The Counseling Process Foundations

A PROCESS In considering the counseling process, think of a beginning, a middle and an end – each with main areas of focus/tasks to accomplish. Think process. *Applies as a whole (1st to last session) *Within sessions Built upon a solid foundation of relationship, moving forward toward goals…a blend of art and of science Applies in all theoretical orientations

Six Stages Stage One: Relationship building Stage Two: Assessment and diagnosis Stage Three: Formulation of counseling goals Stage Four: Intervention and problem solving Stage Five: Termination and Follow Up Stage Six: Research and evaluation Rick wondering about questions we might ask here…e.g. Stage 1: where are the places where legal and ethical issues would arise Stage 2: What assessment would you consider – from an initial look at case info, does it seem to meet criteria for depression? How specifically? What legal/ethical issues here? Stage 3: Important things to know about the setting of goals. What factors that the client brings are going to have an impact here. What goals would you set with her? Stage Four: Here is the intervention stage – consider your developing treatment plan – sketch out an advance idea of your plan to accomplish your goals, think of early, middle and late stages of counseling Stage Five: What is important to consider as you think about termination? Legal/ethical issues? How would you go about it? Stage Six: Research and Evaluation – here the question is how will you know if your work helped this client – how will your experience with him/her inform your future practice?

Stage One Relationship Building Tasks here include… *Laying foundations for trust *Establishing the structure and form the relationship will take *Informed consent process *Articulating roles of counselor and client – developing a collaborative working alliance

Stage One Relationship Building Consider how do we develop rapport, create relationship with our clients? What is it that we bring to the relationship that helps us create a foundation of trust and willingness to work collaboratively toward goals? Core Conditions Necessary for Successful Counseling Originally proposed by Rogers (1957) *Empathetic understanding *Unconditional positive regard *Congruence Carkuff (1969) adds to these… *Respect * Confrontation *Immediacy * Concreteness *Self disclosure Regardless of therapeutic orientation – this holds true

The Purpose Served Empathy  promotes rapport and relationship Unconditional Positive Regard  Client as person of worth – separate from actions Congruence  Genuine self in client interaction Respect  Strength focus Immediacy  Here and Now Confrontation  Promotes realistic, accurate view Concreteness Attention on what is practical Self disclosure -->Promoting positive perception and appropriate focus in counseling relationship Nystul (2003)

Using Counseling Skills Effective Listening Early stages of the counseling relationship afford the chance to build counselor understanding of client and issues faced. Using counseling skills to gather information, to begin to formulate impressions Do… Use listening skills and attend to nonverbals Listen for the underlying communication Don’t… Be a judgmental counselor Jump to conclusions Make language errors (e.g.parroting, jargon)

Stage Two Assessment and Diagnosis Gathering information to promote understanding of client’s situation and perspective…..phenomenological Completion of intake/of psychosocial Standardized (e.g. psychological tests) and Non standardized (e.g. clinical interview) tools Completion of Risk Assessment where appropriate Diagnosis

Stage Two Tasks of this Stage Identifying the nature of the presenting problem – what kind of change is sought Counselor role moreso in helping the client articulate than in pronouncing for them Seeing problem in-context to the client’s larger world. Keeping an eye on strengths and resources. Counselor builds hypotheses during this stage and throughout

Stage Three Formulation of Client Goals The client articulates where they want their counseling journey to take them *Client role as one of driving the bus *Enhances sense of ownership and motivation – factors important in the change process Well identified goals help create a roadmap and means to evaluate Goals may change, evolve as therapy progresses

Five Categories Counseling Goals 1. To change an unwanted or unwelcome behavior 2. To better cope 3. To make and implement decisions 4. To enhance relationships 5. To help client’s journey of growth toward achieving potential Nystul (2003)

Stage Four Intervention and Problem Solving Begins as soon as goals are established – this is plan for how to achieve them Action…directed in accord with new perspectives Talked about…but lived Collaboratively established plan works best Educational in that client is offered information regarding options, and advantages/disadvantages for each

Stage Four Intervention New perspectives on both the way clients have looked at the problem and ways they might approach it *Confrontation vs Carefrontation *Self Disclosure as appropriate *A clear, simple plan toward goals

Stage Four Intervention Characteristics of a good treatment plan… *goals are clearly defined and reachable *plan able to be adapted with time *positive and action-oriented focus Essential to an effective plan…is client’s motivation and willingness to follow it

Prochaska’s Stages of Change Pre-Contemplation Contemplation Preparation/Determination Action Maintenance Relapse See this resource for addictions focus: http://www.addictioninfo.org/articles/11/1/Stages-of- Change-Model/Page1.html

Crafting a Treatment Plan Begins with clearly articulated problem and priority from client’s perspective *primary (presenting) vs underlying Clearly defined, broad goals – global Objectives – behaviorally stated, steps on way to broader goal – mindful of accountability Interventions to be utilized by counselor

Example from Knapp & Jongsma (200 ) Child with Anger Management Issues Problem: Repeated angry outbursts out of proportion to precipitating event Goal: Significantly reduce intensity and frequency of angry outbursts Objectives: Parents clearly define rules and boundaries and follow through with child Intervention: Assist parent in the process of identifying and presenting rules and consequences to child

Termination Collaboration with client in identifying a date in advance – Note that today, Managed care may dictate Role to review progress, create closure in client counselor relationship and plan for future Think of this as a means of empowering client

Stage Five: Termination Counselor Considers Counselor always mindful of avoiding fostering dependency and is aware of own needs Preparation for termination begins long before Open door / plan for possibility of future need Termination considered not just at end of successful relationship, but also is considered when it seems counseling is not being helpful

Research / Evaluation Really completed throughout the counseling process – reflected in… *Generating hypotheses *Trying intervention strategies *Determining if/when goal is met A plan for evaluation