MAP605_Advanced Counselling Skills I

MASTER OF ARTS (PSYCHOLOGY) ADVANCED COUNSELING SKILLS - I MAP605 Kiran Makhijani

CHANDIGARH UNIVERSITY Institute of Distance and Online Learning Course Development Committee Chairman Prof. (Dr.) R.S. Bawa Vice Chancellor, Chandigarh University, Punjab Advisors Prof. (Dr.) Bharat Bhushan, Director, IGNOU Prof. (Dr.) Majulika Srivastava, Director, CIQA, IGNOU Programme Coordinators & Editing Team Master of Business Administration (MBA) Bachelor of Business Administration (BBA) Co-ordinator – Prof. Pragya Sharma Co-ordinator – Dr. Rupali Arora Master of Computer Applications (MCA) Bachelor of Computer Applications (BCA) Co-ordinator – Dr. Deepti Rani Sindhu Co-ordinator – Dr. Raju Kumar Master of Commerce (M.Com.) Bachelor of Commerce (B.Com.) Co-ordinator – Dr. Shashi Singhal Co-ordinator – Dr. Minakshi Garg Master of Arts (Psychology) Bachelor of Science (Travel & Tourism Co-ordinator – Dr. Samerjeet Kaur Management) Co-ordinator – Dr. Shikha Sharma Master of Arts (English) Bachelor of Arts (General) Co-ordinator – Dr. Ashita Chadha Co-ordinator – Ms. Neeraj Gohlan Master of Arts (Mass Communication and Bachelor of Arts (Mass Communication and Journalism) Journalism) Co-ordinator – Dr. Chanchal Sachdeva Suri Co-ordinator – Dr. Kamaljit Kaur Academic and Administrative Management Prof. (Dr.) Pranveer Singh Satvat Prof. (Dr.) S.S. Sehgal Pro VC (Academic) Registrar Prof. (Dr.) H. Nagaraja Udupa Prof. (Dr.) Shiv Kumar Tripathi Director (IDOL) Executive Director (USB) © No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise without the prior written permission of the author and the publisher. SLM SPECIALLY PREPARED FOR CU IDOL STUDENTS Printed and Published by: Himalaya Publishing House Pvt. Ltd., E-mail: [email protected], Website: www.himpub.com For: CHANDIGARH UNIVERSITY Institute of Distance and Online Learning CU IDOL SELF LEARNING MATERIAL (SLM)

Advanced Counseling Skills - I Course Code: MAP605 Credits: 3 Course Objectives:  To familiarize the students with the evolution of Counseling.  To demonstrate the process of counseling to become an effective counselor.  To differentiate different types of training and Counseling. Syllabus Unit 1 – Counseling Psychology: Nature, concept and history of counseling Unit 2 – Effective Counselor: Self-exploration personal qualities and professional training Unit 3 – Process Counseling: Self-exploration personal qualities and professional training Unit 4 – Selection of Counseling Therapy, Termination and Follow-up Unit 5 – Ethics in Counseling: Ethics of Counselor, Need for ethical standards Unit 6 – Group Counseling Unit 7 – Educational Counseling Unit 8 – Vocational Counseling Unit 9 – Transactional Analysis Unit 10 – Assertive Training Unit 11 – Relaxation Training Text Books: 1. Belkin, G.S. (1984), Introduction to Counseling. Dubuque, Iowa: WCB/McGraw Hill. 2. Bellack, A.S., Hersen, M. and Kazdin, A.E. (Eds.) (2012), International Handbook of Behavior Modification and Therapy, New York: Springer Science & Business Media. CU IDOL SELF LEARNING MATERIAL (SLM)

3. Corey, G. (2015), Theory and Practice of Counseling and Psychotherapy, New Delhi: Pearson. Reference Books: 1. Gladding, S.T. (2012), Counseling: A Comprehensive Profession, New Delhi: Pearson. 2. Joyce, P. and Sills, C. (2014), Skills in Gestalt Counseling and Psychotherapy, Los Angeles: Sage. 3. Kaplan, D.M. (2003), Family Counseling for All Counselors, Greensboro N.C.: ERIC. 4. Lister-Ford, C. (2002), Skills in Transactional Analysis Counseling and Psychotherapy, Los Angeles: Sage. 5. Tolan, J. (2012), Skills in Person-centered Counseling and Psychotherapy, Los Angeles: Sage. 6. Feltham, C. and Horton, I.E. (2006), The Sage Handbook of Counseling and Psychotherapy, London: Sage Publications. CU IDOL SELF LEARNING MATERIAL (SLM)

CONTENTS 1 – 11 12 – 20 Unit 1: Counseling Psychology 21 – 45 Unit 2: Effective Counselor 46 – 64 Unit 3: Process Counseling 65 – 80 Unit 4: Selection of Counseling Therapy, Termination and Follow-up 81 – 99 Unit 5: Ethics in Counseling 100 – 114 Unit 6: Group Counseling 115 – 126 Unit 7: Educational Counseling 127 – 141 Unit 8: Vocational Counseling 142 – 151 Unit 9: Transactional Analysis 152 – 167 Unit 10: Assertive Training Unit 11: Relaxation Training CU IDOL SELF LEARNING MATERIAL (SLM)

UNIT 1 COUNSELING PSYCHOLOGY Structure: 1.0 Learning Objectives 1.1 Introduction 1.2 History of Counseling Psychology 1.3 Summary 1.4 Key Words/Abbreviations 1.5 Learning Activity 1.6 Unit End Questions (MCQ and Descriptive) 1.7 References 1.0 Learning Objectives After studying this unit, you will be able to:  Understand the basic concepts of counseling 1.1 Introduction Counseling psychology is a specialty among professional sciences that maintains a spotlight on facilitating personal and interpersonal functioning across the lifetime. The specialty pays explicit attention to emotional, social, vocational, academic/educational, health-related, developmental, and organisational considerations. Counseling Psychologists serve persons of all ages and cultural backgrounds in each individual and group setting. They conjointly consult often with organisations seeking to reinforce their effectiveness or the well-being of their members. CU IDOL SELF LEARNING MATERIAL (SLM)

2 Advanced Counseling Skills - I 1.2 History of Counseling Psychology Technological changes have created a significant impact on people’s life and work. Social and vocational mobility could be a result of industrialisation, so much so it has affected some prime human practices as child-rearing. As a result, man started steerage movement to adapt and deal with the rapid changes within the world. This led to the growth of counseling psychology within the first decade of the 20th century, based mostly upon human considerations for the well- being of the society at large, significantly the younger generations. Counseling must have existed in some form or the other or the opposite since the beginning of human civilization. Man must have wanted comfort, help, and solace from family and close associates. It’s only within the recent past that counseling has emerged as a definite branch of science. As a broad field of psychology, counseling has been influenced by developments within it. Nonetheless in several aspects is a unique field. Modern counseling is a result of the educational system, particularly the American educational system. It has deep roots with regard to individual freedom, rights, dignity, and worth as human beings. The development of counseling psychology is often best appreciated by analyzing the assorted problems that affected and influenced its development. Human nature has been viewed primarily as evil. This view has its origin among the biblical teaching that man is born as a sin. Genesis tells, “The imagination of the man’s heart is evil from his youth.” this view suggests that whatever one desired or longed for was considered evil. Thus man wasn't allowed to follow the course of his desires. It had been society’s, states and communities’ concern to absorb man’s evil nature. Society was held accountable to reduce if not monitored by the means of the vigil, vigorous disciplinary measures, and deterrent action. Opposed to this view, the reformation and renaissance movements propagated the view that human nature was primarily good. This view was galvanized by the concept of God. If God existed, he could not, however, be good. No faith has pictured God being evil. A great exponent of this was Jean Jacques Rousseau, he stated that man was essentially good. In Emilie, printed in 1962, he maintained that children ought to be protected against the corrupt influence of society. CU IDOL SELF LEARNING MATERIAL (SLM)

Counseling Psychology 3 Counseling psychology emerged as an applied specialty within the American Psychological Association (APA) within the Nineteen Forties. It’s been recognized as a specialty by the APA since 1946, and this recognition was reaffirmed in 1998 once the APA initiated a new period of application for specialty recognition. Landmarks within the history of direction psychology include the establishment of the discipline in reference to the profession of psychology, the creation of key professional journals, and necessary conferences held across the time. Two organisations are considered key within the formation and development of counseling psychology: the Society of Counseling Psychology (SCP) of the APA and also the Council of Counseling Psychology Training Programs (CCPTP), the organisation for administrators of training programs in the counseling psychology. Before 2004, SCP was usually cited as “Division seventeen,” referred to the reviewers of original historical material ought to note this reference. Within the present entry, the terms SCP and Division seventeen are used as seems historically appropriate. John Whiteley, a noted scholar of counseling psychology, identifies the foremost distant seeds of counseling psychology within the vocational steering, psychiatry, and psychometrics/individual variations movements together with the emergence of non medical and non psychoanalytic kinds of counseling interventions like Carl Rogers’s person-centered therapy. Later, the expansion of counseling psychology was spurred by the demand for psychological services created by veterans coming back from World War II. Negotiations among representatives from the APA’s divisions twelve (Clinical science) and seventeen (then referred to as direction and Guidance) and what was then the Veterans Administration’s central office workers in psycho therapeutics resulted in the creation of a new position for psychologists within the VA system, “Counseling psychologist (Vocational)” in 1952 to aid veterans in their readjustment to civilian life. As a result of serving to veterans gain employment and education opportunities needed completely different information and skills than addressing psychopathology and neurological injuries, this new position helped to counsel psychology to differentiate from psychiatry and clinical psychology and resulted in the growth of the vocational steering movement. In 1946, APA recognized Division seventeen, counseling and steering. Counseling psychology topics began to be frequently reviewed within the Annual more Review of psychology under this title. The Annual Review of psychology helped to permit specialty by making a place for routine CU IDOL SELF LEARNING MATERIAL (SLM)

4 Advanced Counseling Skills - I analysis of the literature. Within the Fifties, the explosion of enrollment in the educational activity, and also the desires of the returning World War II veterans spurred vital analysis within the areas of career development and counseling orientations. Theories of human development and behavior grew out of those economic and social forces throughout this time period, client-centered, directive, learning, psychodynamic, humanistic, and existential theories further developed. Counseling psychologists command held a major conference on counseling psychology, the Northwestern conference, in 1951. T.C. Gilbert Wrenn, the president of Division seventeen at the time of the conference, addressed the circumstances that he thought-about important leading up to the conference, focusing chiefly on the content of training for doctoral-level counseling psychologists, together with practicum coaching. The Northwestern conference resulted within the initial set of standards for a scholarly person training in the counseling psychology and also the formation of the Division seventeen Committees on Definition. In 1956, the committee’s report, counseling psychology as a Specialty, was an effort to make a additional inclusive statement defining counseling psychology. Donald Super, successive president of Division seventeen after Wrenn, expanded on the statements made at the Northwestern Conference. He helped to clarify the functions of the division by assignment on Definition the task of developing a formal statement concerning the boundaries and focus of the specialty and discussing the necessity to differentiate between counseling and clinical psychology. In 1952 the official name of Division seventeen was modified to counseling psychology, and also the American Board of Examiners in skilled professionals declared that its diplomas would include the term counseling psychology instead of counseling and steering. The looks of the Journal of direction science in 1954 and also the continuing reviews in the Annual Review of psychology helped further establish the professional identity of counseling psychology. Mental Hygiene Movement The terms adjustment and adaptation imbue our thinking about mental health. Society’s idea of mental health is mirrored within the concepts of school children. Research suggests that to be usually considered as mentally healthy one should conform to the behavioral norms of the society. CU IDOL SELF LEARNING MATERIAL (SLM)

Counseling Psychology 5 Another thought of psychological state is that of an all-around personality. The pressures of society for developing an all-around personality are relentless. Willie argues that the concept of abnormality varies according to the frame of reference. Individuals, families, societies and nations go by different frames of reference. One may be considered healthy according to one frame and mentally ill to another frame of reference. Another essential criterion is the individual’s ability and success in mastering the environment. This includes the following: 1. Ability to love 2. Adequacy in inter personal relations 3. Capacity for adaptation and adjustment 4. Efficiency in problem solving Mental health is essential for the complete functioning of the mind. It’s the basic foundation for the growth of the mind. Mental illness renders a person incapable of coping with reality. Mental health is compulsory in order to be able to respond constructively to stress and change and not simply adjust to these factors. Constructive behaviour is a key criterion of mental health and must be the utmost objective of education. The mental health movement was started by Clifford W. Beers, 1909 which seemed to have a favourable effect on guidance. Lightner Witmer, alumnus of Leipzing University started the 1st psychological clinic in 1907 in the University of Pennsylvania, where he also introduced clinical method aiming to aid and assist the learning of school going pupils. Progress in Psychotherapy The advent of psychoanalysis has had tremendous impact on psychotherapy. This led to the need for understanding the causative factors of psychological disorders. Prior to the rise and popularity of psychoanalysis by Sigmund Freud, the field of psychotherapy was dominated by the medical model, which implied that a disorder resulted due to a brain lesion or an injury leading to the damage/destruction of the brain tissue or the parasitical invasion of brain cells. Mental disorders were explained to be mainly caused by organic factors. The treatment used for psychological orders as per the medical model was found to be inadequate, and that the prognosis was also largely dependent on attending to the psychological factors. CU IDOL SELF LEARNING MATERIAL (SLM)

6 Advanced Counseling Skills - I Important Periods in the Development of Counseling The historical development of counseling is often classified into three periods. Sr. No. Period Developments 1 1850-1900  1879, William Wundt, foundation of the first psychological laboratory at 2 1900-1930 Leipzig. 3 1930-1940  1883, Stanley Hall started the first psychological laboratory in the US.  1895, George Merrill established the 1st systematic vocational programme in San Francisco.  1898, Jesse B. Davis, 1st counseling centre in Detroit.  1st convention of International Congress of Psychoanalysis, Salzberg.  Launch of the Mental Hygiene Movement by Clifford Beer.  Adaptations of Binet- Simon tests to American conditions.  Use of psychological principles was advocated in pastoral counseling by Rev. Elwood Worcester.  Publication of books and important psychological tests.  1925, Harry Kitson’s psychology of vocational adjustment.  1913, the National Vocational Guidance Association (NVGA) founded, formed the American Council of Guidance and Personnel Association. Merged with NVGA and became the American personnel guidance association. Father of Counseling Psychology Several radically different approaches to therapy are often known within the profession of counseling and clinical psychology. Smith (1982) reported that the 2 most cogent figures in counseling and clinical psychology were Rogers and Albert Ellis. Rogers and Ellis offer clear distinction amongst the different types of counseling they’re complete opposites. Rogers typically known as “the father of counseling psychology practiced non-directive or person-centered therapy.” Nature of Counseling Psychology Counseling has been defined as “a process by which a person is assisted to behave in a more rewarding manner.” As a process, it takes place over a period of time and promotes healing, comfort, clarification, and reconciliation. People who seek counseling have usually attempted to CU IDOL SELF LEARNING MATERIAL (SLM)

Counseling Psychology 7 change some behavior that is not, in the final analysis, rewarding to them. However, their attempts have been unsuccessful and so they come to counseling with aspirations and anxieties, hoping for a helper who will relieve their distress and help them replace it with something more rewarding. The three basic elements in counseling are the counselee (the person in pain desiring to be healed), the counselor (the helper who listens), and the negative experience, or that which causes pain and distress. The counselee identifies the negative experience and is helped to choose a path that is more satisfactory. Those seeking help are so-called experts on the problem; they have been living with it for weeks, months, and often years. Now they want release. The counselor must, therefore, carefully listen and help the counselees spell out their needs. Counselors assist individuals to identify and achieve goals that they have selected in response to the difficulties they are experiencing. The counselor provides an atmoshere of acceptance and genuine caring to facilitate the process. Scope of Counseling Counseling includes a deep scope for understanding, analyzing, and guiding people to resolve their conflicts. The counselor plays an important role to forestall, scale back, eliminate anxiety, tension, stress, etc. Counseling may be a scientific method of help extended by associate professional in conflict things. It's a secure and confidential collaboration between Counselors and purchasers to push psychological state and Eudaemonia enhance self understanding and resolving issues. Changes expedited by direction include: amendment in perspective, new insight, new ways in of considering things, new awareness of feelings, increased capability to tolerate and regulate feelings, new actions or behaviors, and new choices concerning life. The aphoristic Oxford wordbook (9th Edition) provides a minimum of two definitions of direction that appears to be conflicting, adding to potential confusion: 1. “Give recommendation to (a person) on social or personal issues, particularly professionally.” 2. “The method of helping and guiding purchasers, particularly by a trained person on knowledgeable basis, to resolve personal, social, or psychological issues and difficulties.” CU IDOL SELF LEARNING MATERIAL (SLM)

8 Advanced Counseling Skills - I Changes expedited by direction include: amendment in perspective, new insight, new ways of considering things, new awareness of feelings, increased capability to tolerate and regulate feelings, new actions or behaviors, and new choices concerning life. Counseling has been designated as a process. It’s an interactive process characterized by a novel relationship between the counselor and client that aims to bring about change in the client in various aspects like behaviour, beliefs, and levels of emotional distress. It may also be referred as re-education or retraining of the client. It’s a multisensory and multidimensional. It’s the counselor’s responsibility to each client exceptionally and genuinely. Purpose of Counseling The basic purpose of counseling is to assist individuals use their existing problem solving skills more effectively or to develop new coping skills:  Identify potential: Counselees are encouraged to inspect their potential.  Diagnose the problem: Counselees are motivated to identify their problem, which is detrimental to both personal and professional life.  Develop self image: Encouraged to develop a greater level of maturity for enhanced decision making and problem solving. Characteristics of Counseling  Interactive  Natural  Unbiased approach  Continuous process  Counseling is highly personal process. It has close contact of two persons.  It is a joint quest of counselor and counselee.  The counselor brings change in his feelings and emotions.  The counselor should have full understanding of his task.  It has very intense conversation between the two persons – counselor and counselee. CU IDOL SELF LEARNING MATERIAL (SLM)

Counseling Psychology 9  The interview is the basic technique for counseling process.  Counseling deals with the problems of abnormal behaviour and emotional problems.  Counseling releases him from the feeling of inferiority and compulsion.  The purpose of counseling is to make counselee cheerful, to gain confidence for social responsibility.  Group counseling is an anomaly. 1.3 Summary Counseling psychology is a specialty among professional sciences that maintains a spotlight on facilitating personal and interpersonal functioning across the lifetime. It is a process that involves the client and counselor to investigate and deal with psychological, emotional concerns etc. Counseling as a field of knowledge is to diffuse. It not only involves guidance activities but also focuses on providing therapeutic assistance to individual to facilitate self awareness and deeper understanding of their personalities. Technological changes played a crucial role in the development of counseling psychology. Several movements like the mental hygiene also contributed largely to the development of counseling psychology. 1.4 Key Words/Abbreviations  Counseling: the provision of professional assistance and guidance in resolving personal or psychological problems ● Development: an event constituting a new stage in a changing situation. ● Understanding: Awareness or tolerance. ● Self Awareness: Conscious knowledge of one’s own character and feelings. ● Mental health: A person’s condition with regard to their psychological and emotional well-being. CU IDOL SELF LEARNING MATERIAL (SLM)

10 Advanced Counseling Skills - I ● Purpose of counseling: To help clients achieve their personal goals, and gain greater insight into their lives. ● Eudemonia: Happiness, well-being. ● Counselor: A person trained to give guidance on personal or psychological problems. ● Counselee: One who is being counseled. 1.5 Learning Activity 1. Construct a time line depicting the historical development of counseling psychology. ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- 2. Interview 10 individuals (5 mental health professionals and 5 individuals other than mental health professionals) to understand their view of the purpose of counseling. ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- 1.6 Unit End Questions (MCQ and Descriptive) A. Descriptive Types Questions 1. Define counseling psychology. 2. Discuss the characteristics of counseling. 3. Explain in your own words the purpose of counseling. 4. Write a detailed note on the development of counseling psychology. 5. What is the scope and nature of counseling psychology? B. Multiple Choice Questions 1. __________ is the father of counseling psychology. (a) Sigmund Freud (b) B.F. Skinner (c) Carl Rogers (d) Albert Ellis CU IDOL SELF LEARNING MATERIAL (SLM)

Counseling Psychology 11 2. The basic purpose of counseling is __________. (a) Assist individuals use their existing problem solving skills more effectively (b) To provide ready solutions to problems. (c) To gain confidence for social responsibility (d) To release him/her from the feeling of inferiority and compulsion 3. William Wundt, laid foundation of the first psychological laboratory at Leipzig in the year __________. (a) 1879 (b) 1892 (c) 1918 (d) 1898 4. __________, laid foundation of the 1st counseling centre in Detroit in 1898. (a) Jesse B. Davis (b) William Wundt (c) Albert Ellis (d) Binet 5. Prior to the rise and popularity of psychoanalysis by Sigmund Freud, the field of psychotherapy was dominated by the __________ model. (a) biopsychosocial model (b) psychological model (c) medical model (d) social model Answers 1. (c), 2. (a), 3. (a), 4. (a), 5. (c) 1.7 References 1. Counseling and guidance, 2nd edition, McGraw-Hill Publishing Company Limited. 2. Proactive counseling, Dr. B.L. Gupta, 2008 edition. 3. The basic essentials of counseling, Dr. Indu Dave, Sterling Publishers Private limited.  CU IDOL SELF LEARNING MATERIAL (SLM)

UNIT 2 EFFECTIVE COUNSELOR Structure: 2.0 Learning Objectives 2.1 Introduction 2.2 Self-exploration as a Therapist and Individual 2.3 Summary 2.4 Key Words/Abbreviations 2.5 Learning Activity 2.6 Unit End Questions (MCQ and Descriptive) 2.7 References 2.0 Learning Objectives After studying this unit, you will be able to:  To guide the students capacity in building as therapists and increase their understanding of the desirable qualities of an effective counselor. 2.1 Introduction The profession of psychotherapy goes beyond conventional academic learning. A counselor is ever-evolving and consistently aware of the changing times. They are equipped with the required academic qualification as well as the skill set that empowers them to be objective yet empathise with the client. CU IDOL SELF LEARNING MATERIAL (SLM)

Effective Counselor 13 2.2 Self-exploration as a Therapist and Individual Any individual is ever-evolving; this holds true for a counselor, too. Characteristics of an Effective Counselor Research indicates that regardless of the therapeutic approach employed, some therapists achieve better therapy outcomes than others (Wampold, 2006). If the therapeutic approach is not the most significant difference in therapy outcomes, then it stands to reason that it is the skillset of the therapist that determines how effective therapy is for a client. Thus, it becomes important for a counselor to know, understand, and build the skills required for to bring out effective therapy. According to available evidence (Anderson, Ogles, Patterson, Lambert, and Vermeersch, 2009; Baldwin, Wampold, and Imel, 2007; Duncan, Miller, Hubble, and Wampold, 2010; Lambert, Harmon, Slade, Whipple, and Hawkins, 2005; Norcross, 2011; Wampold, 2007) and APA’s Presidential Task Force on Evidence-Based Practice (2006), there are 14 qualities and behaviours expressed by an effective counselor: 1. Interpersonal skills: An effective counselor verbally articulate, able to express empathy, convey warmth and acceptance, and has congruent affect. 2. Builds trust and acceptance: In the initial stages of therapy, the client may be characteristically hesitant and even reluctant to share. The effective counselor assuages these concerns by making the client feel understood and showing unconditional acceptance. The therapist uses appropriate and non-judgmental expressions throughout the course of therapy. 3. Form a collaborative therapeutic relationship: The therapist sets goals along with the client, based on the mutual trust formed in the earlier stages of therapy. 4. Provide an expert and acceptable explanation of client’s distress: A client often presents with inadequate insight as to the source of their distress. At this point, the therapist needs to provide the client with a psychological explanation of their problems. The explanation is adapted to the client’s socioeconomic background, culture, and CU IDOL SELF LEARNING MATERIAL (SLM)

14 Advanced Counseling Skills - I tradition. The explanation serves as an understanding of the problem and empowers the client to take measures that will help resolve the issues. 5. Formulates a psychologically healthy treatment plan: The therapeutic plan is consistent with the explanation provided for client’s distress. This improves therapy compliance. 6. Being persuasive and convincing: The therapist conveys the explanation in a language that the client comprehends, and clarifies all doubts and questions sufficiently. 7. Monitoring client’s progress effectively: The therapist uses assessment tools and reflections with the client to assess their status. They are attuned to the client’s progress, decline, and inertia. They incorporate learnings from the assessments into the therapy plan to ensure optimal progress. 8. Practises flexibility: The therapist is open to changing the therapy plan. They acknowledge and accept when something is not working, actively work to change it. They are open to changing the course of therapy, adopting a new theoretical approach, or refer them to another therapist, and recommend or use complementary therapies such as medication. 9. Use resistance and difficult topics therapeutically: The effective therapist realises the therapeutic significance of working with and on resistance displayed by the client. They empathetically approach difficult topics and address the core problems leading to the resistance and difficult topics. 10. Reflects optimism: When clients make progress, slow progress or relapse, an effective therapist helps the client acknowledge their own strengths which can help them get healthier. They acknowledge the client’s struggles yet communicate the client’s strengths to them. They communicate hope, both in the ability of the therapeutic alliance working as well as the client’s ability to master problem solving. 11. Aware of their own background as well as client’s context: An effective therapist understands that counseling doesn’t work in a vacuum. They understand the client’s background and the context they function in-socioeconomic background, cultural milieu, CU IDOL SELF LEARNING MATERIAL (SLM)

Effective Counselor 15 different support systems, and occupational background. They know and work to complement any other services- physical, social services, psychiatric- that the client is using. The therapist is aware of their own belief systems which influences of their background on therapist-client relationship. 12. Acknowledges counter-transference: The effective therapist is attuned to their own psychological processes that may influence therapy. They are able to separate their own self from the client. They consistently reflect on their own inputs in therapy to assess if they are truly therapeutic or arising out of their own needs to prove something. They use self-disclosure only for therapeutic purposes. 13. Knows best practises: The therapist is aware of the most effective therapies for their client’s problems. They have a holistic understanding of the genesis of the client’s disorder or concerns, and can use this understanding to help the client. 14. Pursuit of progress of self: They seek feedback on the progress of the client within the context of the therapeutic model or approach that they are using. Analysis of this helps them identify what is working, and to make changes to what is not working. Such changes within a comprehensible model of therapy aids the therapist to determine the outcomes produced by making these changes. Ultimately, an effective therapist is someone who is knowledgeable, empathetic, skilled, a critical thinker, flexible, and reflective. These qualities separate a therapist from an effective therapist. Attributes of an Effective Counselor (Personal Qualities) Professional counselors are authorized mental health therapists who offer assessment, diagnosis, and guidance/counseling to individuals facing a range of life stresses and psychological issues. they assist individuals with relationship problems, family issues, job stress, mental health disorders like depression and anxiety, and many other challenging issues that can impact feelings of well-being and happiness. To be effective in their roles, counselors should enjoy helping others and possess specific attributes and skills: CU IDOL SELF LEARNING MATERIAL (SLM)

16 Advanced Counseling Skills - I 1. Communication Skills: Effective counselors should have excellent communication skills. Although some of these skills can be honed during graduate school and are developed and refined over the course of your career, one should possess certain communication skills before embarking on a counseing career. Counselors need to have a natural ability to listen and be able to clearly explain their ideas and thoughts to others. 2. Acceptance: Being nonjudgmental and accepting important attributes is helping professions. counselors must be able to “start where the client is at.” This phrase is often used in counseling to describe the ability to relate to clients with an open, nonjudgmental attitude – accepting the client for who she/he is and in the current situation. Counselors need to be able to convey acceptance to their clients with warmth and understanding. 3. Empathy: Counselors help people through some of the most difficult and stressful times of their lives. They must be able to display empathy – the ability to feel what another person is feeling. According to Hodges and Myers in the Encyclopedia of Social Psychology, “Empathy is often defined as understanding another person’s experience by imagining oneself in the other person’s situation: One understands the other person’s experience as if it were being experienced by the self, but without the self actually experiencing it. A distinction is maintained between self and other. Compassion and empathy help your clients feel understood and heard. 4. Problem-Solving Skills: It’s not up to a counselor to solve clients’ problems, no matter how much he/she might want to help. But counselors must have excellent problem- solving skills to be able to help their clients identify and make changes to negative thought patterns and other harmful behaviors that might be contributing to their issues. 5. Rapport-Building Skills: Counselors must possess a strong set of interpersonal skills to help establish rapport quickly with clients and develop strong relationships. They must give their undivided attention to clients and be able to cultivate trust. Counselors need to be able to place all of their focus on what their clients are saying and avoid being distracted by their own personal problems or concerns when they are in a session. 6. Flexibility: Flexibility in counseling is defined as the ability to adapt and change the way you respond to meet your clients' needs. You don't stay rigid and stick to a predetermined CU IDOL SELF LEARNING MATERIAL (SLM)

Effective Counselor 17 treatment path when your clients require a different approach. Being flexible is one of the most important attributes of a professional counselor. 7. Self-Awareness: Self-awareness is the ability to look within and identify your own unmet psychological needs and desires, such as a need for intimacy or the desire to be professionally competent. This ability prevents your issues from affecting or conflicting with those of your clients. Self-awareness has a major impact on a counselor’s effectiveness, says professor David Hutchinson in his book, “The Essential Counselor.” 8. Multicultural Competency: Counselors help people from all walks of life. They must display multicultural competency and adopt a multicultural worldview, says Hutchinson. Multicultural competency means that you try to relate to and understand your clients regardless of their race, ethnicity, religious or political beliefs or socioeconomic background. Professional Training for Counselors To become a counselor in India you will require the following qualifications: 1. Bachelor’s degree in Psychology 2. Master’s degree in Psychology 3. Certification courses related to counseling 4. Practical experience in the counseling industry One can choose different areas of work based on their interests such as:  Mental Health Counselors  School Counselors  Rehabilitation Counselors  Career Counselor Each of these areas would also demand specialised training to make one competent in the respective fields. CU IDOL SELF LEARNING MATERIAL (SLM)

18 Advanced Counseling Skills - I Of course along with the professional training, personal qualities and skills play an important role, thus shaping them to the fullest is vital. 2.3 Summary Counselors offer support to individuals experiencing emotional difficulties by serving to them to identify and work through their problems. A Counselor uses techniques such as talking therapy to assist individuals to achieve their own resolutions or develop strategies to handle and remedy their concerns. 2.4 Key Words/Abbreviations  Self awareness: Conscious knowledge of one’s own character and feelings. ● Exploration: The action of deep/detailed understanding an unfamiliar areas of the counselee. ● Empathy: The ability to understand and share the feelings of another. 2.5 Learning Activity 1. As a counselor, how would you check that your client has progressed or not. Explore the techniques to do the same. ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- 2. Review the different areas one could practice as a counselor and discuss about the one that interests you the most. As a classroom activity, groups of students can be made and each can be collectively explored. Each group can do presentation explaining the prospects of the area. ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- CU IDOL SELF LEARNING MATERIAL (SLM)

Effective Counselor 19 2.6 Unit End Questions (MCQ and Descriptive) A. Descriptive Types Questions 1. Discuss in detail, the Characteristics of an effective counselor. 2. Explain the professional qualifications required to practice as a counselor. B. Multiple Choice Questions 1. APA’s presidential task force and evidence based practice suggests that there are __________ number of qualities and behaviours expressed by an effective counselor. (a) 14 (b) 12 (c) 13 (d) 10 2. The therapist and counselor form a __________ therapeutic relationship. (a) One – way (b) mutual (c) collaborative (d) counselor focused 3. The therapist practices __________ in relation to the therapy plan. (a) rigid approach (b) flexible approach (c) eclectic approach (d) wholistic approach 4. The therapist uses self disclosure for __________ purposes. (a) theraputic (b) personal (c) restorative (d) wholesome 5. The highest degree of qualification for a counselor is __________. (a) Bachelors degree in psychology (b) masters degree in psychology (c) certificate course in counseling (d) diploma course in counseling Answers 1. (a), 2. (c), 3. (b), 4. (a), 5. (b) CU IDOL SELF LEARNING MATERIAL (SLM)

20 Advanced Counseling Skills - I 2.7 References 1. Wampold, B.E. (2006). What should be validated? The psychotherapist. In J.C. Norcross, L.E. Beutler and R.F. Levant (Eds.), Evidence-based practices in mental Health: Debate and dialogue on the fundamental questions (pp. 200-208). Washington, DC: American Psychological Association. 2. https://www.apa.org/education/ce/effective-therapists.pdf .  CU IDOL SELF LEARNING MATERIAL (SLM)

UNIT 3 PROCESS COUNSELING Structure: 3.0 Learning Objectives 3.1 Introduction 3.2 Establishing the Counseling Environment 3.3 Taking Notes 3.4 Case History 3.5 Summary 3.6 Key Words/Abbreviations 3.7 Learning Activity 3.8 Unit End Questions (MCQ and Descriptive) 3.9 References 3.0 Learning Objectives After studying this unit, you will be able to:  Explain and evaluate the ideal counseling environment, process of counseling, identification of goals 3.1 Introduction The counseling method could be a planned, structured dialogue between a counselor and a client. It is a cooperative process during which a trained professional helps an individual referred to as the client to spot sources of difficulties or considerations that he or she is experiencing. CU IDOL SELF LEARNING MATERIAL (SLM)

22 Advanced Counseling Skills - I According to the American Counseling Association (ACA), professional counseling is the process of building relationships with individuals that empower them to accomplish mental health and wellness, education, and career goals. It is a collaborative relationship between the counselor and their client. 3.2 Establishing the Counseling Environment It is vital that one establishes a good atmosphere for counseling whether or not within the health facility or private clinic. The health facility is a strange environment, therefore there’s plenty you’ll be able to do to enhance the counseling environment. Even when visiting the home, one can create an improved counseling environment by going to a separate space or asking friends and relatives to wait outside. When one refers to the counseling environment, it’s not just the physical surroundings being reflected upon. It conjointly includes how the counselor greets clients, discusses with them and other aspects of non-verbal communication like eye contact and visual communication. How one treats their clients in these ways is all a part of putting in place a decent counseling environment, and you’re demonstrating your use of fellow feeling and respect. Preparing a good counseling environment lays the mandatory foundation for forming an alliance and building trust. At your own private office, you can decorate it as nicely as you choose, but institutional offices are often less than red. However, the effectiveness of the interview is not solely related to the elegance of the surroundings. What is paramount is the counselor’s concern for the client’s comfort and privacy. Careful attention to such simple matters as introductions and the client’s comfort and sense of control helps establish a relationship grounded in respect and cooperation. Another important aspect is maintaining counselor and client safety. Now the vast majority of mental health encounters are completely risk-free, but in rare cases something happens and harm comes to the counselor, the client, or both must it must be instinctive with the counselor at the beginning of every client interview, to check and ensure counselor safety and that of others. CU IDOL SELF LEARNING MATERIAL (SLM)

Process Counseling 23 Following three principles will help achieve safety: 1. Interview in a place where there are others nearby; 2. Have available an easily triggered emergency alert system, such as an alarm bell; and 3. When the counselor is conducting an interview in a closed office, seat herself/himself closer to the door than the client is, with no furniture (such as a desk) that could serve as an obstacle if a speedy exit should become necessary. The counselor’s appearance can also affect the relationship with the client. One will be perceived as more professional if attention is paid to your dress, grooming, and manner. Clients readily accept conservative clothing and hairstyles; excessively casual dress or manners may suggest nonchalance about the importance of your meeting. Limit your jewelry to something modest; don’t antagonize someone whose cooperation you need with adornments that suggest wealth or status beyond what the client could hope to achieve. If you wear pins, pendants, or items of clothing that indicate a religious affiliation, consider whether any of your prospective clients might regard it as a barrier to an effective relationship. Observe how other professionals in comparison to your setting dress and behave. To conclude, the counseling environment should be  Welcoming (e.g., greet clients appropriately, show them where to sit)  Comfortable (e.g., have comfortable seats, try to sit at the same level)  A place with few distractions (e.g., no telephone, or interruptions from other staff or family members)  A place where privacy and confidentiality can be maintained (e.g., somewhere away from other people)  Non-threatening (e.g., a place where people can feel relaxed and comfortable). Tools to Aid Counseling The best way to communicate information involves an interactive, two-way discussion. It can sometimes be helpful to have prompts to remind us of the information one needs to cover. CU IDOL SELF LEARNING MATERIAL (SLM)

24 Advanced Counseling Skills - I Prompts can take many forms, it could be a checklist of activities or it could be a poster or flipchart or other type of visual aid. Visual Aids Visual aids can be used to reinforce the discussion. Visual aids can also stand alone as methods of providing information. The main disadvantage of using them alone without discussion is that they do not allow for interactive communication and therefore may be misunderstood. If the counselor gives out visual aids without having a discussion one can overcome this difficulty by providing people with an opportunity to ask questions at a later point either in group or individual discussions. Visual Aids and Other Tools for Counseling  Posters  Leaflets or fact sheets  Flip charts  Overhead projector and transparencies  Slide shows  Models (such as female pelvis, penis, etc.)  Chalk or whiteboards  Pictographs (picture leaflets)  Songs, drama or poems  Real-life examples, testimonies or case studies from women  Written notes to remind you of points to cover. 3.3 Taking Notes In most cases, the counselor may want to take notes. Few of us can remember even briefly all the material we hear and one may not have the opportunity to write up the interview right away. So, point out that you will be taking notes, and make sure that this is all right with the client. CU IDOL SELF LEARNING MATERIAL (SLM)

Process Counseling 25 Nonetheless, one should try to keep note taking to a minimum. This will allow the counselor to spend more time observing the client’s behavior and facial expressions for clues to feelings. The counselor may not be able to get everything down on paper or to write complete sentence. Noting down key words that can indicate which issues to explore later or that can serve as reminders when you write up your report can be a good way to deal with the issue. Try to keep the pen in hand; this avoids the distraction of repeatedly picking it up. The only time one could lay it aside is when you discuss especially sensitive topics that the client might not care to have recorded. A client may ask you to keep certain information in your head and out of the chart. When this request comes early in your relationship, it is usually better to comply, especially if it applies with a limited portion of the interview. If the client seems extremely uncomfortable with any note taking, the counselor can explain that you will need some notes for later review to help make sense of it all. In the rare event that the client insists, give in, put down your pen, and later transcribe all that you can remember. What you want is to complete an informative interview, not to win a contest of wills. However, at some point—perhaps not right now when you are trying to complete the interview — you might raise the point again. Having a significant hole in the database could prove problematic, especially if this client will be seen by other counselor s later on. Reviewing a tape recording of a session can help you spot difficulties in your interview style. The counselor can often uncover deficiencies that you would have missed with a less complete record of your conversation. As an everyday practice, however, it has drawbacks: Reviewing a tape takes a lot of time, and clients are far more likely to feel uncomfortable with tape recording than with note taking. If you do decide to make a tape recording, begin only after you have explained its educational purpose and obtained permission. It may also be necessary to explain that state laws and professional ethics could require you to report certain information that has a bearing on the safety of others. Role of Records in Counseling  To stimulate discussion and interaction  To remind the counselor of the information to be communicated  To communicate information in a simple relevant way to the woman and her family CU IDOL SELF LEARNING MATERIAL (SLM)

26 Advanced Counseling Skills - I  To act as a reminder to the woman and family of previous communication  To illustrate examples and consequences of action/inaction  To strengthen links and communication between the different levels of the health system. The Process of Counseling The traditional counseling process includes the following six important interwoven, yet separate components. 1. Opening: The first and most important component in the process is the initial interaction with your client. It’s during this time that the client and counselor get to know each other, and also sets base for the rest of the therapeutic relationship. 2. Exploring Client Understanding: The process of exploration begins when the counselor begins to have an insight about the client. A clear understanding of their past and current concerns will facilitate goal setting, and in turn the process of counseling. 3. Understanding: Important to develop a strong relationship with the client, this can be demonstrated by understanding and by using verbal and nonverbal cues, as well as reflections and paraphrases. 4. Intervention: The intervention process involves choosing the appropriate counseling techniques that will encourage growth within your client. 5. Exploring Problems: Involves learning about your client in depth and their motivation towards counseling. Exploration is necessary in truly understanding a client’s thoughts and feelings in relation to their pressing problem. 6. Empower to Create Own Solutions: Empowering your client is not about providing them with all the answers. It is about empowering them, with your counseling skills, to find their own solutions. The Initial Interview Intake interviews are the foremost common form of interview in psychotherapeutics. They occur once the individual wishes to seek help and decide to seek help from a counselor. CU IDOL SELF LEARNING MATERIAL (SLM)

Process Counseling 27 Intake interviews are the foremost common form of interview in psychotherapeutics. The intake interview is vital in psychotherapeutics as a result of it being the primary interaction that happens between the client and the counselor. The counselor could discuss with the client what to expect throughout the interview, together with the time length. The aim of the intake interview usually includes establishing and identifying any concerns the client could have. Usually, the counselor diagnoses the client using criteria from the DSM IV axis one and two or DSM V. Some intake interviews embrace a mental status examination throughout the intake interview; facilitating the counselor to confirm a treatment plan. In some cases, particular counselor may feel that he or she lacks the experience to best facilitate the client. It’s at that point, that the counselor should refer the client to another source. During the intake interview, each party forms opinions concerning each other which will be either positive or negative. The client begins to understand the characteristics of the expert throughout this intake interview and therefore the clinical relationship between the two starts to form. A client ’ s perception of a counselor throughout an intake interview will either hinder or encourage them to get additional treatment. The more the client understands the positive qualities in their counselor’s, the more probably they’ were to attend sessions within the future. This decision to continue or to not continue treatment is sometimes created when the intake interview takes place. Studies have found that nearly about all clients make a choice whether or not to come back or not after the intake interview. About one-half of psychotherapy clients drop out of treatment and most of those clients do so when they have an intake interview. Therefore, it’s vital that in intake interviews that the counselor expresses to his or her clients that they have an accurate understanding of the client and his or her desires and emotions. This helps the client feel secure, and therefore makes it more likely that the client can still get treatment. Most counselors conduct intake interviews in their own style. However, larger organizations with staff workers pool could have social employees or different workers who conduct these interviews. Interviewers have variable approaches when it involves conducting intake interviews with clients. The approach that the counselor conducts the intake interview sets the tone for the continued course of treatment. Communication style is vital throughout these interviews. Some clients prefer to be asked specific queries by the interviewer, whereas some clients prefer open- CU IDOL SELF LEARNING MATERIAL (SLM)

28 Advanced Counseling Skills - I ended cite their feelings. In several cases, the interviewer will get a way of the clients’ preference. It’s vital that the client build rapport throughout the interview. It’s usually useful to both the client and the counselor to have a balance within which the counselor asks questions to the client. This enables the interview to have somewhat of conversational flow and become more personal. The Role of Rapport in Building a Therapeutic Relationship Rapport is a relationship where there is mutual trust and understanding where both parties involved have the best interests. Rapport building is thus defined as the process of creating rapport and building trustworthy relationships between two parties. Therapeutic rapport refers to the empathetic (caring) and shared understanding of problems between a counselor and a client. It implies a team approach to management of those concerns in contrast to an adversarial approach. With smart therapeutic rapport, a client feels his counselor “has his back” in an exceedingly way that encourages him to difficult to face issues. Likewise, the counselor in a setting with good therapeutic rapport feels respected in a manner that allows her to speak clearly and freely. It is extremely important that the client feels comfortable and safe with the counselor. If the client does not experience this then she/he maybe hesitant to fully disclose and be vulnerable with the counselor. It may not be easy for the client to confide in the counselor, trust may come at a later stage. In order to set base and make the client comfortable rapport building is the premise of the process. Establishing Rapport Rapport is one amongst the foremost necessary features or characteristics of unconscious human interaction. It is Commonality of perspective, being in “sync”, being on constant “wavelength” as the person with whom you are talking to. Techniques to Aid Rapport Building  Matching and Mirroring to Establish Rapport – Posture CU IDOL SELF LEARNING MATERIAL (SLM)

Process Counseling 29 – Breathing – Voice tonality – Speed Gestures – works best when you match gestures when it’s your turn to speak.  Voice Tone, Tempo, and Timbre – The Tone of voice refers to the pitch/frequency of the voice. – The Tempo of voice refers to the speed/pace or rhythm of the voice. – The Timbre of voice is the quality and characteristics of the voice.  Crossover Matching/Mirroring Rather than identically matching/mirroring the client, the counselor may match the client’s body postures etc with similar gestures. The aim is to get the client to relax and feel comfortable then rapport may be established. For example the client may be seated back within the chair crossed legs open; the counselor may sit slightly forward, with arms open (possible leaning on the arms of the chair) along with your legs crossed.  Pacing and Leading Once the counselor and client have matched and established good rapport, the counselor can pace the client by changing the pace either by slowing down and then taking forward the conservation at the pace of the counselor rather than the pace of the client. This can be done with voice quality, tonality, volume, timer, body position.  Be Empathic Displaying empathy and demonstrating that you really care as a counselor is one of the best ways to build rapport. By expressing that you care about them you make them feel special and important, hence they feel more comfortable to discuss their concerns with the counselor. Some Key Considerations  To build rapport the counselor doesn’t have to like or agree to the other person’s model of the world, but at least understand it. CU IDOL SELF LEARNING MATERIAL (SLM)

30 Advanced Counseling Skills - I  The counselor must take a genuine interest in getting to know what’s important to the other person.  Attempt to understand the client rather than expecting him/her to understand you first.  Pick up on the key words, favorite phrases and ways of speaking that someone uses and build these subtly into your own conversation.  Notice how someone likes to handle information. Do they like lots of details or just the big picture? As you speak feedback information in this same portion size.  Breathe in unison with them.  Look out for the other person’s intention — their underlying aim — rather than what they do or say. They may not always get it right, but expect their heart to lie in the right place.  Adopt a similar stance to them in terms of your body language, gestures, voice tone and speed. Respect the other person’s time, energy, favorite people and money. They will be important resources for them. Establishing Trust Trust in the therapeutic relationship provides safety and security, enhancing the development of rapport. Trust is the confidential factor encompassing understanding, compassion, and acceptance, providing the individual with a secure surrounding to process painful (uncomfortable) emotions and reminiscences. The trust and safety in a therapy session permits healing enable place. Often, clients with a substance use disorder are survivors of past traumas. Vulnerability and trust develop slowly throughout the therapeutic relationship. The rapport developed between the clients and also the counselor relies on trust and the ability for the client to become vulnerable in a safe place with someone who is dependable and respectful. 3.4 Case History APA ’s Definition: a record of information relating to a person ’s psychological or medical condition. Used as an aid to diagnosis and treatment, a case history usually contains test results, interviews, professional evaluations, and sociological, occupational, and educational data. CU IDOL SELF LEARNING MATERIAL (SLM)

Process Counseling 31 Components in a Case History 1. Identifying Data: This section is brief, and typically includes the client’s name, age, sex, marital status (or significant other relationship), race or ethnicity, and occupation. Often the referral source (informant) is also included. 2. Chief Complaint: The Chief complaint states the client’s reasons for seeking care ideally in his or her own words. Whereas the free speech that immediately follows encourages the client to talk about all these reasons. 3. Onset, Duration and Progress: This section would include a detailed understanding about the current episode the client is seeking help for. The following must be included:  The first presentation of signs and symptoms  The severity of symptoms  The duration of symptoms  Associated signs and symptoms  Context: Situation or irritant associated with the symptoms/pain  Impact of symptoms on social, occupational functioning. 4. History of presenting illness (HPI): A description of the development of the client’s present illness. The HPI is usually a chronological description of the progression of the client’s present illness from the first sign and symptom to the present. Often it can be helpful to include a psychiatric review of systems in conjunction with the history of the present illness to help rule in or out psychiatric diagnoses with pertinent positives and negatives. It should include some or all of the following elements:  Quality: Include a description of the quality of the symptom (i.e., sharp pain)  Severity: Degree of pain for example can be described on a scale of 1-10  Duration: How long have you had the pain  Timing: Describe when you have pain for example pain with exertion or pain in evening  Context: What is the client doing when the pain begins CU IDOL SELF LEARNING MATERIAL (SLM)

32 Advanced Counseling Skills - I  Modifying Factors: What makes the symptoms better or worse  Associated Signs and Symptoms: counselors may investigate about other sensations or feelings  Sleep: excessive sleepiness (hyper-somnia) or inability to sleep (insomnia).  Appetite and weight: may increase or decrease with an episode of illness. One should also learn how significant the change has been (how much weight has the client gained or lost, and over what period of time?) Also ask whether this weight change was intentional. 5. Past Psychiatric History: The counselor ought to acquire information concerning all psychiatric illnesses and their course over the client’s lifetime, as well as symptoms and treatment. Description of past symptoms should include  When they occurred,  How long they lasted, and  The frequency and severity of episodes. Special considerations should include:  History of past suicidal ideation, intent, plan, and attempts should be reviewed including the nature of attempts, perceived lethality of the attempts, save potential, suicide notes, giving away things, or other death preparations.  Violence and homicidality history which includes violent actions or intent. Specific questions about domestic violence, legal complications, and outcome of the victim.  Non-suicidal self-injurious behavior including any history of cutting, burning, banging head, and biting oneself. 6. Past Medical History:  Account of major medical illnesses and conditions as well as treatments, both past and present.  Any past surgeries CU IDOL SELF LEARNING MATERIAL (SLM)

Process Counseling 33 An understanding of the client’s coping strategies and reaction to illness should be noted. Past medical history is an important consideration when determining potential causes of mental illness as well as co morbid or confounding factors and may dictate potential treatment options or limitations. Any neurological issues including seizures, head injury, and pain disorder should also be clearly noted. Allergies to medications must be covered, including which medication and the nature of, the extent of, and the treatment of the allergic response, it can impact any psycho pharmacological intervention. Medical Illnesses can  precipitate a psychiatric disorder  mimic a psychiatric disorder  be precipitated by a psychiatric disorder or its treatment (metabolic syndrome in a client on a second-generation antipsychotic medication)  Influence the choice of treatment of a psychiatric disorder. 7. Family History: Many psychiatric illnesses are familial and have a genetic predisposition, if not cause, a careful review of family history is an essential part of the psychiatric assessment. An accurate family history will be beneficial in defining a client’s potential risk factors for specific illnesses but also the formative psychosocial background of the client. Family traditions, beliefs, and expectations may also play a significant role in the development, expression, or course of the illness. The family history is also important in identifying potential support as well as stresses for the client and, depending on the degree of disability of the client, the availability and adequacy of potential caregivers’ further intervention can be formulated. The counselor must also keep in mind that the diagnosis ascribed to a family member may or may not be accurate and some data about the presentation and treatment of that illness may be helpful. Medical illnesses present in family histories may also be important in both the diagnosis and the treatment of the client. Formulation of a genogram is often helpful. 8. Developmental and Social History: The focus here lies on reviewing the stages of the client’s life, plays a crucial role in determining the context of psychiatric symptoms and illnesses and may, in fact, identify some of the major factors in the evolution of the disorder. Details CU IDOL SELF LEARNING MATERIAL (SLM)

34 Advanced Counseling Skills - I regarding current psychosocial stressors could also be revealed in the course of obtaining a social history. An effective way to acquire the social history would be to attempt to acquire the information chronologically to ensure all information is covered. Chronologically the stages would be:  Prenatal history  Infancy (Developmental milestones, family atmosphere, amount of contact with parents, early medical history, toilet training, etc.)  Early and Middle Childhood (Adjustment to school, academic achievement, hobbies/ activities/interests, peer relationships, relationship with parents, important life changes, etc.)  Adolescence (All areas listed for early and middle childhood, presence of acting out (legal, drugs, sexual), early dating reaction to puberty, etc.)  Early and Middle Adulthood (Career/occupation, interpersonal relationships, satisfaction with life goals, hobbies/interests/activities, marriage, medical/emotional history, relationship with parents, economic stability, etc.)  Late Adulthood (Medical history, ego integrity, reaction to declining abilities, economic stability, etc.) 9. Defense Mechanisms: Refers to strategies that the client uses to cope with illness. These strategies for dealing with emotions and behaviors are called defense mechanisms. Potentially Harmful Defense Mechanisms  Acting out: Is performing an extreme behavior in order to express thoughts or feelings the person feels incapable of otherwise expressing. When a person acts out, it can act as a pressure release, and often helps the individual feels calmer and peaceful once again. Self-injury may also be a form of acting-out, expressing in physical pain what one cannot stand to feel emotionally. ● Denial: Is the most primitive, as its characteristic of early childhood development. it refers to the refusal to accept reality or facts, acting as if a painful event, feeling or CU IDOL SELF LEARNING MATERIAL (SLM)

Process Counseling 35 thought didn’t exist. Denial is often used by people in everyday life as they want to avoid dealing with painful events or areas of life that they don’t wish to acknowledge. ● Devaluation: Attributing exaggeratedly negative qualities to the self or others. ● Displacement: Redirecting of thoughts feelings and impulses directed at one person or object, but taken out upon another person or object. People often use displacement when they cannot express their feelings in a safe manner to the person they are directed at. ● Dissociation: When a person loses track of time and/or person, and instead finds another representation of their self in order to continue in the moment. A person who dissociates often loses track of time or themselves and their usual thought processes and memories. People who have a history of any kind of childhood abuse often suffer from some form of dissociation. ● Fantasy: When used as a defense mechanism, is the channeling of unacceptable or unattainable desires into imagination. ● Intellectualization: Is the overemphasis on thinking when confronted with an unacceptable impulse, situation, or behavior without employing any emotions whatsoever to help mediate and place the thoughts into an emotional, human context. Rather than deal with the painful associated emotions, a person might employ intellectualization to distance themselves from the impulse, event or behavior. ● Projection: Is the misattribution of a person’s undesired thoughts, feelings, or impulses onto another person who does not have those thoughts, feelings or impulses. Projection is used especially when the thoughts are considered unacceptable for the person to express, or they feel completely ill at ease with having them. ● Repression: Is the unconscious blocking of unacceptable thoughts, feelings and impulses. The key to repression is that people do it unconsciously, so they often have very little control over it. “Repressed memories” are memories that have been unconsciously blocked from access or view. CU IDOL SELF LEARNING MATERIAL (SLM)

36 Advanced Counseling Skills - I ● Splitting: Is a very common ego defense mechanism. It can be defined as the division or polarization of beliefs, actions, objects, or persons into good and bad by focusing selectively on their positive or negative attributes. ● Reaction formation: Is the converting of unwanted or dangerous thoughts, feelings or impulses into their opposites. ● Somatisation: A tendency to experience and communicate psychological distress in the form of somatic symptoms and to seek medical help for them. More commonly expressed, it is the generation of physical symptoms of a psychiatric condition such as anxiety. Effective Defense Mechanisms  Altruism: Constructive service to others that brings pleasure and personal satisfaction. ● Humor: When used as a defense mechanism, is the channeling of unacceptable impulses or thoughts into a light-hearted story or joke. Humor reduces the intensity of a situation, and places a cushion of laughter between the person and the impulses. ● Sublimation: The channeling of unacceptable impulses, thoughts and emotions into more acceptable ones. For instance, when a person has sexual impulses they would like not to act upon, they may instead focus on rigorous exercise. Refocusing such unacceptable or harmful impulses into productive use helps a person channel energy that otherwise would be lost or used in a manner that might cause the person more anxiety. ● Suppression: The conscious decision to delay paying attention to a thought, emotion, or need in order to cope with the present reality; making it possible to later access uncomfortable or distressing emotions whilst accepting them. Mental Status Exam (MSE) A mental status exam is the counselor’s evaluation of the client’s current mental functioning, an expression of a person’s emotional responses, mood, cognitive functioning and personality. Similar to the physical medical exam that is designed to review the major organ systems, the mental status exam reviews the major systems of psychiatric functioning. It was introduced by Adolf Meyer in 1902 and has gained immense popularity since its introduction. CU IDOL SELF LEARNING MATERIAL (SLM)

Process Counseling 37 Components of a Mental Status Examination  General Appearance and behaviour: Similar to behavioral observations, focuses on client’s clothing, posture, gestures, speech, personal care/hygiene, and any unusual physical features such as physical handicaps, tics, or grimaces are noted. Other important areas are facial expressions, eye contact, and activity level, degree of cooperation, physical attractiveness, and attentiveness. Is the client-friendly, hostile, seductive, or indifferent?  Mood and affect: Mood refers to the dominant emotion expressed during the interview. Affect defined as to the client’s range of emotions. An understanding can be acquired through indicators such as the client’s speech, facial expressions, and body movements. Affect can be judged according to variables such as its depth, intensity, duration, and appropriateness. Affect can be described as cold or warm, distant or close, labile, and, blunted or flattened. Mood can be described as euphoric, hostile, anxious, or depressed.  Thought: An understanding whether there are delusion present or absent. Delusions being defined as fixed, false beliefs that the patient’s culture and education cannot account for. Specific Delusions include:  Delusions of Death: Also called nihilistic delusions; rare symptoms are extreme cases of delusions of ill health.  Delusions of Grandeur: The false belief is that the patient is someone of exalted station or has powers or gifts not possessed by other people.  Delusions of Guilt: One believes they have committed some grave error or sin, for which they may claim to deserve punishment.  Delusions of Jealousy: The client believes that his/her spouse has been unfaithful.  Delusions of Persecution: Clients believe that they are being threatened, ridiculed, discriminated against, or otherwise interfered with. CU IDOL SELF LEARNING MATERIAL (SLM)

38 Advanced Counseling Skills - I Perception It is important to note whether there are any illusions, hallucinations and feeling of depersonalization and derealisation. Hallucinations are false sensory perceptions in the absence of stimuli to account for them and can be of the following types: auditory, visual, tactile, olfactory, and gustatory (taste). Depersonalization is a feeling that one is not oneself or that something has changed. Derealisation is a feeling that one’s environment has changed in some strange way that is difficult to describe. Cognition The elements of cognitive functioning are:  Alertness: Alertness is a global observation of level of consciousness, i.e., awareness of, and responsiveness to the environment, and this might be described as alert, clouded, drowsy, or stuporous.  Orientation: Questions related to awareness of time/place/person: Is assessed by asking the patient where he or she is (e.g., what building, town and state) and what time it is (time, day and date).  Concentration: Assessed by several tests, commonly serial sevens test subtracting 7 from 100 and subtracting 7 from the difference 5 times. Alternatively, spelling a five- letter word backwards, saying the months or days of the week in reverse order, serial threes (subtract three from twenty five times), and by testing digit span.  Memory (both short and long term): Is assessed in terms of immediate registration (repeating a set of words), short-term memory (recalling the set of words after an interval, or recalling a short paragraph) and long-term memory (recollection of well known historical or geographical facts).  Fund of knowledge: The client’s basic knowledge (often called as fund of knowledge) and awareness of social events is assessed.  Abstract reasoning: The ability to abstract a principle from a specific example is another traditional test that depends heavily on culture, intelligence and education.  Insight: Awareness into illness. CU IDOL SELF LEARNING MATERIAL (SLM)

Process Counseling 39  Judgment: The ability to decide upon an appropriate course of action to achieve realistic goals. Identification of Goals and Goal Setting The counseling process is a step by step process. One must follow the process to maximise positive outcomes in the client’s therapy treatment of resolving various psychological, social, emotional and developmental issues. The counseling process has some significant major goals through which the entire treatment and positive outcomes the treatment rests on. Verbal and non verbal cues of one’s body language play an important role in the counselors counseling process to bring out the best solutions for client issues. Goals are determined by the counselor and the client as a team. Goals should obviously be established with relation to the factors that are distressing to the client and cause a negative impact on the client’s life. Often Counseling theorists do not agree on appropriate counseling goals because they are often general, vague and saturated with implications. However there are five most commonly named goals of counseling: 1. Facilitating behaviour change. 2. Improving the client’s ability to establish and maintain relationships. 3. Enhancing the client’s effectiveness and ability to cope. 4. Promoting the decision-making process and facilitating client potential. 5. Development. These goals are not mutually exclusive and will naturally be emphasized by some theorists and not others. Hackney & Cormier (1996) identify the following three goals that are important for the counseling process. 1. Goals serve as a motivational function in the counseling process. 2. The goals can also have educational function in counseling, in that they can help clients acquire and learn new responses and behaviours CU IDOL SELF LEARNING MATERIAL (SLM)

40 Advanced Counseling Skills - I 3. The goals can also meet an evaluative function in the counseling whereby the client’s goals help the counselor to choose and evaluate various counseling strategies appropriate to the client’s goals. Krumbolz (1966) suggested three additional criteria for judging counseling goals, as follows: 1. The goals of counseling should be capable of being stated differently for each individual client. 2. The goals should be compatible with, though not identical to, the values of the counselor. 3. The degree to which goals of counseling are attained by each client should be observable. The below briefly describes of the different types of goals and their aims that the counselor and client can develop. Types of goals Aims 1. Developmental Goals Meeting or advancing anticipated growth and potential development 2. Preventive Goals The Counselor helps the client avoid some undesired outcomes. 3. Enhancement Goals Identifying skills and/or further developing them through assistance of a counselor. 4. Remedial Goals Assisting a client to overcome and/or treat an undesirable development. 5. Exploratory Goals Evaluating options, assessment of skills, and trying of different and new activities, environments, relationships 6. Reinforcement Goals When clients require assistance in recognising that what they are doing, thinking or feeling is right and okay. 7. Cognitive Goals Acquiring the basic foundations of learning and cognitive skills. 8. Physiological Goals Focusing on the basic understandings and habits for good health. 9. Psychological Goals Focus on developing good social interaction skills, learning emotional control, developing a positive self-concept. While Developing Goals the Counselor should keep the Following in Mind to Enhance the Process of Goal Setting (S.M.A.R.T. Goals) S.M.A.R.T. is a popular method for setting goals (especially in Cognitive Behavioural Therapy) and has the following components: CU IDOL SELF LEARNING MATERIAL (SLM)

Process Counseling 41 Specific (S): the counselor and client should discuss and develop specific goals for the client – general goals are too broad and focusing energy on one thing is less difficult. For example, the client’s goal is “to study more.” This is too general. It is not exact about how many hours you want to study. Be specific! Measurable (M): A goal should be measurable, how will you know when you have achieved it? Setting a goal that is measurable will help the counselor and client gauge the client’s efforts and then lead to further discussions of whether one is progressing or not. Using the previous example, saying that you want to study 5hours a day is both specific and measurable. The track to success will be clearer with a measurable goal. Achievable (A): Make attainable goals. It should be possible to reach that goal. The goals set should be realistic to reach them. To make goals attainable, the client should be aware of his/her limitations. Working towards dealing those limitations and superimposing it with the strengths makes the path more attainable. Making goals attainable encourages resilience. Realistic (R): The goals need to be in line with reality. If you have established a goal to study 23hours a day, or to win X Factor by this Tuesday, one may want to reconsider the direction your goal is taking you. The counselor should guide the client and encourage realistic goals to attain keeping in mind the variety of factors that can influence the successful completion of goals. Time frame (T): Establish a clear amount of time that the client going to dedicate to the goals. One can take time to think over how much time it will realistically take to achieve the goal. Very often people become frustrated and give in because they were too impatient. People often fail to reach their goals because they did not work often enough or long enough. Your success is worth the time! How Goal Setting Can Impact Mental Health? According to Rose and Smith, (2018), collaborative goal setting is a robust method when it comes to mental health support. The study, which gathered data over a 14-month time frame, found that goal achievement and the strength of a working alliance were demonstrated to have a positive effect on personal recovery, for those in the study. CU IDOL SELF LEARNING MATERIAL (SLM)

42 Advanced Counseling Skills - I 3.5 Summary The counseling method could be a planned, structured dialogue between a counselor and a client. It’s a cooperative process during which a trained professional helps an individual referred to as the client to spot sources of difficulties or considerations that he or she is experiencing. It is vital that one establishes a good atmosphere for counseling whether or not within the health facility or private clinic. Tools to aid counseling include various visuals tools, real life examples, flipcharts, etc. records keeping in counseling plays an important role and serves various functions like communicating information, stimulate discussions and interactions etc. The process of Counseling mainly comprises of 5 stages that include extensive sessions of case history taking, exploration of goals and implementation of strategies to achieve goals. One might face major concerns like resistance, transference and counter transference which will be discussed in the next chapter. 3.6 Key Words/Abbreviations  Rapport: Defined as a harmonious relationship between people while understanding each other’s feelings and ideas. ● Trust: Means developing a good rapport, gaining a sense of confidence and feeling that your counselor is really able to listen and understand your needs. ● Mental Status Examination (MSE): Psychological equivalent of a physical exam that describes the mental state and behaviors of the person being seen. ● History of Presenting Illness (HPI): A detailed interview prompted by the chief complaint or presenting symptom. ● Smart Goals: Specific Measurable Achievable Realistic Timed goals. CU IDOL SELF LEARNING MATERIAL (SLM)

Process Counseling 43 3.7 Learning Activity An opportunity for you to reflect on how you interact with people and the factors that influences this. 1. Use your notebook to record how you greet and treat people and how you are greeted and treated over the course of a few days. Try to include different interactions, for example, in a shop or bank, at work, or in a new place. ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- 2. How did the different interactions you had make you feel? Did you feel welcome and included? Did you ever feel unwelcome or isolated? ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- 3. If you did not visit a new place during this time, think about a time when you have visited a new place, especially a new institution such as a government building or an official office. How did you feel? What was done or could have been done to make the experience better? ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- 4. If you are working in groups, share your findings and discuss them. ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- 5. What are the most important things that people can do to make others feel welcome and comfortable? What things should you try to avoid? What influences the way you interact with other people? ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- CU IDOL SELF LEARNING MATERIAL (SLM)

44 Advanced Counseling Skills - I 3.8 Unit End Questions (MCQ and Descriptive) A. Descriptive Types Questions 1. Discuss the various components of case history and mental status examination 2. What the practical consideration a therapist should follow to ensure a facilitative counseling environment? 3. Describe the tools that aid the counseling process. 4. How does the counselor would identify the goals and set goals? B. Multiple Choice Questions 1. MSE was introduced by __________ in the year __________. (a) Adolf Meyer, 1902 (b) Krumbolz, 1966 (c) Rose & Smith, 2018 (d) Adolf Meyer, 1966 2. Which of the following is a harmful Defence mechanism? (a) Suppression (b) Repression (c) Sublimation (d) Humor 3. Timbre of voice refers to __________. (a) quality and characteristics (b) pitch of voice (c) frequency of voice (d) speed/pace 4. MSE is designed to examine __________ function. (a) psychiatric (b) cognitive (c) physical (d) psychological 5. In SMART goals, R stands for __________. (a) ritualistic (b) resilience (c) rational (d) realistic Answers 1. (a), 2. (b), 3. (a), 4. (a), 5. (d) CU IDOL SELF LEARNING MATERIAL (SLM)