isolation of each other. Rather, the
connection between each of them is explained and if required, demonstrated.
Each of these areas can affect the others. How one thinks about a problem can affect how
s/he feels physically and emotionally. It can also alter what one does about it. There are
helpful and unhelpful ways of reacting to most situations, depending on how one thinks
about them.
E.g. an individual goes to a party and meets and greets many people. However, an old friend
doesn’t return the individuals smile and walks past him. an unhelpful thought in such a case
may be that “He ignored me, which probably means that he doesn’t like me”. This thought
may lead to emotions of sadness, dejection and feeling low, probable physical problems
such as low energy, low appetite, sleep difficulties etc. This may lead to Action in the form of
leaving the party immediately, avoiding meeting that friend further etc.
In the same situation, if one thinks a helpful thought such as, “probably my friend did not
notice me, was absorbed or thinking about something else”, it will lead to no maladaptive
emotions or physical problems in the individual. He will be able to continue enjoying the
party and may even approach his friend and speak to him, if given a chance.
The same situation, thus can lead to two very different results, depending on how one thinks
about the situation. How one thinks has an effect on how one feels and what one does. In
the example, in the first case, the individual jumps to a conclusion without very much
evidence for it leading to:
• a number of uncomfortable feelings
• an unhelpful behavior.
This can be understood with the help of a diagram:
Dobson and Block (1988) suggested that Cognitive Behavior therapies share three
propositions:
1) Cognitive activity affects behavior
2) Cognitive activity may be monitored and altered
3) Desired behavioral change is achievable through cognitive change
Thus, Cognitive Behavioral Counseling can help the client to break the vicious circle of
altered thinking, feelings and behavior. When the client is able to see the parts of the
sequence clearly, s/he can change them - and so change the way s/he feels.
Hawton et al. (1989) offered a process-oriented definition proposing that Cognitive Behavior
therapies are typified by their:
• Expression of concepts in operational terms
• Empirical validation of treatment
• Specification of treatment in operational terms
• Evaluation of treatment with reliable and objective measures
• Emphasis on “here and now”
• Objective to help clients bring about desired changes in their lives
• Focus on new learning and changes outside the clinical setting
• Explicit description of therapeutic procedures to the client
• Collaboration of the client and counsellor to deal with identified problems
• Use of time limits and explicitly agreed goals.

BASIC TENETS

Objectives of Cognitive Behavioral Counseling

The aims of cognitive behavioral counseling are twofold:
1) To reduce distress by teaching skills to recognize, evaluate and change relevant cognitive
processes.
2) In later phases, to engender an understanding of themes in maladaptive cognitions in
order to modify enduring sets of attitudes and beliefs that are the basis of the client’s
vulnerability.
The approach to a problem involves the following steps:
• Eliciting automatic thoughts
• Testing their accuracy and viability
• Developing realistic alternatives
• Identifying and challenging underlying maladaptive schemata.
Three types of cognitive phenomena determine mental problems, especially those which are
emotional in nature:
Automatic thoughts, cognitive distortions, and schemata
Automatic thoughts are the more autonomous, often private cognitions that flow rapidly in
the stream of everyday thinking and may not be carefully assessed for accuracy or relevance.
Since many people are unaware of them, they become difficult to desist or change. E.g. in
depression, thoughts about loss, defeat, rejection or hopelessness are common. An
important component of treatment is to make clients aware of their negative automatic
thoughts. Often, clients are so accustomed to having negative thoughts, and the thoughts
come to them so quickly, that they are not even aware of having them. Furthermore, clients
rarely come into treatment having a clear understanding of the ways in which negative
thoughts impact affective, physiological, and behavioral processes. Therefore, a first step in
treatment is to help clients to become more aware of their thoughts, primarily through self-
monitoring exercises.
Cognitive distortions refer to misinterpretations of reality that lead to negative conclusions.
These include over-generalization (a single instance is taken as an example of a wide range
of situations), dichotomous thinking (only extreme points of view are considered),
personalizing (assuming oneself to be the cause of an event or problem) etc.
Schemas are fundamental rules or templates for information processing that are shaped by
developmental influences and other life experiences. Information about oneself and one’s
environment is perceived, stored, and recalled through schemata which are assumed to
evolve with repeated experiences. Once a schema is activated by a congruent mood state or
event, it dominates perceptions of current and future situations. Because they play a major
role in regulating self-worth and behavioral coping strategies, schemas are a frequent target
of CBT interventions.

The Process of Counseling

In the process of counseling, the counselor aims to blend empathy with an active and a
problem-focused approach. This active approach is also seen to be the responsibility of the
client. The client is expected to develop a curious and questioning attitude towards their
condition, trying to form hypotheses or links between their thoughts and feelings. The client
is also expected to participate actively with the counselor so that both of them reach an
understanding of his problems.
An important part of the process of counseling is assigning of Homework by the counselor
and the client being responsible for its timely completion. Homework exercises usually are
given in order to ensure generalization of skills acquired during the counseling sessions.
Completion of these exercises is associated with better outcomes. Homework also helps
structure counseling by serving as a recurrent agenda item that links one session with the
next.
Psycho education is another key feature of cognitive behavioral counseling. When possible,
the therapist uses illustrations from the client’s own experiences to demonstrate counseling
principles and procedures. For example, if a client exhibited a “mood shift” (a sudden
appearance of a strong emotion suggesting that he or she had just had an outpouring of
intense automatic thoughts) early in counseling, the therapist might pause to help the client
identify the automatic thoughts. Material gleaned from this process can then be used to
explain the basic cognitive model (the relationship between cognitions and emotions) and to
introduce the client to the concept of automatic thoughts. Readings and other educational
aids are also used extensively. Typically, clients are asked to read self-help books,
pamphlets, or handouts during the beginning phases of counseling. Workbooks can be used
for specific problems such as depression, obsessive-compulsive disorder, and other anxiety
disorders.
In a typical counseling session, an active, problem-focused style is followed. It usually begins
with a review of homework tasks followed drawing up an agenda for the session in order of
importance. Only a limited number of issues can be addressed in a single session. The
counselor seeks to identify salient cognitive and behavioral dimensions of the problem.
Specifically, the counselor tries to differentiate between objective reality and the client’s
subjective appraisal of the same. When the target maladaptive cognitions and behaviors are
identified, a range of strategies are used to evaluate their addictiveness, and to develop
more realistic and useful alternatives. At the end of the session, the counselor reviews the
material covered in the session, seeks the clients feedback, and gives a homework
assignment to be completed before the next appointment.

Therapeutic Relationship
The counsellor assumes the role of educator, teaching the client about cognitive models that
have been developed to understand the etiology and, more importantly, the maintenance of
the client’s specific problems. The counsellor is also responsible for teaching clients the
cognitive and behavioral techniques designed to alleviate their problems. The client is
considered to be the expert on his or her personal experiences, and the two of them work
together to overcome the client’s difficulties.
As in other counseling approaches, the counsellor-client relationship is important in
cognitive counseling and provides the medium for improvement. Counselor function as
guides to enable their clients to acquire the understanding that will help them to cope better
with their problems—the process of guided discovery— and also as catalysts to promote the
kind of corrective experiences outside of counseling that will enhance the clients’ adaptive
skills. The counsellor plays an active role in helping to pinpoint present problems, focusing
on important areas, proposing and rehearsing specific cognitive and behavioral techniques,
planning homework assignments, and re-evaluating the experiences during counseling.
Most of the therapist’s verbal statements are in the form of questions, reflecting the basic
empirical orientation and the immediate goal of converting the client’s closed belief system
into an open system. The counsellor actively engages the client in working out the agenda
for each session and elicits feedback from the client regarding the counsellor’s suggestions
and behavior during the session.
The term collaborative empiricism is often used to describe the therapeutic relationship in
Cognitive Behavioral Counseling. A highly collaborative relationship is established in which
counsellor and client work together as a team to identify maladaptive cognitions and
behavior, test their validity, and make revisions where needed. A principal goal of this
collaborative process is to help clients effectively define problems and gain skills in managing
these problems. As in other effective counseling approaches, cognitive behavioral counseling
also relies on the nonspecific elements of the therapeutic relationship, such as rapport,
genuineness, understanding, and empathy.

TECHNIQUES
Several Cognitive and Behavioral techniques are used by the counselor in order to arrive at
maladaptive cognitions and also to help replace them with more adaptive ones.

Cognitive Techniques
 Cognitive Rehearsal: In this technique, the client is asked to recall a problematic
situation of the past. The counsellor and client work together to find out the solution
to the problem or a way in which the difficult situation if occurs in the future may be
sorted out. e.g. a shy person may rehearse how to approach a shopkeeper and ask
for his required things.
 Validity Testing: The counsellor tests the validity of beliefs or thoughts of the client.
Initially, the client is allowed to defend his viewpoint by means of objective
evidence. The faulty nature or invalidity of the beliefs of the client is exposed if he is
unable to produce any kind of objective evidence.
 Daily Record of Dysfunctional Thoughts (DRDT): It is the practice of maintaining a
diary to keep an account of the situations that arise in day-to day life. The thoughts
which are associated with these situations and the behavior exhibited in response to
them are also mentioned in the diary. The counsellor along with the client reviews
the diary/journal and finds out the maladaptive thought pattern and how do they
actually affect the behavior of an individual.
 Modeling: It is one of the cognitive behavioral counseling techniques in which the
counsellor performs role-playing exercises which are aimed at responding in an
appropriate way to overcome difficult situations. The client makes use of this
behavior of the therapist as a model in order to solve the problems he comes across.
 Homework: The homework is actually a set of assignments given by counselor to
clients. The client may have to take notes while a session is being conducted, review
the audiotapes of a particular session or he may have to read article/books that are
related to the counseling.
 Aversive Conditioning: Among the different techniques used by counselors, the
aversive conditioning technique makes use of dissuasion for lessening the appeal of
a maladaptive behavior. The client while being engaged in a particular behavior or
thought for which he has to be treated, is exposed to an unpleasant stimulus. Thus,
the unpleasant stimulus gets associated with such thoughts/behaviors and then the
client exhibits an aversive behavior towards them.
 Systematic Positive Reinforcement: The systematic positive reinforcement is one of
the techniques in which certain (positive) behaviors of a person are rewarded with a
positive reinforcement. A reward system is established for the reinforcement of
certain positive behaviors. Just like positive reinforcement helps in encouraging a
particular behavior, withholding the reinforcement deliberately is useful in
eradicating a maladaptive behavior.
 Evidence Record: When people feel upset about something, they may have
thoughts that they believe confirm their feelings. People may also have negative
thoughts about themselves, such as “I am a loser” or “Nobody likes me.” Persons,
Davidson and Tompkins suggest using an Evidence Record to test the validity or
 truthfulness of these thoughts. List everything that supports the thought and
everything that disproves the thought to create this record. This can help determine
if negative thoughts are the result of a mood, or if they’re based on truth.
 Positive Data Log: Thoughts can contribute to distress and affect behavior. Persons,
Davidson and Tompkins developed a Positive Data Log to help change thoughts that
contribute to distress into thoughts that help people reach their goals. Choose one
thought that contributes to distress, such as “Nobody likes me.” Then, pick a mood-
enhancing thought, such as “I am likable.” In the Positive Data Log, record all
evidence that supports the helpful thought. For example, a bank teller smiling at you
may be evidence of likability. Therefore, you would record this in the Positive Data
Log.
The most important and frequently used cognitive technique is the use of questions that
encourage the client to break through rigid patterns of dysfunctional thinking and to see
new perspectives. The two terms most often used to describe this form of inquiry are
Socratic questioning (asking questions that guide the client to become actively involved in
finding answers) and guided discovery (a series of questions that help the client explore and
change maladaptive cognitive processes). Examples of some of the specific techniques that
might be included in guided discovery are examining the evidence exercises and two-column
analyses of the advantages and disadvantages of holding a core belief.

Behavioral Techniques
Activity and pleasant event scheduling are commonly used to help depressed clients’ reverse
problems with low energy. These techniques involve obtaining a baseline of activities during
a day or week, rating activities on the degree of mastery and/or pleasure, and then
collaboratively designing changes that will reactivate the client, stimulate a greater sense of
enjoyment in life, or change patterns of social isolation or procrastination.
Graded task assignments, in which problems are broken down into pieces and a stepwise
management plan is developed, are used to assist clients in coping with situations that seem
especially challenging or overwhelming.
Some of the most useful behavioral methods for treating anxiety disorders are hierarchical
exposure to feared stimuli, relaxation training, and breathing training. Exposure protocols
can be either rapid or gradual. Typically, a hierarchy of exposure experiences is developed,
with sequential increases in the degree of anxiety provoked. Clients are encouraged to
expose themselves gradually to these stimuli until the anxiety response dissipates and they
gain a greater sense of control and mastery. Progressive relaxation and breathing exercises
may be used to reduce levels of autonomic arousal and support the exposure protocol.
These techniques also may be used alone to help manage panic attacks or other symptoms
of anxiety disorders.
One particularly useful way to encourage the client to use behavioral skills learned in
counseling sessions is to develop a coping card. Key elements of a coping strategy or
management plan—typically including both behavioral and cognitive strategies—are
recorded on a small card that the client carries at all times. Coping cards might contain, for
example, antisuicide plans detailing what to do if suicidal thoughts return, strategies for
coping with critical remarks from a spouse, or specific ideas for combating procrastination at
work. Coping methods that are generated and rehearsed in counseling sessions are then
carried out with the help of coping cards in real-life situations.

RECENT RESEARCH AND ADVANCES

The Evidence Base for Cognitive Behavioral Counseling

Treatment interventions have demonstrated the effectiveness of cognitive behavioral
counseling in the treatment of common mental health problems, including the anxiety
disorders, generalized anxiety, panic, phobias, obsessive compulsive disorder, posttraumatic
stress disorder, bulimia and depression.
It has also been developed for use in an increasing range of mental health and health
difficulties including severe and enduring mental health problems, such as psychosis,
schizophrenia, bi-polar disorder, anger control, pain, adjustment to physical health
problems, insomnia and organic syndromes, such as early-stage dementia.
There is an extensive research base around this approach in working with children and
people with learning disabilities, severe and enduring mental health problems and “difficult
behavior” generally.
Research into the contribution of psychological factors to physical health problems (such as
low back pain, chronic fatigue, recovery from surgery for example) is growing and has led to
the development of Cognitive behavioral approaches in these areas.
Developments in cognitive-behavioral counseling research, theory and practice are occurring
rapidly. Its application of is happening in many fields other than mental health, e.g.
education and training, public health, organizational psychology, forensic psychology,
management consultancy, sports psychology for instance.

Computer Assisted Counseling

One of the newest and most interesting methods of conducting cognitive behavioral
counseling is through computer-assisted counseling. Multimedia software has been shown
to be effective in the treatment of depression, and innovative multimedia programs using
virtual reality have been developed for exposure counseling for anxiety disorders. In one
study, a computer-assisted counseling software program was shown to be superior to
standard counseling in helping clients acquire knowledge about the counseling sessions and
in reducing maladaptive cognitions. Computer programs are typically combined with the
human elements of counseling in an integrated treatment package. There are cognitive
behavioral counseling sessions in which the user interacts with computer software (either on
a computer, or sometimes via a voice-activated phone service), instead of face to face with a
therapist. This can provide an option for clients, especially in light of the fact that there are
not always therapists available, or the cost can be prohibitive. For people who are feeling
depressed and withdrawn, the prospect of having to speak to someone about their
innermost problems can be off-putting. In this respect, computerized counseling can be a
good option.
Computer-assisted counseling can be used to decrease the amount of clinician time required
for effective counseling, provide stimulating psychoeducational experiences, and offer
engaging alternatives to standard treatment

INDICATIONS FOR COGNITIVE BEHAVIORAL COUNSELING

Cognitive behavioral counseling can be used to:
1) Remove or moderate the symptoms of the disorder as a sole treatment or in combination
with medication;
2) Reduce the likelihood of relapse or recurrence;
3) Increase adherence to recommended medication treatment;
4) Address specific psychosocial difficulties (e.g., marital discord, low self-esteem) that may
either have preceded or been caused by the problem; or
5) Modify underlying beliefs (schemas) that contribute to dysfunctional personality trends or
disorders.
The indications for cognitive behavioral counseling are determined more by client and
counsellor variables than by the nature of the problem.
Clients: The ideal clients are psychologically minded; able to recognize and label their
emotions; to become aware of their automatic thoughts; and to see the connection between
thoughts, feelings, and behaviors. The degree of fit between the client’s own personal
notions of psychology and the basic cognitive model is important. Clients who adhere to
such popular notions as the relation between stress and psychological disorders and the
importance of self-control seem to benefit more from cognitive behavioral counseling than
those wedded to Freudian concepts such as the unconscious and infantile fixations. High
intelligence is not a prerequisite. Motivation for counseling is important but not initially
crucial. Some hopeless, unmotivated, or depressed clients become highly motivated once
they experience improvement.
Counselor: As in any counseling approach, counselor characteristics are important. The ideal
counselor is psychologically minded, versatile, attentive, empathic, and uncritical. They do
not bring their own “personal baggage” (such as the need to control or show off) into the
counseling session. Skill in conducting cognitive counseling is obviously important for
successful treatment. Several studies have shown a surprisingly high correlation between
counselor’ competency and successful outcome. Counselor who are skilled at educating
clients about the cognitive nature of their problems and how to resolve them seem to get
the best results.

CRITICAL APPRAISAL
Strengths
In many ways, cognitive behavior counseling has changed the fields of psychotherapy and
clinical psychology (Wilson, 1997). The several major ways that it has had an impact include:

Effectiveness
There is ample evidence that cognitive-behavioral counseling is effective (Chambless et al.,
1998; Emmelkamp, 1994; Hollon & Beck, 1994; Smith et al., 1980). In fact, it appears to be
the treatment of choice for many disorders (Wilson, 1997). On average, a client who
received any of the forms of cognitive behavior counseling was functioning better than at
least 75% of those who did not receive any treatment.

Breadth of Application
A contribution of major proportions has been the extension of the range of applicability of
counseling. Traditional counseling had been reserved for the middle and upper classes who
had the time and money to devote to their psychological problems. Cognitive Behavioral
counseling has changed all that. Now, even financially strapped individuals with a wide range
of psychological problems and disorders and even chronic mental illness can be helped by
counseling. Clients at lower socio-economic levels with limited sophistication were offered
hope by these broad band of counseling techniques.

Limitations
Notwithstanding frequent successes with different individuals, for no obvious reason, some
clients do not respond to cognitive behavioral counseling. Some with longstanding chronic
conditions who have been treated by many professionals without lasting results may not do
well in time-limited counseling. Sometimes an appropriate pharmacological agent added to
counseling may produce better results. The counsellor should also consider a change of
strategy; for example, spending more time on empathic listening and less on exploration or
becoming more active and directive.
Several limitations to this treatment are suggested by clinical experience. Clients with
severely impaired reality testing (e.g., fixed delusions) or impaired reasoning abilities or
memory function (e.g., organic brain syndromes) do not appear to respond well to cognitive
behavioral counseling. However, cognitive methods may have a place even in those
conditions if integrated into a total therapeutic regimen.
Cognitive behavioral counseling has come under fire from therapists who claim that the data
does not fully support the extent of attention and funding it receives.

BEHAVIOUR AND COGNITIVE THEORY OF COUNSELLING

Behavior therapy, evolved from the theories of learning formulated by Pavlov, Watson,
Thorndike, Skinner, Wolpe and Eysenck, and later from the experiments of Bandura and
other psychologists who were interested in the effects of observation on the individual’s
learning experience. The behavioral approach, widely used in the 1950s, emphasized the
importance of overt behavior and its environmental context.
Behavior therapy has been effective in shifting attention away from the intensely
introspective approach to clients. The Freudian approach, emphasized on the role of
unconscious forces and unseen impulses which were the root cause of most human
problems. In order to deal with these problems, it was necessary to engage in a series of
verbal transactions between client and therapist, as they would throw light on the hidden
areas of personality.
Contrast to this, the behavioral approach focuses directly on the client’s undesirable
behavior. This approach facilitates relearning and healthy behavioral change through various
methods.
The rationale of behavior therapy is that maladaptive and neurotic problems which have
been learned can, according to the same principles of acquisition, be unlearned.
The counselor or therapist is concerned with a person’s observable behavior, and also with
the environmental context in which behavior takes place. Details of the past are important
only to relate to present behavior and to understand the client’s emotional life. The term
‘counter-conditioning’ is sometimes used to describe the processes and techniques which
are central to behavior therapy.

The Therapeutic Relationship

The behavioral approach places some emphasis on the quality of the client counselor
relationship. The importance of rapport and partnership within the therapeutic relationship
is recognized. Richards and McDonald (1990) refer to this ‘joint approach’ which they see as
necessary, especially in the early stages of counseling. In relation to handling strong
emotions expressed by clients, they also stress the value of using ‘empathic statements’
which will convey the counselor’s attitudes of acceptance and understanding. Empathy,
therefore, has some place in behavioral counseling, but is not especially highlighted or
deliberately fostered.
Clients are encouraged to become active participants in their own therapy. A fundamental
goal of the behavioral approach is to encourage a sense of personal control in clients. Clear
communication between counselor and client is valued, and this is especially relevant in
relation to specific problem behavior which needs to be changed, and the goals which the
client wishes to achieve. They are also directive in formulating and maintaining individual
programmed of therapy for clients.
Focus of Therapy – In behavioral counseling there is strict adherence to principles and
procedures, which have been scientifically tested for their effectiveness in relation to
specific problems. Techniques and methods used are adapted to meet the individual needs
of clients.
A basic aim of counseling is to enable clients to exercise more control over their own
behavior and the environment.
Another aim is, to help clients reduce the distress, anxiety and inconvenience central to
most behavioral problems.
Behavioral counseling can also be conducted in groups, and this is highly successful for
therapy since many client’s experience problems in their social and family relationships. The
group becomes a source of support and feedback for clients, provides valuable training,
opportunities for overcoming limited skills and changing problem behavior in a safe
environment.

The Initial Assessment

The initial assessment of the client’s problems should be accurate and comprehensive so
that an individual action plan can be devised. The client’s problems should be identified
early, and these should also be set in the context in which they occur. In addition, the
client’s physical and emotional responses in these situations need to be identified. The
following considerations are also important:
• The nature of the problem
• The client’s first experience of the problem and where it occurred
• The sequence of events following the experience
• Factors which may have prompted the problem
• The client’s actions and thoughts in the problem situation described How frequently the
problem behavior occurs
• The duration and intensity of the problem behavior
• Any factors which worsen or relive the problem
• Effects of the problem on aspects of everyday life, including work, social life and family
• Identification of other people associated with the problem.

Observation of Clients
Apart from the information clients convey verbally at the initial assessment, they also
provide non-verbal clues about the nature and severity of their problems. Changes in voice,
tone and general demeanor will, for example, say much about the level of distress a specific
problem causes to a client.
Interview assessment affords an opportunity to identify the factors which individual clients
find personally reinforcing. These factors include praise, attention and encouragement, and
they can prove useful in helping clients to change problem behavior.

Setting and Implementing Goals

The setting of specific goals follows the initial assessment or behavioral analysis. These goals
need to be considered jointly by both client and counselor, and the client should be fully
aware of the purpose of these, goals.
Commitment to objectives is important too, and one way of achieving this is to establish a
contract between counselor and client in which desired changes are clearly stated. It is
essential that clients experience some measure of control in the setting and implementation
of goals and to this end ongoing communication and negotiation between client and
counselor is the norm.
When goals have been discussed and correctly defined, an action plan is set up and a
definite decision is made by both client and counselor to work together.
There are some clients who do not respond well to a behavioral approach. In behavioral
therapy, assessment continues throughout all the sessions. This is important in order to
ensure that goals are either being met or altered in the light of changing situations.

Behavioral Methods and Procedures

The methods and procedures used in behavioral therapy are all designed to meet the needs
of individual clients. However, behaviorism does have within its repertoire a wide range of
methods which can be used with clients and counselors’ creativity and innovations are
valued as well.
Some of the behavioral techniques, which are frequently used successfully in Therapy:
• Relaxation training
• Systematic desensitization
• Client self-monitoring
• Practicing and planning behavior
• Assertiveness training
• Social skills training
• Reinforcement methods
• Modeling
• Focus on physical exercise and nutrition
• Imagery and visualization

[Link] Training: Anxiety and stress are common problems for many clients who seek
behavioral counseling. In view of this, relaxation training is a central focus of the approach
and is used extensively for a variety of problems. Anxiety affects people at three levels –
psychological, physiological and behavioral. When clients talk about anxiety, they sometimes
describe it as a vague feeling of losing control or as a sense that something awful will
happen.
Anxiety tends to increase the heart and breathing rates and may cause a variety of other
symptoms including muscle tension, irritability, sleep problems and difficulty in
concentrating. Counselors can show clients how to reduce these effects by teaching
concentration on the following key areas:
Many anxious people tend to breathe in a shallow fashion from the chest, and clients can be
taught to change this pattern so that deeper abdominal breathing is learned. This has the
effect of increasing oxygen supply to the brain and muscles which, in turn helps to improve
concentration, promote a state of calmness along with deeper feelings of connectedness
between mind and body. When deep breathing is accompanied by progressive relaxation of
body muscles, and visualization of a peaceful scene, reduction of general anxiety is bound to
follow
Clients can be taught to set aside time each day for relaxation, and this is especially
beneficial for those people who suffer from stress-related conditions such as tension
headaches, poor sleep patterns and high blood pressure.

Activity
[Link]
The technique to make a person relaxed is given in the box below. Sit quietly in a chair until
you feel still and comfortable. Beginning with your feet, allow all the muscles of your body to
relax. Place your hand on your abdomen and breathe in slowly and deeply through your
nose. You should feel your abdomen extend as you do this. Now breathe out slowly through
your mouth, noting how your abdomen returns to its usual shape. Repeat the breathing
exercise for about five minutes, then sit still again and experience your relaxed state. A slight
variation of the exercise is to repeat a chosen word or phrase each time you breathe out.

[Link] Desensitization
Systematic desensitization is a technique devised by Joseph Wolpe. It is used in behavioral
counseling as a means of helping clients deal with irrational fears and phobias. Wolpe
believed that anxiety responses are learned or conditioned, and that it is possible to
eliminate these responses if the anxious individual is helped to relax in the face of the
anxiety-producing stimulus. The person is, therefore, ‘systematically desensitized’ to the
fearful object or situation through a process of exposure to it, while in a relaxed state.
Progressive muscle relaxation methods and deep breathing are integral to this technique,
and clients are taught how to reduce anxiety in this way before they confront their fear.
Constructing an appropriate ‘hierarchy’ is another important feature of systematic
desensitization, and involves outlining a series of situations or scenes relating to the phobia.
Each scene in the hierarchy is ranked from mildly anxiety-provoking to extremely anxiety-
provoking.

Case Study 1: Constructing Hierarchy

The following is an example of a hierarchy which was used to help a client called Vanitha,
aged twenty, who had a phobia about eating in front of strangers. Vanitha’s phobia was
embarrassing and inconvenient because it meant that she refused to socialize on many
occasions. She also found herself increasingly isolated at work, and decided to seek help
when she no longer felt able to accompany her friends to the lunch canteen. The counselor
taught Vanitha the relaxation procedure and breathing methods and then helped her to
design and work though the following hierarchy, which she was encouraged to practice on
regular basis.
Visualize:
 Asking a close friend to accompany you on a visit to a restaurant.
 Phoning a restaurant to make a reservation.
 Getting dressed for your evening out.
 Doing your hair and putting on makeup.
 Opening the door to greet your friend.
 Walking to the restaurant a short distance away.
 Meeting people along the way.
 Passing other cafes and restaurants as you walk along.
 Arriving at the door of the restaurant.
 Speaking to the waiter about your reservation.
 Walking to the table with your friend and the waiter.
 Looking at the menu and discussing it with your friend.
 Placing an order with the waiter.
 Looking at your food when it arrives.
 Picking up the knife and fork and starting to eat.
 Tasting the food and enjoying it. Looking around at the other diners.
 Noting that other people are enjoying themselves, becoming aware that other
people occasionally glance at your table.
 Continuing your meal and the conversation with your friend.

Designing the Hierarchy

Clients need to give a detailed history of the phobia, with special emphasis on those aspects
of it which cause the most anxiety. What made this client most anxious was the thought of
being observed while eating. For this reason, observation was presented towards the end of
the hierarchy which meant that Vanitha could work gradually towards it.

[Link]-life Desensitization
This exercise was based on imagery, and that later on the client and counselor constructed a
hierarchy for ‘real-life’ exposure. Real-life desensitization is perhaps the most effective
method of dealing with phobias, and is quite often used following a period of visual or
imagery desensitization.
‘Exposure therapy’ is another term used to describe this form of treatment, and it is
especially effective for phobias which include a ‘social’ element. However, real-life exposure
does take time, because the introduction of anxiety-provoking stimuli needs to be very
gradual. Not all clients with phobias are willing to undertake real-life exposure, since the
process causes some degree of initial discomfort at least. It also needs to be practiced over a
period of time, on a regular basis and in spite of probable setbacks.

[Link] Self-Monitoring
In behavior therapy, clients are sometimes asked to maintain records of their behavior,
which are problematic along with any attendant conditions. A self-record may take the form
of a daily diary, and one of the benefits of this kind of self-monitoring is that clients often
react to their own observations by reducing the frequency of their own problem behavior.
People, who smoke, for example, may not realize how many cigarettes they get through in a
day, until they see the evidence on record. Client self - monitoring does have great
therapeutic potential, though clients need to be well motivated to pursue it.

[Link] Training
Assertiveness training is widely used in behavior therapy and counseling. Clients often
experience difficulties in several key areas which include:
• Expressing their feelings
• Asking for what they need or want
• Saying no to requests from others
The most important aspect of assertiveness training is in helping clients differentiate
between ‘submissive’, ‘aggressive’ and ‘assertive’ styles of communication. When people are
submissive, they tend to ignore their own rights and needs, and this can result in feelings of
depression and anger which are never really expressed. Aggressive people may be bullying
and demanding, characteristics which inevitably alienate others. On the other hand,
assertive behavior involves direct person-to-person communication, without manipulation,
hostility or self-abnegation.
Assertiveness training is often conducted in a group setting, and non-assertive clients who
express an interest are sometimes referred to them so that they can increase their self-
awareness and confidence generally.

Case Study – 2: Assertiveness

Suma who was twenty-seven and unemployed attended an assertive training programme.
During the first session, the group facilitator asked each person to identify their usual style
of relating to others. Suma said straight away that she usually found herself helping other
people. She found it difficult to refuse once someone asked her for help. When she did help,
she often felt resentful afterwards. In spite of her resentment, however, she lacked the
courage to refuse friends or family when they made their requests. During the training
sessions, the group facilitator helped Suma to see that it wasn’t courage but skill which she
lacked in dealing effectively with repeated requests.

The course provided Suma and the other group participants with a set of skills which would
help them develop assertiveness. They were taught to differentiate between assertive,
aggressive, passive and manipulative behavior. They were also given practice in dealing with
conflict, expressing feelings appropriately, dealing with awkward situations, and saying ‘no’
confidently.
The skills which Suma learned on the course helped her in her next job interview. She did
not allow herself to become overawed by the interviewers. She expressed herself
confidently and clearly, and was offered the job. In addition, Suma stopped giving in
automatically to family and friends when they asked for favors.

[Link] skills Training

Clients also frequently experience difficulties in social situations, and this is another area in
which behavioral counseling offers some support to clients. Practicing and planning behavior
is one aspect of social skills training, and this may take the form of role play of a specific
situation seen as problematic or daunting by the client. The practice of interview techniques
is one example of this kind of approach, and in behavioral counseling such methods and
techniques are commonly used. In social skills training there is an emphasis on setting
achievable goals so that maximum positive reinforcement is obtained for new behaviors
early on.

[Link]
Observational learning or modeling is sometimes used to help client’s acquire new forms of
behavior. The emphasis in this technique is on showing clients that certain behaviors can be
undertaken (in this case by the counsellor) in a calm and non-threatening way. This is
especially effective when used in conjunction with systematic desensitization, especially
when the counselor ‘models’ the behavior which the client associates with anxiety and
stress. Videotapes are sometimes used as part of a modeling programme, and ‘participation
modeling’ is another variant.
This technique refers to a process in which both client and counselor participate. A
counselor might, for example, model attitudes of composure and calm while walking into a
restaurant. Later on, the client can practice this behavior in the company of the counselor.

[Link]
Understanding of reinforcement principles is essential in behavioral counseling. Certain
problems, such as persistent cleansing rituals or hypochondria, require environmental
reinforcement to make them continue.
As Avery (1996) points out, people who look for dirt will always find it, and those who seek
reassurances about their health are likely to get it from friends and family. In these two
problem situations the environmental reinforcement can be broken, in the next instance, by
helping the client to interrupt the cleansing ritual and substituting something else. In the
second instance, they can enlist the help of the client’s friends and persuade them to
‘withhold reassurance’.

Positive Reinforcement
Positive reinforcement is based on the work of Skinner and his theory of operant
conditioning. The behavioral approach to counseling places considerable emphasis on the
practice of systematically reinforcing a client’s desired behavior, while at the same time
ignoring any problematic behavior. If positive reinforcement is continued over a period of
time, then maladaptive behavior should become extinct.

Clients can also be encouraged to identify and use their own reinforcers. This kind of self-
reinforcement will vary for different-clients, but activities which are calming or relaxing are
effective in most cases. One client, a woman in her mid-forties, suffered from obsessive
compulsive disorder (OCD), which in her case took the form of persistent tidying and
checking. In conversation with her counselor, she mentioned that she used to love playing
the piano, and later on she returned to this interest and used it as a calming self-reinforcer
which helped her to break the tidying and checking compulsion.
 [Link] Exercise and Nutrition
In recent years a great deal of attention has been given to the importance of exercise and
diet in the maintenance of individual fitness. Although the link between physical health and
these two factors has always been accepted, the significance of diet and exercise in relation
to psychological health was traditionally less emphasized. Clients often eat less or more
while under stress and it is a good idea to address this aspect of their behavior with them.

Case Study - 3: Diet and exercise One client, called Jaya, described the depression and
feelings of tiredness that she experienced at work. During counseling, she revealed that she
regularly skipped breakfast, and then snacked on convenience food for the rest of the day.
She also worried about her weight, and took no exercise because she felt she was too busy
to do so. Through a process of self-monitoring, Jaya was able to chart her mood swings in
diary form, and afterwards to see that her depression was certainly exacerbated by dietary
neglect and inertia.
It is possible to ‘unlearn’ patterns of behavior which contribute to feelings of depression,
stress and tiredness, and it is also possible for clients to re-learn’ healthier habits though
they do need encouragement, feedback and support in order to do this.

CLIENTS WHO BENEFIT FROM THIS APPROACH

Clients with a wide range of problems – phobias, certain aspects of depression and lack of
assertiveness respond well to behavioral counseling. However, any psychological difficulty
manifest through observable behavior is likely to respond well to this approach. Clients who
suffer from obsessions and compulsions often find that behavioral counseling enables them
to deal more effectively with their problems. People with sexual difficulties often seek help
through behavioral therapy and counseling, and clients with speech problems such as
stammering or an inability to speak publicly-can also be helped. Behavioral therapy is widely
used in stress management and assertiveness training and its principles arc applicable in the
management of childhood behavior problems, and very often care of the elderly

LIMITATIONS OF BEHAVIOUR THEORY OF COUNSELLING

The behavioral approach is especially helpful in dealing with problems manifest through
overt behavior. This strength is, in fact, also its weakness, since the problems often stem
from deeper and hidden origins which need to be addressed in the long-term. A client who
has a phobia about the dark, for example, may well respond to a behavioral approach in
counseling, but unless the hidden insecurity which prompted the phobia in the first place is
identified, lasting cure of the problem is unlikely. On the other hand, even temporary
alleviation of the phobia might give the client sufficient inclination to look at less obvious
issues, so that overall real progress is made and insight gained. Clients need to be fully
committed, especially at the beginning of counseling when stress levels are high and the
gratification gained obtained through problem behavior is still very attractive.
Counselors who work from a strictly behavioral perspective are at risk of adopting a
mechanistic or over-simplified view of clients. This is because a basic principle of this
approach is that people react in an automatic way to stimuli – a view which leaves little
room for the influence of thinking, or cognition in determining behavior. However, now,
there is an increasing emphasis on the role of thinking in determining behavior, which
means that clients seeking help are now more likely to be offered Cognitive-Behavior
Therapy than the older form of behavior therapy.

COGNITIVE THEORY OF COUNSELING

Cognitive counseling provides a model for understanding and intervening in human behavior
in which the point of entry is through the thinking process. The fundamental assumption is
that more effective thinking will result in more satisfactory (to the client) behavior and
feelings. For certain clients, identifying faulty thinking and learning more effective ways of
viewing life experiences can result in rapid improvement.
Cognitive counselors regard erroneous thinking as the source of emotional upset and
ineffective behavior. Events occur in each person’s life that involve loss, disappointment, and
failure to accomplish valued goals. Cognitive therapists believe that people who are able to
think effectively about their experiences are able to put negative events in perspective and
get on with life, and those who do not think effectively tend to perseverate on negative
happenings and allow them to disrupt their happiness and effectiveness.
Albert Ellis (1997), founder of rational-emotive behavior therapy, is probably the best-known
cognitive therapists. Like Rogers and Perls, he was trained as a psychoanalytic therapist, but
he came to believe that the traditional approach was inefficient and that the process
sidetracked clients from learning how to live more effectively. Influenced by learning theory,
Ellis began to develop a new approach to counseling in which clients are taught to think
rationally about blocks to accomplishing love and work goals. Psychiatrist Aaron Beck and
psychologist Donald Meichenbaum has both gained recognition for their development of
related theories of cognitive counseling and psychotherapy.

The Nature of People

For cognitive theorists, humans are thinking beings with the capacity to be rational or
irrational, erroneous or realistic, in their thinking. According to Patterson and Watkins
(1997), “Cognitive therapy is based on the commonsense idea that what people think and
say about themselves-their attitudes, ideas, and ideals-are relevant and important”.
Cognitive therapists subscribe to the view that what people think about their experiences
determines how they feel about those experiences and what they will do.
Ellis, Beck, and Meichenbaum all posit internal dialogue that mediates a person’s reactions
to stressful events. Ellis explains that negative emotion and ineffective behavior are the
results of irrational thinking. It is not the events in people’s lives that create bad feelings, but
how they think about these events. For example, suppose a person is snubbed at a party by
someone he or she thinks is attractive. Such an event might be unpleasant for almost
anyone, but it becomes a problem, according to rational-emotive behavior therapy (REBT),
when the snubbed individual “catastrophizes” about the event. The individual may have
such “irrational” thoughts as “I can’t stand being snubbed” or “If this person can’t like me,
no one else ever will.”
If the person simply thinks, “It’s too bad that person snubbed me; I’d like to spend time with,
him or her,” then negative emotion will not get out of hand and the person can plan to work
toward another opportunity for contact. However, if the person catastrophizes about the
incident, negative emotion and ineffective behavior result. Energy is wasted in self-pity and
in either avoiding contact with or planning retaliation against the other person. Such
behavior does not achieve the desired result of having further opportunity to spend time
with the person.
The REBT view of personality is often referred to as an ABC theory, in which A is an activating
event, B is the person’s thought about the event, and C is the emotional and behavioral
reaction. If the thinking at B is irrational, the emotional reaction will be negative and the
behavior is likely to be inappropriate and ineffective for accomplishing the desired outcome.
This is a highly active and directive approach which incorporates elements of teaching,
persuasion, debate and even humor within its repertoire.
There are many similarities between Beck’s and Ellis’s views of how humans come to behave
ineffectively. Ellis has listed eleven specific irrational thoughts. Anyone or more of which
may lie at the source of an individual’s difficulties. Examples include the following:
• “I must be unfailingly competent and perfect in all I undertake.”
• “It is horrible, terrible, or catastrophic when things do not go the way I want them to go”.
• I should always be loved and approved of by everyone.
• I cannot change my behavior because of my awful past.
• I have no real control over my problems, which are caused by external factors.
Ellis has identified all the statements as applying to love and/or work motives. It is easy to
see how extreme ideas like those just quoted would result in feelings that one could not be
successful and behaviors that are not well designed to bring about success.
Beck (1972) has focused more on the nature of erroneous thought processes than on
specific life events. He identified several patterns of erroneous thinking including the
following:

Selective abstraction: Focusing only on certain details while ignoring others.

Dichotomous thinking: Believing that everything is good or bad, black or white, with, nothing
in between.
Overgeneralization: Arriving at far-reaching conclusions on the basis of little data.
Magnification: Overestimating the importance of an event (the same as the REBT concept of
catastrophizing).
Arbitrary inference: Drawing conclusions that things are bad with no evidence.
Personalization: viewing events as related to oneself when they are not.

Ellis speaks of ‘irrational and rational thoughts,’ Beck of “automatic thoughts,” and
Meichenbaum of “self-instructions” all of which are spontaneous thought processes that
occur when an individual is confronted with experience. These thought processes derive
from adults’ instructions that children internalize while growing up and later apply to new
situations.
Thus, from this perspective, parenting practices influence one’s subsequent ability to think
effectively, to feel confident and competent, and to behave using the maximum amount of
one’s resources. For clients to change their behavior, they must learn new ways of thinking,
which is the means by which cognitive counseling achieves its purpose.

The Counseling Process

The counseling process has similar elements in each of the cognitive systems and cognitive
restructuring is the principal mechanism of change.
The first step is to have the client describe the stressful situations in his or her life and to
identify the faulty thinking that underlies the feelings. The counselor identifies the irrational
thoughts, automatic negative thoughts, and silent assumptions that the client uses to
interpret (erroneously) his or her experience. The cognitive errors and distortions may be
explained to the client, (as occurs in REBT), or discussion is structured so that the client
comes to see his or her errors of reasoning (as in Beck and Meichenbaum’s approach). Then
more adaptive alternative patterns of thinking can be developed.
In REBT, the alternatives are relatively easy to construct once the irrational thinking is
identified because they are direct modifications of Ellis’s list of irrational thoughts.
For example, the thought “I must be loved and accepted ‘by almost everyone” might be
modified to “It would be nice to be widely cared for, but there are some significant people
who like me and I can get along okay even if I don’t get the attention I want from everyone
else.’
The counseling process adds D & E components to ABC theory of personality where D is the
disputing intervention (D). The scientific method is used to identify Where E is new rational
thoughts (E) about the client’s situation. When this occurs, the client will change in
cognition, affect, and behavior.
Ellis has referred to this process as “de propagandizing” because it results in the client’s
giving up irrational beliefs that he or she was taught (as propaganda) during the formative
years. Techniques such as persuasion, suggestion, instruction, and discovery of new ways of
thinking through the ‘Socratic’ method are common in the cognitive therapies. Planning of
specific actions to take place outside of counseling, rehearsing the client’s role in these new
actions, and reviewing success are also parts of the cognitive counseling process. Thus,
clients are given homework assignments in order to experiment with their environment
between sessions and acquire new learning.
Beck’s cognitive approach leads to examination of the client’s story for examples of selective
abstraction, dichotomous thinking, overgeneralization, magnification, arbitrary inference,
and personalization in the client’s response to troublesome circumstances. Seeing that a
client looks at behavior in an all-or-nothing manner, makes mountains of molehills or jumps
to conclusions, the counselor helps the client understand the erroneous nature of his or her
thinking.
Meichenbaum also suggests that it is important to look for self-talk that, if present, would
lead to better conclusions. Thus, it is important to consider what the client has overlooked
as well as the cognitive errors that he or she has made.
The cognitive approach to counseling is placed near the rational and counselor-controlled
end of the continuum of counseling theories. The counselor enters the client’s world of
experience through his or her thinking (cognitive) processes, and the counselor takes charge
of the counseling. Nevertheless, it is the client’s goal of coping more effectively with
troublesome experience that shapes the content for counseling.

Stages of Counseling
Although Ellis places little importance on first-stage counseling skills, the other cognitive
therapists see the conditions of the first stage as important to establishing a therapeutic
alliance with the client, creating a climate of trust so that the client will respond to the
interventions the counselor suggests. None of the cognitive therapists would see the first-
stage conditions alone as sufficient for effective and efficient treatment.
In cognitive counseling, the in-depth exploration process of the second stage allows the
client to identify issues with which he or she is experiencing difficulty and to explore the
thought patterns that underlie the unpleasant feelings and ineffective behaviors.
The counselor helps the client identify fallacies in perceptions, inaccuracies in information,
and self-defeating behaviors. Although the effect attached to certain circumstances signals
where the client is experiencing difficulty and the severity of that difficulty, discussion
focuses more on thoughts and actions than on feelings.
The client’s goal of becoming more effective in managing troublesome aspects of his or her
life becomes clearer. Some cognitive counselors (e.g., Ellis) tend to move fairly quickly
through this stage, others engage in more discussion, and their exploration process may not
seem very different from that of a person centered or psychoanalytic counselor, except for
the emphasis on thoughts.
The third stage is more elaborate in the cognitive approach than in others. The client is
instructed to go out and behave differently, either by implementing newly discovered
rational thinking or possibly by experimenting with finding – new information about his or
her beliefs about others. Scientific problem solving, led by the counsellor but with the client
as an active participant, leads to plans of action. As with any new learning experience, new
patterns may not be implemented perfectly at first, but reinforcement and refinement are
necessary. Cognitive counseling aims to bring about changes in actions in a comparatively
short time.
Cognitive Therapy Techniques
Humor is used as a way of helping clients to ‘interrupt’ their own seriousness and to
separate themselves from stuffy, outmoded and dysfunctional beliefs.
Homework to the clients which include self- monitoring and recording of negative thoughts
and self- sabotaging beliefs, as well as exercises in critical thinking and questioning.
Written work is sometimes included which may take the form of writing down and disputing
personal beliefs which may have caused problems in the past.
Imagery is also used in which clients are sometimes asked to imagine themselves responding
in positive ways to situations which have been problematic for them in the past. R
ole plays are also used. For example, a client could role play some feared or threatening
future event such as public speaking or a job interview.
Modelling is also used. It is not restricted to counseling sessions but may be extended to
models of positive behavior which clients may have observed in others.
The technique of cognitive distraction is used as a means of helping clients deal with anxiety
and depression. This means encouraging clients to learn relaxation procedures, yoga or
meditation but it also means teaching them how to dispute the irrational beliefs which cause
problems for them.
It advocates reading, listening to tapes, attendance at lectures and workshops and generally
becoming independent in the search for improvement and change. Hence, this approach is
also viewed as self-help approach.
Semantic Correction is another technique used with clients who over generalize or make
sweeping statements.
Shame attacking exercises are used with clients who are fearful of exposing personal
weakness or those who are inhibited about expressing themselves. They are encouraged to
take risks and engage in some form of activity which will prove to them that their fears are
exaggerated. For example, a client may be asked to become more gregarious socially, either
in dress, behavior or manner.

CLIENTS WHO BENEFIT FROM THIS APPROACH

Clients who lack assertiveness or those who experience problems in relation to negative
thinking and depression.
Clients who need specific interventions such as family or marital therapy may also be helped
by this approach.
The principles of this approach can be applied to education and child therapy and this
flexibility of application is one of its main assets.

LIMITATIONS OF BEHAVIOUR THEORY OF COUNSELING

Clients who wish to conduct an in – depth study of childhood events and attendant traumas
cannot seek this therapy as this approach tends to minimize the past.
The active, directive and action- based nature of the approach may not appeal to some
clients and some of them may feel threatened by it.

SOLUTION FOCUSED THERAPY

The Solution focused approach originated in family therapy. Solution Focused Therapy
treatment is based on over twenty years of theoretical development, clinical practice, and
empirical research of the family therapists Steve de Shazer, Kim Insoo Berg and colleagues at
the Brief Family Therapy Centre in Milwaukee, as well as Bill O’Hanlon, a therapist in
Nebraska. The members of the Brief Therapy Practice in London pioneered the method in
the United Kingdom.
Solution-Focused Therapy is different in many ways from traditional approaches to
treatment. It is a competency-based model, which minimizes emphasis on past failings and
problems, and instead focuses on clients’ strengths and previous successes. There is a focus
on working from the client’s understandings of her/ his concern/situation and what the
client might want different. The basic tenets that inform Solution-Focus Therapy are as
follows:
It is based on solution building rather than problem solving.
The therapeutic focus should be on the client’s desired future rather than on past problems
or current conflicts.
Clients are encouraged to increase the frequency of current useful behaviors
No problem happens all the time. There are exceptions that is there are times when the
problem could have happened but did not. This can be used by the client and therapist to co
construct solutions.
Therapists help clients find alternatives to current undesired patterns of behavior, cognition,
and interaction that are within the clients’ repertoire or can be co constructed by therapists
and clients as such.
Differing from skill building and behavior therapy interventions, the model assumes that
solution behaviors already exist for clients.
It is asserted that small increments of change lead to large increments of change.
Clients’ solutions are not necessarily directly related to any identified problem by either the
client or the therapist.
The conversational skills required of the therapist to invite the client to build solutions are
different from those needed to diagnose and treat client problems.
Solution Focused Therapy differs from traditional treatment in that traditional treatment
focuses on exploring problematic feelings, cognitions, behaviors, and/ or interaction,
providing interpretations, confrontation, and client education (Corey, 1985). In contrast, SFT
helps clients develop a desired vision of the future wherein the problem is solved, and
explore and amplify related client exceptions, strengths, and resources to co-construct a
client-specific pathway to making the vision a reality. Thus, each client finds his or her own
way to a solution based on his or her emerging definitions of goals, strategies, strengths, and
resources. Even in cases where the client comes to use outside resources to create solutions,
it is the client who takes the lead in defining the nature of those resources and how they
would be useful

INGREDIENTS OF SOLUTION FOCUSED THERAPY

General Ingredients of Solution Focused Therapy

Most psychotherapy, SFT included, consists of conversations. In SFBT there are three main
general ingredients to these conversations.
First, there are the overall topics. SFT conversations are centered on client concerns; who
and what are important to the clients; a vision of a preferred future; clients’ exceptions,
strengths, and resources related to that vision; scaling of clients’ motivational level and
confidence in finding solutions; and ongoing scaling of clients’ progress toward reaching the
preferred future.
Second, as indicated in the previous section, SF conversations involve a therapeutic process
of co-constructing altered or new meanings in clients. This process is set in motion largely by
therapists asking SF questions about the topics of conversation identified in the previous
paragraph and connecting to and building from the resulting meanings expressed by clients.
Third, therapists use a number of specific responding and questioning techniques that invite
clients to co-construct a vision of a preferred future and draw on their past successes,
strengths, and resources to make that vision a reality.
Specific Active Ingredients
Some of the major active ingredients in SFT include developing a cooperative therapeutic
alliance with the client; creating a solution versus problem focus; the setting of measurable
changeable goals; focusing on the future through future oriented questions and discussions;
scaling the ongoing attainment of the goals to get the client’s evaluation of the progress
made; and focusing the conversation on exceptions to the client’s problems, especially those
exceptions related to what they want different, and encouraging them to do more of what
they did to make the exceptions happen.

THE PRACTICE OF SOLUTION FOCUSED THERAPY

The goals of the therapy are the goals which clients bring with them, providing they are
ethical and legal. The counselor’s role is to help clients to begin to move or continue to move
in the direction they want. They do this by helping:
• to identify and utilize to the full the strengths and competencies which the client brings
with him;
• to enable the client to recognize and build upon exceptions to the problem, that is, those
times when the client is already doing (thinking, feeling) something which is reducing or
eliminating the impact of the problem;
• to help the client to focus in clear and specific terms on what they would consider to be
solutions to the problem.
The counsellor acknowledges and validates whatever concerns and feelings the client
presents, and seeks to develop a rapport, a cooperative ‘joining’, in which the counsellor
offers the client a warm, positive, accepting relationship and the client feels understood and
respected.
In SFT, the counsellor shares expertise with the client by adopting a learning position, ‘a one-
down position’, in which the client is encouraged to teach the counsellor about her way of
looking at the world. The counsellor matches the language of the client, offers
encouragement and genuine compliments and adapts her stance according to what the
client finds helpful. The client is respected as being an expert in her own life, while the
counsellor has expertise in creating a therapeutic environment.
It is not the usual practice to offer clients a fixed number of sessions. It is more common to
consult with the client at the end of a session to hear what she feels about meeting again,
and if a further session is necessary, when that should take place.

FOCAL ISSUE
Solution Focused therapists (SFT) stress the importance of negotiating a focal or central issue
for the work. The clearer and more defined the agenda, the greater the likelihood that the
counseling will be efficient and effective.
SFT attends to the problem as presented by the client. The closer the counsellor can keep to
the client’s agenda, the more likely the client will be motivated to change. It is not always
possible to achieve this at the beginning as clients are often confused, anxious,
overwhelmed and unsure how counseling can help them.
The priority is to find a common language to describe what the client wants to change and to
begin to explore how those changes would affect the client’s life. The counsellor needs to
find leverage – a solvable problem which the client both wants, and is able, to work upon.
Clients who present with broad, diffuse, and poorly understood problem patterns and who
need considerable time to form a trusting alliance are more likely to need an extended
period of exploratory work. It is a great advantage when clients can articulate their problem
and their goals, but it does not mean that initial vagueness about the future disqualifies
them from brief solution focused work. It simply means that the counsellor has to work
harder and take longer.

THE MESSAGE
Near the end of each session, the solution focused counsellor will complement the client on
what he is doing, thinking or saying which is helpful. She may also give him a task to
perform. At the end of the first session, clients are usually asked to ‘notice between now and
the next time we meet, those things you would like to see continue in your life and come
back and tell me about them’.

TREATMENT PRINCIPLES
There are a number of principles which guide solution focused work. They apply both to how
the client should approach the problem and to how the counsellor should conduct the
counseling

If it is not broken do not fix it.

SFT emphasizes that people have problems, rather than that they are problems. It avoids a
view of clients as being sick or damaged and instead looks for what is healthy and
functioning in their lives.

Small change can lead to bigger changes.

Change is regarded as constant and unavoidable. Initiating a force for change can have
repercussions beyond the original starting point. Experiencing change can restore the
person’s sense of choice and control in his or her life and encourage the making of further
changes.

If it is working keep doing it.

The client is encouraged to keep doing what she has shown she can already do. This
constructive behavior may have started prior to the counseling. Clients may need to
continue with a new pattern of behavior for some time before they feel confident about
maintaining it. If it is not working stop doing it. Clients in SFT are encouraged to do
something different (almost anything) to break the failure cycle. This may run counter to
family scripts such as, ‘If at first you don’t succeed, try, and try again.’

Keep counseling as simple as possible.

There is a danger that the beliefs of the counsellor, particularly if they demand a search for
hidden explanations and unconscious factors, will complicate and prolong the relationship.

INTERVENTIONS
The following interventions are commonly found in solution focused practice. How and
when they are used will depend upon the judgment of the therapist.

Pre-session change
When making an appointment, the client is asked to notice whether any changes take place
between the time of making the appointment and the first session. Typically, the counsellor
will enquire about these changes early on in the first session. By granting recognition to pre-
session change, the counsellor can build upon what the client has already begun. The client
may present the counsellor with clear clues about strategies, beliefs, values and skills which
are transferable into solution construction. This ‘flying start’ helps to accelerate the process
of change and increases the likelihood of the counseling being brief. Positive pre session
change is empowering for the client because the changes have taken place independently of
the counsellor and, therefore, the credit belongs solely to the client.

Exception seeking
The counsellor engages the client in seeking exceptions to the problem, that is, those
occasions when the problem is not present, or is being managed better. This includes
searching for transferable solutions from other areas of the client’s life, or past solutions
adopted in similar situations.

Competence seeking
Solution Focused Therapy The counsellor identifies and affirms the resources, strengths and
qualities of the client which can be utilized in solving the problem. Coping mechanisms
which the client has previously used are acknowledged and reinforced.

The miracle question

This is a central intervention typically used in a first session, but which may also reappear in
subsequent sessions. It aims to identify existing solutions and resources and to clarify the
client’s goals in realistic terms. It is a future-oriented question which seeks to help the client
to describe, as clearly and specifically as possible, what her life will be like, once the problem
is solved or is being managed better. The question as devised by Steve de Shazer follows a
standard formula:
Imagine when you go to sleep one night, a miracle happens and the problems we’ve been
talking about disappear. As you were asleep, you did not know that a miracle had happened.
When you wake up what will be the first signs for you that a miracle has happened?
This imaginary format gives the client permission to rise above negative, limited thinking and
to develop a unique picture of the solution. An open expression of what they believe they
want can either motivate them further towards achieving their goals, or perhaps help them
to realize that they really don’t want these changes after all. It can also highlight conflicts
between what they themselves want and what other people in their life want for them. The
counsellor helps the client to develop answers to the miracle question by active listening,
prompting, empathizing and therapeutic questioning.

Scaling
The counsellor uses a scale of 0-10 with clients with 10 representing the morning after the
miracle and 0 representing the worst the problem has been, or perhaps how the client felt
before contacting the counseling service. The purpose of scaling is to help clients to set small
identifiable goals, to measure progress and to establish priorities for action. Scaling
questions can also assess client motivation and confidence. Scaling is a practical tool which a
client can use between sessions. The use of numbers is purely arbitrary - only the client
knows what they really mean.

Reframing
Using the technique of reframing, the counsellor helps the client to find other ways of
looking at the problem, ones which are at least as valid as any other, but which, in the
opinion of the counsellor, increase the chances of the client being able to overcome the
problem.

COMPATIBILITY WITH ADJUNCTIVE THERAPIES

SFT can easily be used as an adjunct to other therapies. One of the original and primary
tenets of SFT is that if something is working, do more of it. It is suggested that therapists
should encourage their clients to continue with other therapies and approaches that are
helpful
For example, clients are encouraged to continue to take prescribed medication, stay in self-
help groups if it is helping them to achieve their goals, or begin or continue family therapy.
Finally, it is a misconception that SFT is philosophically opposed to traditional substance
abuse treatments. Just the opposite is true. If a client is in traditional treatment or has been
in the past and it has helped, he or she is encouraged to continue doing what is working. As
such, SFT could be used in addition to or as a component of a comprehensive treatment
program.

TARGET POPULATIONS
SFBT has been found clinically to be helpful in treatment programs in the U.S. for adolescent
and adult outpatients (Pichot & Dolan, 2003), and as an adjunct to more intensive inpatient
treatment in Europe. SFT is being used to treat the entire range of clinical disorders, and is
also being used in educational and business settings.
Meta-analysis and systematic reviews of experimental and quasi-experimental studies
indicate that SFT is a promising intervention for youth with externalizing behavior problems
and those with school and academic problems, showing medium to large effectives (Kim, in
press; Kim & Franklin, 1997).
While SFBT may be useful as the primary treatment mode for many individuals in outpatient
therapy, those with severe psychiatric, medical problems, or unstable living situations will
most likely need additional medical, psychological, and social services. In those situations,
SFT may be part of a more comprehensive treatment program.

UNIT 5
COUNSELLING IN VARIOUS SETTINGS

PALLIATIVE COUNSELLING
• Palliative care counseling is a therapeutic approach that helps patients and their
caregivers cope with the challenges of a life-threatening illness.
• It involves providing emotional support, guidance, and resources to enhance well-
being, reduce suffering, and assist in decision-making.
• Palliative care Counselling for patients is designed to help people who are in
palliative care to deal with the emotions related to losing their independence, the
prospect of dying, quality of life, and any other issues that may arise during the time
they are in care.
• Usually, healthcare professionals tend to focus mainly on organs and their diseases.
Palliative care goes beyond treating diseases—it cares for the whole person. It
addresses physical, emotional, social, and spiritual needs, recognizing that illness
affects both patients and their families. Pain and symptoms can worsen with stress
or anxiety, so a holistic approach ensures better well-being. This makes palliative
care unique from conventional medical care.
Common Issues Addressed in Palliative Counseling
• Fear of death and dying
• Grief and anticipatory loss
• Depression and anxiety
• Feelings of being a burden
• Loss of dignity and autonomy
• Family conflict and communication barriers
• Existential crises and search for meaning
Palliative Care Counseling: Principles and Practice

 WHO's Nine Principles of Palliative Care (2011 Statement)

1. Relief from pain and distressing symptoms
• Palliative care aims to alleviate pain and symptoms such as breathlessness, nausea,
fatigue, and anxiety.
• Symptom control enhances the patient's comfort and quality of life.
2. Affirms life while recognizing dying as a normal process
• Palliative care neither denies nor avoids death; instead, it accepts dying as a part of
the life cycle.
• It focuses on making this phase dignified and meaningful.
3. Does not hasten or postpone death
• The goal is not to speed up or delay the process of dying.
• Care is centered on comfort rather than curative treatments.
4. Integrates psychological and spiritual support
• Addresses emotional concerns such as depression, anxiety, and fear of death.
• Helps patients find meaning in life and peace through spiritual support.
5. Helps patients live actively until death
• Encourages meaningful engagement in daily activities for as long as possible.
• Uses symptom management to enable better mobility and social interactions.
6. Provides family support throughout the illness and bereavement
• Educates and guides families in caregiving.
• Offers bereavement counselling to help cope with grief after the patient's passing.
7. Uses a multidisciplinary team approach
• Doctors, nurses, social workers, counselors, and spiritual advisors collaborate.
• The holistic approach ensures all aspects of care are covered.
8. Enhances quality of life and may impact illness progression
• Effective symptom management can prolong life by reducing stress and
complications.
• Psychological and emotional well-being can also positively affect disease
progression.
9. Applicable early in illness alongside life-prolonging treatments
• Palliative care is beneficial even when curative treatments like chemotherapy or
dialysis are ongoing.
• Helps manage side effects and improve treatment tolerance.

THE 7C’S OF PALLIATIVE CARE

1. Communication
2. Coordination
3. Control symptoms
4. Continuity of care
5. Continued Learning
6. Career Support
7. Care in the Dying Phase

Communication:
• Open and respectful communication with patients, families, and healthcare
professionals to understand needs, goals, and concerns.
Coordination:
• Ensuring that care is coordinated effectively, involving all relevant healthcare
professionals and services.
Control of Symptoms:
• Helping the patient feel better by reducing physical pain, emotional distress (like
anxiety or sadness), and spiritual suffering to improve quality of life.
Continuity:
• Ensuring that patient receives smooth, uninterrupted care—even when they move
between hospitals, home, or other care settings, or when different doctors and
nurses are involved.
Continued Learning:
• Healthcare providers regularly update their skills and knowledge through training to
provide better palliative care using the latest methods and practices.
Career Support:
• Providing support and resources for caregivers to help them cope with the
challenges of caring for a loved one with a serious illness.
Care in the Dying Phase:
• Providing kind and respectful support to patients nearing the end of life, prioritizing
their comfort and quality of life.

THE ROLE OF COUNSELLING IN PALLIATIVE CARE

Counseling plays a vital role in palliative care, providing emotional, psychological, and
spiritual support to patients and their families as they navigate serious illnesses. It helps
individuals cope with anxiety, grief, fear, and existential distress, promoting a sense of peace
and acceptance.
• Emotional Support: Helps patients and families process emotions, reducing stress
and anxiety.
• Communication Aid: Facilitates difficult conversations about prognosis, treatment
choices, and end-of-life decisions.
• Spiritual and Existential Support: Addresses deeper concerns about meaning,
purpose, and legacy.
• Caregiver Support: Helps caregivers manage emotional burdens, preventing
burnout.

Who provides palliative counseling?

1. Psychologists & Counselors
• Help patients and families cope with emotional distress, grief, anxiety, and
depression. They use therapy approaches like CBT, mindfulness, and acceptance-
based techniques to address fear, guilt, and anticipatory grief. Their support is
crucial for managing uncertainty, role changes, and end-of-life fears, especially for
those struggling with severe emotional distress or diagnosis adjustment.
2. Palliative Care Physicians & Nurses
• They provide holistic care by addressing prognosis, treatment options, and end-of-
life preferences with compassion. They manage distressing symptoms, offer
emotional support, and refer patients to specialized counseling when needed,
playing a key role in palliative care consultations and medical decision-making.
3. Social Workers
• Help patients and families navigate practical and psychosocial challenges by
providing emotional support, coordinating care, and advocating for patient rights.
They assist with financial concerns, insurance, resource access, family counseling,
and care transitions. Their support is crucial when families face logistical, financial,
or social difficulties related to illness and caregiving.
4. Chaplains & Spiritual Care Providers
 • Support patients' spiritual, religious, and existential needs, helping them explore
meaning, purpose, suffering, and the afterlife. They offer prayer, rituals, and
discussions for comfort, assist with guilt or unresolved conflicts, and guide families
toward peace and reconciliation. Their support is essential when patients face
spiritual distress or seek religious guidance.

PSYCHOLOGICAL INTERVENTIONS IN PALLIATIVE COUNSELLING

1. Dignity Therapy (Chochinov, 2011)
• Developed by Dr. Harvey Chochinov. It helps patients maintain self-worth and leave
a meaningful legacy by reflecting on life experiences, values, and achievements.
Through structured interviews, patients share cherished memories and messages for
loved ones, which are recorded, transcribed, and turned into a written document.
This process reinforces personal meaning, reduces distress, enhances a sense of
identity, and provides family members with a lasting record to support grief and
healing.
2. Cognitive Behavioral Therapy (CBT)
• It helps patients manage negative thoughts and emotional distress by challenging
unhelpful beliefs and introducing coping strategies like mindfulness and relaxation.
It reduces anxiety and depression, improves emotional regulation, and enhances
overall well-being.
3. Supportive Psychotherapy
• It focuses on providing emotional support, encouragement, and validation to help
patients cope with illness and end-of-life challenges. Unlike deeper psychotherapies,
it emphasizes present concerns, reducing distress, enhancing coping, and supporting
informed decision-making. Techniques include active listening, empathy,
encouragement, problem-solving, psychoeducation, and relaxation strategies. Used
throughout the palliative journey, it improves quality of life, reduces anxiety and
depression, strengthens coping skills, and fosters hope and meaning.
4. Psychoeducational interventions
• It combines psychological support with education to help patients and families cope
with illness. They enhance knowledge about disease and treatment, improve coping
and decision-making, and reduce distress. These interventions strengthen resilience,
improve discussions on care preferences, and enhance overall quality of life.
5. Psychodynamic psychotherapy
• It helps patients explore unconscious emotions, past experiences, and relationship
patterns that influence their coping with illness. It focuses on processing grief, fears,
and unresolved conflicts while fostering self-awareness and emotional resilience.
Through a supportive therapist-patient relationship, individuals gain insight into
their feelings, reduce distress, and find meaning in their experiences.

ADVANTAGES
• Emotional Support: Helps patients and families cope with grief, fear, and distress.
• Improved Quality of Life: Addresses physical, emotional, and spiritual well-being.
• Better Decision-Making: Guides patients in making informed choices about care.
• Enhanced Communication: Helps patients and families talk openly about end-of-life
wishes, ensuring their values and preferences are respected.
• Support for Families: Helps caregivers manage stress and bereavement(loss).

DISADVANTAGES
• Emotional Difficulty: Discussing end-of-life issues can be distressing.
• Resistance to Counseling: Some patients or families may be reluctant to engage.
 • Availability Issues: Limited access to trained palliative counselors in some areas.
• Time Constraints: Brief medical appointments often limit the opportunity for in-
depth counseling, reducing the chance to explore patients’ emotional or
psychological concerns.
• Cultural and Personal Beliefs: Some individuals may prefer to avoid discussions
about death.

REFERENCES
 Hill, C.E. (2009). Helping skills: Facilitating exploration, insight and action. APA,
Washington D.C.
 Patterson, E.L., & Welfel, E.R. (2004). The counselling process. California: Brooks
/Cole publishing Company.
 Egan, G. (2007). The skilled helper: A problem-management and opportunity-
development approach to helping. (9th ed.)
 Jones, R. N. (2008). Basic skills: A helper’s manual. New Delhi: Sage Publications.
 Shertzer, B. E. & Stone, S, C. (1980). Fundamentals of counseling, 3rd ed. Boston:
Houghton Mifflin
 Ivey, A. E., Ivey, M. B., Carlos P. Zalaquett, C.P. (2017). Intentional Interviewing and
Counseling- Facilitating Client Development in a Multicultural Society. London:
Brooks Cole.
 Downing, J., Atieno, M., Debere, S., Mwangi-Powell, F., & Kiyange, F. (Eds.). (2010).
Palliative care. African Palliative Care Association.