1. #2: Beginning Stage of the Counselling Process
CHCCSL503B
Facilitate the counselling relationship
#2: Beginning Stage of the Counselling Process

2. 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

3. 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

4. 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.

5. 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’

6. 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:

7. 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)]:

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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.

16. 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

17. 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

18. 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
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)

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

20. 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

21. 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

22. 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

23. 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

24. 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

25. References
Active Listening (Do’s & Don’ts), online video, accessed 5 June,
American Counseling Association (1996) A Practitioner's Guide to ethical Decision Making Site last updated: 2012
An introduction to Person Centred Therapy, online video, accessed 5 June, 2012.
Australian Counselling Association (2012) Professional Supervision Site last updated: not disclosed
Biblos (2011) Online Parallel Bible Project, Site last updated: not disclosed
Centre for Global Health (2012) Encouraging Dialogue: Listening, Questions, Paraphrasing, and Reflecting Feelings 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 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

26. 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,
Dictionary.com, 2012, accessed 6 June, 2012, Site last updated: not disclosed
Ending counselling, online video, accessed 7 June, 2012,
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.
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,
“Listening skills – Paraphrasing” , online video, accessed 6 June,2012,
National Institute on Alcohol Abuse and Alcoholism (NIAAA) (2003) Site last updated: not disclosed
Psychology Suite 101 (2012) Site last updated: not disclosed

27. References
Ruskin, John, 2009, How to.com, Brighton, U, acessed 6 June, 2012,.
Steven, J. C. (2010) Site last updated: 2010
Stevens, T.G. (2010) Overcome Anger and Aggression Site last updated: not disclosed
Strengths-Based Counseling, online video, accessed 5 June, 2012,
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) Site last updated: not disclosed
Tom rath why we focus on weakness, online video, accessed June 5, 2012,
Victorian Government Department of Health (2009) Community Health Priority Tools Site last updated 2009
Western Ottawa Community Resource Centre (2012) Site last updated: not disclosed