Module II

Counselling Process
 Topics to be covered

Counseling Relationship

Counseling Interview and Termination

 Counseling Relationship

• The interplay between therapist and patient wherein the

union is of a professional nature, but also marked by
empathy, understanding, and validity, with the therapist
bringing along expert training, skills, and individual
knowledge to apply to any issues the patient might have.

• Examples: “ The counseling relationship between the

client and her therapist had grown quite close over the
years and she was saddened to be moving away."
 Therapeutic Relationship
• The union shaped within therapy between a psychotherapy
professional and the patient receiving therapy.

• There has been a great deal of theory and research regarding this
interaction: how it varies and alterations over time and the
substantial implications that the dynamic has for the manner in
which remediation is given and its results.

• The union has ethical dimensions which are frequently established

in practice guidelines.

• THERAPIST-PATIENT RELATIONSHIP: "A healthy therapist-patient

relationship is essential for positive results."
 Intervention

• Deal with the issues and an action on part of the

therapist for the client and their problems. When guided
by the nature and of the problem and the selection, the
therapist and the orientation, the setting, and the
willingness and ability of the client to proceed

• INTERVENTION: "Intervention is a technique used in

addictions counselling with an individual and significant"
 Boundary Issues
• In therapy and health care, refers to ethical issues which surround
the relationship between a therapist and a patient.

• Ideally, boundaries set limits not only on their areas for discussion
but also on their physical distance.

• A boundary sees to it that issues on trust and vulnerability are not

violated.

• BOUNDARY ISSUES: "In a therapist-patient relationship, boundary

issues arise when either or both parties cross the line from
professional to personal."
 Active Listening
• A psychotherapeutic approach that occurs when the professional
listens to a patient meticulously and diligently, inquiring as required,
in an effort to completely comprehend the matter related with the
message and the level of the patient's feelings.

• The professional usually repeats whatever the patient has stated to

guarantee the patient that they have been comprehended.

• Active listening is used commonly in conjunction with client-centered

therapy practices.

• ACTIVE LISTENING: "Active listening is one of the most common

approachs to therapy by a professional."
 Structured Learning

• Elaborate psycho-therapeutical approach that tries to

teach individuals to apply positive knowledge's that lead
toward successful and healthy life.

• This therapy includes four important elements:

modelling, role playing, performance feedback and
training transfer.

• Patient learns appropriate behaviour through provided

examples and given homework.
 How to Build a Trusting
Counselor Patient Relationship
• The fundamental goal of counseling is to help individuals who are experiencing
personal challenges be able to resolve them and improve their emotional well-being.

• Establishing an open and trustworthy relationship with your patients creates the
foundation for how they’ll most effectively reach their goals, and it’s also a significant
measure of your therapy’s success.

• Building genuine connections from a trusting counselor patient relationship is possible

when these factors exist:
• 1) When one is empathetic.

• People who choose counseling as a career path are usually empathetic by nature. It’s
widely said that empathy is the key emotion one must possess to make a good
counselor. An abundance of sensitive emotions will be brought forward during the
counseling process, and it’s the counselor’s job to help their clients feel understood
and respected. But an effective relationship also involves a reasonable balance of
emotions.
• The focus is on the patient.
• Counseling requires a great deal of listening—it’s how therapy works: they talk, you listen. It’s
your job to stay focused and give each patient the full attention they need, and you need, in order
to gain insight to make an accurate assessment, and ultimately develop a suitable therapy plan.

• Objectives are set.

• After you’ve listened to your client share their story, and taken good notes, the next step is to
establish clear objectives, based on the specific issues and needs of your client. By
communicating a defined set of objectives, with milestones along the way, you’re helping your
client feel hopeful their issues can come to resolution.

• Practicing unconditional positive regard in your therapy.

• It’s a notion that allows your patients to open up and be forthcoming in their feelings, and honest
about actions that may have called them to seek counseling. If your patient feels you are judging
them in a negative manner based on what they have shared and revealed, the opposite effect will
ensue.

• Preparedness.
• A good counselor will prepare for each session by reviewing notes from previous sessions and
developing a strategy, based on research and proven counseling practices, for each patient’s
goals. Good counselors also know that continued education and research play a significant role
in developing their knowledge, and that’s what makes good counselors great ones.
• The patient and flexible.
• In reality, the client sets the pace in how they accept and apply the counseling they are receiving.
This requires patience and flexibility. Goals may be tied to a timeline, but depending on how
slowly (or quickly) a client progresses, you may choose to modify a given therapy and change
course.

• There’s no coddling.
• Your job is to help your client overcome and manage their troubles and anxieties, but coddling
your client only slows down the process. Progress will come at a pace your client is comfortable
with, and sometimes it won’t come without a little push. Each session should end with a takeaway
—an “assignment” for your client to put to work in their life as a step closer toward their goal.

• Therapist relationship is professional.

• Simply stated: you are the teacher, your patient is the student. Effective counselors establish a
clear boundary between being friendly in nature, and having a “friendship.” Crossing that
boundary can have serious implications on a therapy’s effectiveness, and in some cases can
result in an ethics complaint against your license.

• Therapist is unbiased.
• Effective counselors don’t use their personal beliefs or preferences to sway their approach to
counseling—and they’re sensitive to each client’s lifestyle, culture or religious choices, as well. A
good counselor will look for ways to integrate a client’s beliefs into an effective care plan, if and
when it makes sense.
• You seek help yourself.
• You may not have the expertise to handle every issue of every patient that comes your way. Your
patient is spending good money on counseling services and deserves fairness and honesty from
you. If you feel inadequate about addressing a patient’s issue, seek consultation from a
colleague, or refer your patient to a counselor more qualified to counsel them.

• Proper procedures are followed.

• Always obtain the patient’s informed consent before administering treatments and therapies. It’s
often a legal requirement imposed on counselors, and is also a crucial part of helping prevent
malpractice claims against a counselor.

• Confidentiality is indisputable.
• A counselor always, always maintains confidentiality—of every patient. While using one client’s
scenario—perhaps to illustrate the success of a therapy being recommended—in another client’s
therapy is acceptable, names and specifics of a client should never be given.

• The best testament to the quality of your counseling will be largely determined by your patient’s
progress and healing.
• Your counselor patient relationship also plays a significant part. As sessions progress, patients
should become happier, see things in a new light, approach situations more positively and be
able to help themselves, rather than relying solely on your guidance to get them through issues
that arise. They’ll be able to keep their emotions in check, make better choices, and be hopeful
about the future.
Process
• First interaction (Greetings)
• Building relationship
Assessment
• Counselling Interview
• Psychological test
• Helping the client understand the problem
Goal setting
Intervention plan
Termination of the relationship
Follow up
Building Relationship

Rapport
Building Trust
• Ethical and multicultural competence
• Greetings
• Helping client for feeling safe
• Attending behaviour
• Clear boundaries
• Genuineness
• Listening
• Empathy
• Unconditional positive regards
• Paraphrasing
• Reflective practice
• Silence
Appropriate body language:

S: Sitting at comfortable angle and distance

O: Open posture. Arms and legs uncrossed
L: Leaning forward time to time. Looking genuinely interested.
Listening attentively
E: Effective eye contact without staring
R: Remaining relatively relaxed
Avoid in order to build relationship:
• Asking two or more questions on same time
• Asking too many questions
• distract yourself
• Keep thinking something else
• Keep making notes at the time of counselling
• Inappropriate body language
Counselling Interview

Counselling interview focus on information

related to client, developing rapport with client
and help client to explore his or her problems.
Counselling interview is different from clinical
or diagnostic interview.
Intentional Interviewing is designed to facilitate
the drawing out of client stories, enabling clients
to find new ways of thinking about these stories
and finding new ways of acting.
Closed questions:
Closed questions are useful for seeking factual information or data
gathering. They are typically effortless to answer, and require little
thoughts.
Example: How old are you?
Have you had counselling before?
Open Question:
Open questions are designed to help clients think, reflect, focus, elaborate,
or be more specific and express their thoughts and feelings.
Open questions are intended to encourage exploration, seek clarification
and establish mutual understanding.
Examples: What inspired you to….?
What other issues are important to you?
How do you feel about the situation?
What makes you think you were partly responsible for your
dreadful ordeal?
Terminating Relationship
Termination is a final stage of counselling and it is ending of therapeutic
relationship between counsellor and client.
This is most often ignored stage or taken for granted.
A formal termination serves three functions:
• Counselling is finished and it is time for the client to face their life
challenges.
• Changes which have taken place have generalised into the normal
behaviour of the client
• The client has matured and thinks and acts more effectively and
independently
Timings of Termination:
• Have clients achieved behavioural, cognitive, or affective goals?
• Can clients concretely show where they have made progress in what
they wanted to accomplish?
• Has the context of the initial counselling arrangements changed?
• Whether the client has acquired abilities to plan and work productively
• Whether the client can better play and enjoy life
Resistance to Termination
Clients and Counsellors may not want
counselling to end. In many cases this may be
the result of feelings about the loss and grief or
insecurities of losing the relationship. For
clients, this is something to process. For
counsellors, this is an issue for supervision.