1. #3: Middle Stage of the counselling process
CHCCSL503B
Facilitate the Counselling Relationship
#3: Middle Stage of the counselling process

2. 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

3. 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

4. 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

5. 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).

6. 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.

7. 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: ]

8. 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
Youtube video: Strengths-Based Counseling

9. Clients’ past & present strengths can include: -Physical Health
-Social Supports
-Emotional Resilience
-Spiritual Outlook
-Vocational/Financial
-Intellectual/Giftedness
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?

10. 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

11. 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”

12. 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

13. 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

14. 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
Youtube Video: “Listening skills – Paraphrasing”
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
Uploaded by CIPDPublishing on Nov 19, 2008

15. 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.

16. 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

17. 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.

18. 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

19. 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.

20. 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

21. 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.

22. 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

23. 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.

24. 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

25. 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)

26. 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

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

28. 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

29. 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

30. 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

31. 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)

32. 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.

33. 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

34. 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

35. 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