#2: Beginning Stage of the Counselling Process CHCCSL503B Facilitate the counselling relationship #2: Beginning Stage of the Counselling Process

Lesson outline Overview of stages of the counselling process Assessment & contracting Beginning Stage: Identify & prioritise client concerns Presenting issues & primary concerns Underlying issues Situations needing immediate notification or referral

Overview of Counselling Process Essentially, 3 key phases can be identified in the counselling process: Beginning, Middle & Terminating These phases can be broken down into a further 8 stages: Preparation Joining (establishing the relationship) Active listening Emphasis on emotions Emphasis on thoughts (clarifying the problem) Emphasis on thoughts (restructuring thoughts) Emphasis on behaviour Closure See Geldard (2012) flow chart p 152 Get students to look at flow chart of the 7 stages in Geldard, 7th Ed, p 152

Overview of Beginning Stage Our aim is to assist the client with their presenting issues, & to provide immediate notification &/or referral where required. A presenting issue: is what a client may describe as their difficulty during the initial stages of counselling. In order for a client to feel that they can disclose their presenting issue, however, the client must first feel they trust the counsellor.

Overview of Beginning Stage To build trust the counsellor engages in the stages of Preparation, Joining (establishing the relationship) & Active Listening. See Geldard 2012, p 152 With the relationship begun, begin assisting the client in initial problem identification & clarification using micro skills. After careful open/closed questioning & microskills, assist the client to prioritise needs & develop short term goals. Activity: Skilled helper Workbook: Exercise 1.3, p 8: ‘Strengths & Soft Spots’

Assessment & contracting Beginning Stage Client-centered assessment: counsellor & client collaborate to help clients tell & reframe these stories so as to understand their problems Important to develop boundaries through contracting: to avoid a mismatch between client’s & counsellor’s expectations, typically with client's believing that counselling is about 'advice giving'. 1. View sample intake form & case note layout handout 2. Activity: Discuss sample contract: think about why each of the 8 headings are included on this contract See: http://www.howto.co.uk/wellbeing/counselling-skills/helping_the_client_feel_safe/

Assessment & contracting Important items in the contracting process: Duty of Care & response to threats of harm to self &/or others Discussion around confidentiality Accepted & unaccepted behaviours General & specific goals The nature of the 'therapeutic relationship' The counselling methods used by the counsellor Issues that the client wishes to discuss & not discuss Attendance at counselling sessions (including frequency and number – and discuss around review of these as necessary) Adapted from: How To (2012)]: http://www.howto.co.uk/wellbeing/counselling-skills/helping_the_client_feel_safe/

Identify & prioritise client concerns The Presenting Issue: what a client describes as their main difficulty during the initial stages of counselling. Presenting issues can encompass: Communication Decision-making Intimacy Finances Sexual incompatibility Management of family responsibilities Child behavior problems / Parenting Employment http://pubs.niaaa.nih.gov/publications/niaaa-guide/index.htm

Identify & prioritise client concerns Primary Concerns: the main problems in the client’s life resulting from the presenting issues. Assist clients to identify their primary concerns in relation to their presenting issues Eg: The client may identify their presenting issue as job loss. Their primary concern as a result of this may be inability to service their mortgage, with an impending consequence of losing their home In pairs, think of some potential primary concerns related to these presenting issues: Child’s truancy from school Domestic violence Being unemployed Being bullied in the workplace Going bankrupt Depression after a divorce

Identify & prioritise client concerns Counsellor’s role at this stage: Engagement with client – to commit to the helping process Initial stress reduction as clients unburden themselves of ‘secrets’/untold stories Helping clients tell their stories so rapport strengthens Trust helps counsellor & client explore the nature & depth of clients’ presenting issues Be aware presenting issues & primary concerns may be straight forward or complex: Assist clients to clarify priorities for working on these concerns. Activity: Skilled Helper Workbook: p 42-43,Exercise 5.6:Listening to your own feelings & emotions Egan textbook, p 96

Identify & prioritise client concerns How to help clients tell their stories: Learn to work with all styles of storytelling – fear of self-disclosure varies between individuals & cultures Single-issue or multiple-issue stories – client’s stories vary enormously Stories about client’s inner world (‘I feel lonely/depressed’) or outer world (problems with relationships) Egan, (2007) p 100 ‘The disclosure process itself may be as important as any feedback the client receives from the therapist’ Egan, p 97 Egan, p 98 – 101 Clients present with different dilemmas: failed solutions, approach-approach conflicts, choices re which strategy to use, difficulty in implementing known strategies. Egan Exercise book p 8: SOFT SPOTS exercise - pairwork

Identify & prioritise client concerns Clients vary in how honest they are; some lie or hide by telling partial, ambiguous or general stories Start where the client starts: ‘Your job is to stay with clients no matter where they are, not forcing them to be where you would like them to be’ Egan, (2007) p 100 Egan, p 100

Identify & prioritise client concerns Questions to help clients ask themselves to identify problems: What’s problematic in my life? What issues do I need to face? What do I need to resolve? What would those who know me best say of me? What keeps me back from doing what I want to do/ being what I want to be? Pair activity: Skilled Helper Workbook: Exercise 5.7,p 43 – 47: Listening for core messages

Underlying Issues Identify underlying issues: those that aren't readily apparent when the client presents to you, however are generally the key concern that has contributed to the clients issues in the first place Underlying issues may be the key to resolving presenting issues, eg: depression, eating disorders, social phobia, anger management Counsellors help clients recognise & understand the underlying causes for certain behaviours

Underlying Issues This can empower people to control/modify their reactions & prioritise issues to work on Clients may experience strong emotional reactions Eg: A client may express that they have a pattern of entering domestically violent relationships, but as you continue your therapeutic relationship with the client, you become aware that they experienced physical abuse as a child. It is likely that this underlying issue is one of the key causes of the presenting issue, & if not addressed, it is probable that the initial presenting issue will continue to occur.

Working with underlying issues: Benefits and rewards: are possible through understanding the psychology that underlies an issue Risks: that the issue is beyond the scope of the counsellor’s experience and skills http://www.redcouchpsychologycounsellingtherapyclinicmelbourne.com.au/

The benefits can include: Underlying Issues The benefits can include: Reduction in stress and distressing symptoms More hope and more positive outlook on life Greater sense of control Improved confidence and self-esteem Relief at letting go of a burden Increased focus and direction - continue

Underlying Issues Heightened sense of happiness and fulfillment Increased sense of life satisfaction Greater enjoyment of life Better connection in relationships Pride/accomplishment in mastering a challenge A sense of peace at releasing past trauma or pain Increased health benefits http://www.redcouchpsychologycounsellingtherapyclinicmelbourne.com.au/ Group brainstorm activity on presenting issues, primary concerns & underlying issues: Case Study dialogue Salat handout ACTIVITIES TO DO AFTER THIS SLIDE – these exercises flow in a teaching order to follow up on ‘Identifying Underlying Issues’: 1. Egan Exercise Book Activities: IN CLASS ACTIVITIES P 42 – 43 Ex 5.6 LISTENING TO YOUR OWN FEELINGS & EMOTIONS P 43 – 47 EX 5.7 LISTENING FOR CORE MESSAGES – pairwork 2. Case Study Dialogue Salat – with group brainstorm activity on identifying Presenting Issues, Primary Concerns and Possible Underlying Issues (see handout)

Referral & Reporting The Beginning stage also must encompass: Identifying situations needing immediate action or referral Dealing with them promptly

Referral & Reporting Managing a crisis requires appropriate & swift action Inaction or an inappropriate reaction can further the distress Be aware of not making decisions in isolation

Categories of priority: Referral & Reporting Categories of priority: Immediate priority The safety or wellbeing of client or others is at risk High priority Delaying service will exacerbate situation Medium or low priority Interim supports are available and the situation is stable http://www.health.vic.gov.au/pch/downloads/community_health_priority_tools.pdf

Referral or Immediate Priority: Referral & Reporting Referral or Immediate Priority: Immediate action is required for: • Clients at risk of harm to selves or others • Clients with safety issues at home • Clients feeling unsafe or vulnerable due to abuse or domestic violence, whether physical, financial or emotional

High priority clients include: Referral & Reporting High priority clients include: People with a risk to their safety or that of others The homeless and those at risk of homelessness Refugees Aboriginal or Torres Strait Islander people People with an intellectual disability People with a serious mental illness Complex care needs requiring a coordinated team approach http://www.health.vic.gov.au/pch/downloads/community_health_priority_tools.pdf

Client issues requiring referral: Referral & Reporting Client issues requiring referral: Include (but are not limited to) indicators of: Child protection issues Suicide prevention/intervention Domestic and family violence Mental health issues Alcohol and other drugs issues Industry Skills Councils (2011) Video: DVD: Corey, G: Theory & Practice of Counselling & Psychotherapy - The Case of Stan - Interview 1: Intake & Assessment

References Active Listening (Do’s & Don’ts), online video, accessed 5 June, 2012. http://www.youtube.com/watch?v=yIjnB9zp0sw American Counseling Association (1996) A Practitioner's Guide to ethical Decision Making http://www.counseling.org/Counselors/PractitionersGuide.aspx Site last updated: 2012 An introduction to Person Centred Therapy, online video, accessed 5 June, 2012. http://www.youtube.com/watch?v=Qpfm5sY0OX0&feature=related Australian Counselling Association (2012) Professional Supervision http://www.theaca.net.au/documents/Supervision_Complete.pdf Site last updated: not disclosed Biblos (2011) http://bible.cc/psalms/23-4.htm Online Parallel Bible Project, Site last updated: not disclosed Centre for Global Health (2012) Encouraging Dialogue: Listening, Questions, Paraphrasing, and Reflecting Feelings http://www.globalhealthcommunication.org/the_center/contact_us Site last updated: not disclosed Corey, G. (2009) Theory and Practice of Counselling and Psychotherapy 8th ed. Brooks/Cole Cengage Learning, California p.386 Corey, G., Corey, M.S. & Callanan, P. (2011) Issues and Ethics in the Helping Professions, 8th ed. Brooks/Cole Cengage Learning, California p.78, 117, 141, 269 Dictionary.Com (2012) Roget’s Thesaurus http://dictionary.reference.com/browse/ambivalence Site last updated: not disclosed Egan, G. (2007) The Skilled Helper, 9th ed. Brooks/Cole Cengage Learning, California Feltham, C. & Dryden, W. (2004) Dictionary of Counselling 2nd ed. Whurr Publishers Ltd, London p.9 Geldard, D. & Geldard, K. (2012) Basic Personal Counselling, A Training Manual For Counsellors 7th ed. Pearson NSW p.376

References Corey, M., & Corey, G. (2011) Becoming a Helper, 6th ed. Brooks/Cole Cengage Learning, California p.151, 152, 153 Counselling Skills Lecture 4: Paraphrasing & Reflecting Feelings, online video, accessed 4 June, 2012, http://www.youtube.com/watch?v=_M67ioQ1K2Y&feature=channel&list=UL Dictionary.com, 2012, accessed 6 June, 2012, http://dictionary.reference.com/browse/ambivalence Site last updated: not disclosed Ending counselling, online video, accessed 7 June, 2012, http://www.youtube.com/watch?v=7sv6emlOJeI&feature=related Industry Skills Councils (2011) CHC51708 Diploma of Counselling Training Package Australian Government Department of Education, Employment and Workplace Relations Interview Stories: Open versus Closed Questions, online video, accessed 4 June, 2012. http://www.youtube.com/watch?v=RoB--jhPIus Ivey, A.E., Ivey, M.B. & Zalaquett, C.P. (2010) Intentional Interviewing and Counselling, Facilitating Client Development in a Multicultural Society 7th ed. Brooks Cole, California Johari Window, online video, accessed 6 June, 2012, http://www.youtube.com/watch?v=c7rlCgy6i88&list=UUSnEXvOOpzPkB01mvlUl-2g&index=1&feature=plcp “Listening skills – Paraphrasing” , online video, accessed 6 June,2012, http://www.youtube.com/watch?v=V_T4B9XANCw National Institute on Alcohol Abuse and Alcoholism (NIAAA) (2003) http://pubs.niaaa.nih.gov/publications/niaaa-guide/index.htm Site last updated: not disclosed Psychology Suite 101 (2012) http://linda-smallwood.suite101.com/counselling-and-endings---how-to-manage-them-a298878 Site last updated: not disclosed

References Ruskin, John, 2009, How to.com, Brighton, U, acessed 6 June, 2012,. http://www.howto.co.uk/wellbeing/counselling-skills/helping_the_client_feel_safe/ Steven, J. C. (2010) http://www.basic-counseling-skills.com/strengths-based.html Site last updated: 2010 Stevens, T.G. (2010) Overcome Anger and Aggression http://www.csulb.edu/~tstevens/b-anger.htm Site last updated: not disclosed Strengths-Based Counseling, online video, accessed 5 June, 2012, http://www.youtube.com/watch?v=RtADcIJYLzA Summers, N. (2012) Fundamentals of Case Management Practice, Skills for the Human Services 4th ed. Brooks Cole, California p.335, 337, 409 The Red Couch Counselling & Psychology Clinic (2009) http://www.redcouchpsychologycounsellingtherapyclinicmelbourne.com.au/ Site last updated: not disclosed Tom rath why we focus on weakness, online video, accessed June 5, 2012, http://www.youtube.com/watch?v=_A0ZE4_37As&feature=autoplay&list=PL974DFE9331A092A8&playnext=2 Victorian Government Department of Health (2009) Community Health Priority Tools http://www.health.vic.gov.au/pch/downloads/community_health_priority_tools.pdf Site last updated 2009 Western Ottawa Community Resource Centre (2012) http://www.wocrc.ca/en/programs-and-services/counselling-information-referral/Limitations-of-Counselling.aspx Site last updated: not disclosed