#3: Middle Stage of the counselling process CHCCSL503B Facilitate the Counselling Relationship #3: Middle Stage of the counselling process

Lesson outline 2. MIDDLE STAGES: working through client concerns Supporting clients to experience & process their difficulties: using a person-centred approach Finding strengths: Using a strengths based approach Exploring clients’ feelings Identifying & working with underlying issues Responding to strong emotion Dealing with hesitation & ambivalency Working with change in clients’ lives

Middle stage Middle stage: To assist working through issues, counsellor & client now participate in the following stages: Continue (as in the beginning stage) to support the client through active listening & attending Emphasis on emotions –enable the client to get in touch with & release emotions Emphasis on thoughts to clarify the problem and to restructure how they view the problem See Geldard (2012) flow chart page 152 . See Geldard (2012) flow chart p 152

Person-Centred approach Perhaps the single-most important quality the counsellor should demonstrate is a Person-Centred approach whereby the client directs the process & only shares and works on what they feel comfortable doing without feeling 'pushed' DVD: Corey: Theory & Practice of Counselling & Psychotherapy - The Case of Stan - #5: Person Centered therapy

Strengths-based approach Strengths based counselling involves: Concentrating on what clients are capable of instead of a 'deficit- model’ (ie: looking at what a client can't do).

Strengths-based approach Believing everyone inherently has strengths, & working towards these strengths assists individuals to overcome problems. Making parallels or links from strengths clients used in their past experience to the present difficulties they are experiencing Reframing to help clients see their strengths. Celebrate clients’ achievements throughout counselling.

Strengths- based approach Some strengths-based questions you may present to your client: “What are you good at?” Or “what do you consider to be your strengths?” “How have you overcome issues similar issues to this in the past?” “How can you use skills and resources to overcome your current situation?” “Who can assist you to overcome this?” “What are your goals for the future?” [Adapted from: http://blog.iqmatrix.com/life-coaching/creating-your-life-resource-list-mind-map ]

Strengths- based approach Help clients locate their own resources to solve problems, make decisions & capitalise on their strengths Youtube video: tom rath why we focus on weakness http://www.youtube.com/watch?v=_A0ZE4_37As&feature=autoplay&list=PL974DFE9331A092A8&playnext=2 Youtube video: Strengths-Based Counseling http://www.youtube.com/watch?v=RtADcIJYLzA

Clients’ past & present strengths can include: -Physical Health -Social Supports -Emotional Resilience -Spiritual Outlook -Vocational/Financial -Intellectual/Giftedness http://www.basic-counseling-skills.com/strengths-based.html Self reflection & discussion activity: The Skilled Helper, page23 -27, Exercise 4.1 Reviewing some basic developmental tasks How often ( in class & in life in general) do you concentrate on your own & people’s strengths, compared to weaknesses? How easy or difficult was it for you to find strengths in this exercise?

Exploring clients’ feelings Reflection of Feelings: Microskills are powerful tools. They assist clients in identifying underlying issues by: Enhancing a client’s level of self awareness by ‘talking out’ the issues Feeling ‘safe’ to explore issues in more depth through the helping relationship

Exploring clients’ feelings Moving away from “head talk” or “content” Clients “own” their feelings and feel understood Example: Client: “I was telling her how she was using me and wanting me to play the role of provider and I was tired of it and wished she could see how that was impacting on me, but she just doesn’t and when I said that to her she just sternly looked at me and I just walked out.” Counsellor response: “ You were really angry” or “You were furious”

Exploring clients’ feelings Avoid reflecting feelings when: a situation requires immediate attention, e.g. someone needs emergency accommodation a client wallows in feelings to avoid problem solving or action a client seems to be losing control and becoming agitated… “ I hear you’re angry, let’s just take a breath and address the situation in a minute” Youtube video: Counselling Skills Lecture 4: Paraphrasing & Reflecting Feelings http://www.youtube.com/watch?v=_M67ioQ1K2Y&feature=channel&list=UL

Exploring clients’ feelings Common errors of reflection: Stuck on content – using same words and repeating the story rather than attempting to get below the surface Depth/Intensity – Incorrect matching of degree of feeling, happy is not the same as elated or content Meaning – adding or taking away from what was expressed… respond from client’s frame of reference Language – avoid over interpretation, avoid use of psychological language

Exploring clients’ feelings In summary, reflecting back, clarifying & reviewing feelings encourages the client to consider how they feel & why they feel that way Whatever the counsellor picks up on can be talked through together http://www.globalhealthcommunication.org/tool_docs/48/provsession_4-6.pdf Youtube Video: “Listening skills – Paraphrasing” http://www.youtube.com/watch?v=V_T4B9XANCw Group Activity: Geldard (2012) Chapter 7: page 69 – Practice examples of reflection of feelings & page 70 - triad role plays 3. YOUtube Video: Reflecting back and paraphrasing http://www.youtube.com/watch?v=xrbXMaiR_Ww Uploaded by CIPDPublishing on Nov 19, 2008

Working with underlying issues A more deep-seated issue that arises through the therapeutic relationship Often the key concern that contributes to the presenting issue.

Working with underlying issues Underlying issues may be apparent to both counsellor and client ... or out of awareness of both The Johari window is a framework for understanding the level of awareness we have: Youtube video: Johari Window http://www.youtube.com/watch?v=c7rlCgy6i88&list=UUSnEXvOOpzPkB01mvlUl-2g&index=1&feature=plcp

Working with underlying issues To identify underlying issues: Use rapport, trust & client/counsellor collaboration to aid increased awareness Be attuned to a client’s situation & probable issues; explore these with the client Imperative to work with the probable issues, not engage in a process of gross interpretation without factual input.

Working with underlying issues For example: When a client has problems with expressing anger aggressively, it’s useful for us to know that anger comes from fear and a sense of helplessness So when a client fears losing control of a situation, they may not be able to acknowledge feeling hurt or fear. Yet these are the underlying feelings http://www.csulb.edu/~tstevens/b-anger.htm

Responding to strong emotions Working with Strong Emotional reactions While working with clients’ strong emotions, it may become apparent that they are also experiencing underlying feelings. Eg: a client might feel hurt at not having their needs met. If the client doesn’t feel that they can express this emotion freely, it could perhaps progress into the secondary emotion of anger.

Responding to strong emotions A counsellor may decide to work with strong emotions such as anger by using basic reflection of feelings. If the counsellor is more skilled, they may be able to use advanced techniques such as: Reframing Gestalt ‘Empty Chair’ technique Thought stopping Challenging self-destructive beliefs

Responding to strong emotions Warning: It can be difficult to assist a client in controlling inappropriate anger if you are a new counsellor. If you are concerned that you are inexperienced in this area, you are best to refer the client on. Alternatively, you may prefer to manage & control anger through assertiveness. Remember: If the client shows violence towards others and/or property, you may have a Duty of Care to disclose this.

Ambivalence & reluctance Definition of ambivalence: The simultaneous existence of two opposed and conflicting attitudes emotions, etc. Inability to make a decision due to simultaneously being drawn in opposite directions http://dictionary.reference.com/browse/ambivalence

Ambivalence & reluctance Reluctance: Misgivings about change: Clients may be reluctant to seek out counselling for various reasons “ Society looks down on people who seek help” “The whole experience will be too emotionally painful” “Counselling probably won’t help much” “I’ll have to reveal all my dark secrets” “I’ll be embarrassed and feel worse about myself than I do now” “my family and friends will think I’m odd” Egan, 2010,p.116 Reluctance to seek help is the first form of reluctance... Some reason taken from Egan above.

Ambivalence & reluctance Reluctance: Misgivings about change as part of the counselling process: Fear of Intensity Lack of Trust Fear of Disorganisation Shame The Cost of Change Loss of Hope Egan, 2010,p.117 Fear of Intensity – Intensity of the helping process can cause both helper and client to back off. Good helpers are prepared for intensity and work with it and support clients Lack of Trust – Some clients find it difficult to trust, and it takes them time to reveal themselves... A combination of patience, encouraging, and challenging is demanded of the helper Fear of disorganisation – Some people fear self-disclosure because they feel they cannot face what they might find out about themselves. Digging into inadequacies and issues leads to a certain amount of disequalibrium and disorganisation... But growth takes place at crisis points... By challenging clients to take “baby steps” that don’t end in disaster, counsellors help clients build confidence. Shame – primarily an exposure to oneself, might be defined as an acute emotional awareness of a failure to be in some way. Empathy and support help clients deal with shame The cost of change – surrender to comfortable but unproductive patterns of living... Challenge of working more diligently, suffer the pain of a loss (of an unproductive pattern) acquiring skills to live more effectively... Change is hard work, counselling is not magic Loss of Hope – some clients think, “Change is impossible, why try?” sensitive challenge leads a client to self-responsibility

Ambivalence & reluctance Uncertainty, ambivalence and ambiguity occur when the client has reached an impasse and is stuck “Stuckness” derives from Gestalt Therapy to describe the predicament of the client It refers to the client being unable to reconcile discrepancies Ivey, A.E., Ivey, M.B. (2010)

Ambivalence & reluctance Allow clients to express their ambivalence: Unresolved ambivalence decreases motivation to change Disagreeing with clients about changing or confronting anyone with negative feedback about themselves only serves to trap them in opposition, where they assume the other side of the argument Summers, N. (2012) Activity: The Skilled Helper Exercise book, p 30 – 33 Exercises 4.5 & 4.6 My own reluctance & My own experience of resistance

Working with changes in clients’ lives Acknowledging & working with change Counsellors work with clients to identify their life’s patterns

Working with changes in clients’ lives As one of life’s constants, change can come from landmark life experiences, unexpected events or crises: - New school or job - Getting married - Having a child - Separation or divorce - Empty nest - Retirement - National disaster - Accident

Working with changes in clients’ lives These situations are normal but can raise difficult emotions Counselling can be helpful when life changes are creating too much stress, negatively impacting a client’s life, or leaving a client feeling stuck and unable to adjust

Working with changes in clients’ lives As with underlying issues, if clients can recognise parallels & links in their life patterns, particularly relating to past decisions & past behaviours, they may be empowered to rethink future decisions & behaviours to improve their life

Working with changes in clients’ lives Through helping clients to identify problems, find strengths, examine underlying issues & emotional reactions, action plans can be formed Meaningful intervention requires the client to do something to enable that to happen Eg. If a client’s goal is to improve parenting, intervention could include inviting the client to read parenting material, referring them to a parenting group, find more support within the family, etc Summers, N. (2012)

Common errors in counselling To conclude, a summary of common errors in counselling: Advice giving Imposing your own values Limited reflection of feeling and content  Parroting  Too many questions  Attempting to find solution too quickly.

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