c

COUNSELLING
Counseling denotes ³giving advice´. It is a wider procedure concerned with emotion as
well as giving information.
Peplau (1952) said that the ³counseling´ in nursing have to do with helping the client to
remember and to fully understood fully what is happening to him in the present situation
so that the experience can be integrated with rather than disassociated from life.´

Peplau (1962) believed that nursing interventions should aid client in recognizing their
dysfunctional behavior, help them to describe the behavior verbally, connect to the causes
and consequences of their behavior, search for more functional behavior and transfer the
improved behavior to other situation.
Nurse therapist has developed skills through intensive supervised educational
experiences to provide helpful individual, group or family therapy. Peplau suggested that
it is essential for the staff nurse working in psychiatry to have a general knowledge of
basic counseling techniques. A therapeutic or helping relationship is established through
use of the interpersonal techniques and is based on knowledge of theories of personality
development and human behavior.

Rogerian counseling involves the counselor's entry into the person's unique
phenomenological world. In mirroring this world, the counselor does not disagree or
point out contradictions. Neither do he / she attempt to delve into the unconscious.
Rogers describes counseling as a process of freeing a person and removing obstacles so
that normal growth and development can proceed and the person can become more
independent and self-directed.

Counseling is a dynamic and purposeful relationship between two persons, who approacha mutually
defined problems with mutual considerations of each other to the end that thetroubled one or less mature
is aided to a self determined resolution of the problem.
(Wren 1962).

Counseling is helping relationship that includes someone seeking help ,someone willing
to give help who is capable or trained to help in a setting that permits help to be given
and received .(Cormeir & Hackney 1987).

Counseling is an accepting, trusting & safe relationship in which client learns to discussfreely what
respects them, to define their goals, to acquire the essential social skills & todevelop the courage & self-
confidence to implement desired new behavior.

(Vedanayagan 1988)
The psychiatric nurse uses counseling interactions to assist the client in improving orregaining their
previous coping abilities, fostering mental health and preventing themental illness and disability (ANA,
2000).Counseling interventions may occur in avariety of settings and may include the following:

Communication andinterviewing techniques

Problem solving skills

Crisis interventions
Stress management

Relaxation techniques

Assertiveness training

Conflict resolution

Behavior modifications.

Counseling is an important intervention during one-to-one interaction with the clients or

during the presentation of psycho education groups, medications groups and discharge
planning groups. Clients, family members and significant others are given an opportunity
any concerns they may have. The counselor provides reassurance and clarification as he
need arises. Reassurance helps the client to regain self confidence and decreases feelings
of guilt, anxiety or fear. Clarification helps the client gain a clearer picture of reality by
understanding behavior & feelings.

Concept of Counseling
Î Counseling is the relationship between two persons in which, one of them
attempts to assist the other in organizing himself to attain a form of
happiness, adjustment to a life situation i.e. self actualization.

Î An accepted, trusting and safe relationship will be formulated in which

clients will learn too discuss their problems, acquires the social skills,
courage, confidence to implement desired new behavior.

Î The relationship between two personnel or the interaction between the

counselor i.e., one professionally trained worker and the counselee i.e. the
person who seeks services or who cannot cope up alone

Î Helps the individual to become aware of himself and the ways in which he
is reacting to the behavioral influences of his environment.

üeaning of Counseling
Counseling is a helping relationship which includes:

Someone seeking help

Someone willing to give help

Capable or trained to help

In a setting that permits help to be given and received.

It is accepting trusting & safe relationship in which client learns to discuss freelywhat respects them, to
define their goals, to acquire the essential social skills & todevelop the courage & self-confidence to
implement desired new behavior.
Patterson (1967) has pointed out certain behaviors that are not synonymous with the
process of effective counseling:
c

Counseling is not giving the information, though information may be present.

Counseling is not giving an advice.

Counseling is not the behavior by persuading, threatening or compelling without

the use off physical force.

Counseling is not interviewing, though interviewing is involved.

üodels for counseling

Psychoanalytic : This model follows the teachings of Sigmund Freud. The emphasis is on
the client's childhood experiences and relationships with the parents, and on the
client's psychosexual development. Psychoanalysis seeks to uncover the secrets of
the human psyche hidden in the unconscious mind. Psychoanalysts attempt to develop a
relationship of transference with their clients, in which the clients relate to their analysts
just as they did to their parents in childhood. During this process the client's defense
mechanisms are identified and replaced with healthy behavior patterns. Psychoanalysis
usually takes many years to complete with 1-3 sessions every week.

Psychodynamic: This model does not follow Freud's idea of psychosexual development.
However, stages of social development over the life span are still important in this model.
Lifetime experiences are examined and defense mechanisms are identified. The client is
helped in learning appropriate decision-making skills and behaviors. Psychodynamic
therapy often involves long term therapy, but not as long as psychoanalysis.
The psychoanalytic and psychodynamic approaches propose that our childhood
experiences can strongly influence our reactions in the present without our even realizing
it. This does not mean that our present behaviors are the fault of our parents, nor that our
past determines our future. However, it does provide us with information necessary and
helpful for changing the negative influences of our past.

Client-centered or Rogerian: Carl Rogers believed that reality for the individual is the
sum total of one's experiences and perceptions over a lifetime. According to Rogers, the
goal of achieving one's potential can be attained in counseling provided that the therapist
provides an atmosphere of genuineness, unconditional acceptance, and empathy. The
counselors are non-directive in that they refrain from sharing their own beliefs, values, or
opinions with the client. They offer neither approval nor judgment of the client's
decisions. This also is long-term therapy.

Behavioral : This model is very "scientific" in nature in that the counselor and client only
work on what can be observed and measured. A problem behavior is observed; a plan for
changing it is implemented; progress is measured and reported. Behaviorists believe that
individuals are shaped by their environment. Some behaviorists believe that we learn
through conditioning. Others believe that we can learn by observing the behaviors of
others and the consequences of those behaviors. In either case, the theory is that, if
the antecedent or the consequence of the client's behavior is changed, then the behavior
of the client will be changed as well.

amily Systems: This model views problems as belonging to the family rather than to
any one individual. Each family member both influences and is influenced by the other
me
mbe
rs of
the
imm
edia
te
fami
ly
and
the
exte
nde
d
fami
ly.
Sub-
syst
ems
are
iden
tifie
d
with
in
the
fami
ly.
Fam
ily
of
origi
n
issu
es is
stud
ied.
Gen
ogra
ms
are
used
to
char
t
beha
vior
patt
erns
and
expe
rien
ces
acro
ss
seve
ral
gene
ratio
ns
of
the
exte
nde
d
fami
ly.
Eve
n
thou
gh
ther
e
may
be a
focu
s
clie
nt,
the
entir
e
fami
ly is
invo
lved
in
ther
apy,
so
that
dysf
unct
iona
l
fami
ly
inter
acti
on
patt
erns
can
be
chan
ged.
Ele
men
ts in
cou
nseli
ng
proc
ess
Cou
nseli
ng
invo
lved
two
indi
vidu
als;
it¶s
a
com
mun
icati
on
bet
wee
n
the
Cou
nsell
or
and
the
cou
nsel
ee.

Cou
nsell
or ±
a
prof
essi
onal
ly
train
ed
pers
on
who
can
assis
t or
help
the
cou
nsel
ee.


ccc  c
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 c
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c c c
 
 c
c
c c
c
ndivi
diual
¶s
belie
f in
perso
n
abilit
y to
solve
perso
nal
probl
ems
with
the
aid
of a
symp
atheti
c
listen
er.
Clien
t i.e.
the
coun
selee
is the
pivot
, he
takes
an
activ
e part
in the
proce
ss of
thera
py.
Hega
ins
insig
ht
into
his
probl
em
with
the
help
of
the
coun
sellor
. He
only
decid
es
and
takes
neces
sary
actio
n.
The
coun
sellor
¶s
role
is
passi
ve.
This
type
of
coun
sellin
g is a
grow
th
exper
ience
.
Theg
oal is
the
indep
ende
nce
and
integ
ratio
n of
the
client
rathe
r
than
the
probl
em
orien
ted.T
he
coun
sellor
creat
es an
atmo
spher
e in
whic
h the
client
can
work
out
his
ownu
nders
tandi
ng.
The
emot
ional
aspec
ts are
conc
entra
ted
more
; it
leads
to a
volu
ntary
choic
e of
actio
n.
A.
üoti
vatio
nal
Cou
nselli
ng
It
invol
ves
discu
ssing
the
feeli
ngs
and
incen
tives
with
the
client
.The
coun
sellor
cane
ncou
rage
to
estab
lish
helpi
ng
relati
onshi
p to
avoid
desp
air
feeli
ngs
and
work
throu
gh
thefe
eling
s of
their
moti
vatio
n.
If the
client
show
s
unwi
lling
ness
to
parti
cipat
e in
learn
ing
activi
ties,
coun
sellor
has
toass
ess
any
facto
r
from
the
past
or
prese
nt
that
migh
t be
negat
ively
influ
encin
g
moti
vatio
nfor
learn
ing.
üoti
vatio
nal
coun
sellin
g
helps
the
client
to
work
towa
rds
healt
h
prom
otion
.
â.
Psyc
holo
gical
coun
sellin
g
They
rely
on
conv
ersati
on
betw
een
the
client
and
the
thera
pist.
This
may
take
in the
form
of
quest
ions
and
answ
ers,
recon
struct
ion
of
past
histo
ry or
discu
ssion
of
curre
ntdiff
iculti
es. It
consi
sts of
an
emot
ion-
laden
mon
olog
ue by
the
patie
nt or
the
thera
pistm
ake
an
initia
tive
in
maki
ng
the
patie
nt to
spea
k out
his
repre
ssed
feeli
ngs
and
emot
ions.
5.
üar
riage
coun
sellin
g
Advi
ce
and
help
will
be
provi
ded
in
selec
ting
the
spou
se.
To
ident
ify
positi
ve
aspec
ts
ofrel
ation
ship
as
well
as
those
cause
confl
icts.
To
solve
the
probl
ems
relate
d to
their
marit
alpro
blem
s and
marit
al
relati
onshi
p. It
is
direc
ted to
help
the
coupl
es to
talk
const
ructi
velya
bout
probl
ems
in
marit
al
relati
onshi
ps.
6.
Prob
lem±
solvi
ng
Cou
nselli
ng
Suita
ble
for
patie
nts
with
reacti
on to
stress
and
with
mino
r
affec
tive
probl
ems.
The
patie
nt is
helpe
d to

Ident
ify
and
list
probl
ems
that
are
causi
ng
distre
ss

Cons
ider
what
pract
icabl
e
cours
es of
actio
n
migh
t
solve
or
reduc
e
each
probl
em.

Selec
t1
probl
em
ant
try
out
the
cours
es of
actio
n that
appe
ars
most
feasi
ble
and
to
succe
ed.
7.
Beha
viora
l
coun
sellin
g
To
chan
ge
speci
fic
and
parti
cular
beha
vior
and
to
treat
the
beha
viora
l
disor
ders,
beha
viora
l
coun
sellin
g
will
be
effec
tive.
It is
base
d on
the
princ
iple¶
learn
ing
byco
nditi
onin
g¶.
8.
Indiv
idual
coun
sellin
g
Coun
sellin
g
may
be
prece
de by
an
inter
view,
the
coun
sellor
will
try to
estab
lish
rapp
ortan
d
struct
uring
has
to be
done
so
that
client
unde
rstan
ds
what
to
expe
ct at
coun
sellin
g.Itw
ill be
use
to get
infor
mati
on,
to
give
infor
mati
on
and
to
chan
ge
beha
vior.
9.
Grou
p
coun
sellin
g
New
ways
of
work
ing
to
help
peopl
e,
wher
e
peer
grou
p
value
s are
more
impo
rtant
e.g.
adole
scent
s.
The
indiv
idual
may
gain
an
insig
ht
and
unde
rstan
ding
into
his
own
probl
ems
throu
ghlist
ening
to
other
s,
who
will
be
discu
ssing
their
diffic
ulties
,
ideas
,
value
s
may
beco
mem
ore
unde
rstan
dable
and
acce
ptabl
e.
The
coun
sellin
g
grou
p
helps
the
indiv
idual
to
chan
ge
and
enco
urage
his
desir
es,
abilit
ies
throu
gh
their
relati
onshi
p in
an
acce
pting
and
mean
ingfu
l
socia
l
situat
ion.
10.
Shor
t
term
coun
selin
g
sed
in
situat
ional
crisis
in
whic
h
disru
ption
of
life
occur
red.
It
focus
es or
conc
ern
of
the
client
or
famil
y. It
can
be
relati
vely
mino
r
conc
ern
or a
majo
r
crisis
but
what
ever
the
situat
ion,
it
need
s
imm
ediat
e
actio
n.
Coun
selor
s will
assist
the
client
and
guide
s
probl
em
solvi
ng in
a
syste
matic
way
or
decis
ion
maki
ng.
In
crisis
situat
ions
the
coun
selor
can
share
probl
em
solvi
ng
abilit
ies
with
the
client
.
11.
Long
term
coun
selin
g
It
exten
ds
over
a
prolo
nged
perio
d of
time.
(Dail
y,
week
ly, or
mont
hly
basis
)
It
focus
es for
the
client
who
exper
ience
s
devel
opme
ntal
crisis
may
need
long
term
coun
selin
g.e.g
wom
en
with
meno
paus
e:
wom
en
with
breas
t
feedi
ng.
12.El
ectic
coun
selin
g
The
coun
selor
will
make
use
of
both
direc
tive
&
non
direc
tive
coun
selin
g
whic
h
may
beco
nside
red
usefu
l for
the
purp
ose
of
modi
fying
the
ideas
&
attitu
de of
coun
selee.
It
putsc
heck
on
the
client
¶s
emot
ional
expre
ssion
when
ever
it is
in his
inter
est.
The
techn
iques
are
electi
ve in
natur
e
beca
use
they
have
been
deriv
ed
from
all
sourc
es of
coun
selin
g,
selec
ting
the
best
and
leavi
ng
out
hat
what
is
least
requi
red.
It is
possi
ble
for
the
coun
selor
to
alter
nate
betw
een
direc
tive
&
non
direc
tive
meth
odse
ven
in the
same
inter
view
with
out
disru
pting
the
non
direc
tive
perm
issiv
e
relati
onshi
pwit
h the
client
.
1A.
Clini
cal
coun
selin
g
The
diagn
osis
&
treat
ment
of
mind
funct
ional
mala
djust
ment
s and
to
find
bette
r
adjus
tmen
t&
self-
expre
ssion
.
A
relati
onshi
p
prim
arily
indiv
idual,
face
to
face
betw
een
coun
selor
&
client
. The
study
ofthe
indiv
idual
as a
uniq
ue
whol
e;
speci
fic
beha
viors
are
obser
ved
and
speci
fic
traits
mayb
e
inferr
ed
but
the
goal
is
parti
cular
indiv
idual.
It
descr
ibes
the
probl
em
and
also
sugg
ests
the
soluti
on or
reme
dies
for
the
probl
em.
It
inclu
des
traini
ng,
actua
l
pract
ice in
diagn
osis,
treat
ment,
preve
ntion
and
resea
rch.
1â.
Stud
ent
coun
selin
g
It is
conc
erned
with
helpi
ng
the
stude
nt to
solve
his
probl
ems
perta
ining
to the
choic
e
ofed
ucati
onal
instit
ution
s,
cours
es,
meth
ods
of
study
,
adjus
tmen
t,
vocat
ional
choic
es
,etc.I
tdeal
s
with
total
perso
nalit
y of
the
indiv
idual,
it
conn
ects
direc
tly to
the
need
s of
thein
divid
ual,
in a
perso
nal
conta
ct
situat
ion.
15.
Place
ment
coun
selin
g
Coun
selor
will
advis
e to
the
coun
selee
s in
regar
d to
jobs
&
posts
whic
h are
suita
ble
for
the
client
depe
nd
upon
his
abilit
ies,
attitu
des
and
inter
ests.
16.
Psyc
hoth
erap
eutic
coun
selin
g
Psyc
holo
gicall
y
train
ed
indiv
idual
s
cons
cious
ly
attem
pts
verba
lly to
assist
the
other
perso
ns to
modi
fy
emot
ional
attitu
des
with
subje
ct are
awar
e of
the
perso
nalit
yreor
ganiz
ation
throu
gh
whic
h he
is
unde
rgoin
g.
17.
Voca
tiona
l
coun
selin
g
Proc
edure
cente
red
about
he
probl
em
of
selec
ting a
vocat
ion
and
prepa
ring
for it.
If
anyp
roble
m
rises
withi
n the
speci
fied
vocat
ion,
neces
sary
steps
or
advic
es
will
be
carri
ed
outto
solve
those
probl
ems.
It
gives
great
er
contr
ol
over
his
own
futur
e
actio
ns.
Coun
selor
will
help
the
client
to
impr
ove
his
allro
und
perso
nalit
y
devel
opme
nt &
helps
thein
divid
ual to
devel
op
skills
and
effici
ency,
mast
ery
over
the
vocat
ion
so
that
theco
unsel
ee
will
be
best
amon
g his
co-
empl
oyee
s in
his
profe
ssion
.
18.
Dieta
ry
coun
selin
g
Helpi
ng
the
indiv
idual
to
learn
more
about
diet
&
nutrit
ional
need
s.
Help
s the
perso
nbec
ome
more
awar
e of
the
role,
foods
plays
in
provi
ding,
main
taini
ng &
build
ing
healt
hand
stren
gth.
üini
mizi
ng
some
of
the
disco
mfort
s of
disea
se.
It is
easie
r to
acce
pt
diet
modi
ficati
ons if
the
perso
n
unde
rstan
ds
the
benef
its of
good
nutrit
ion.
Instr
uct
the
perso
n
about
good
nutrit
ion
in
many
ways
.
Arra
nge
plann
ed
conv
ersati
onsw
ith
the
indiv
idual
durin
g
whic
h you
can
discu
ss
dieta
ry
issue
s.
Expl
ore
the
speci
ficne
eds
of
the
client
and
deal
with
quest
ions
relate
d to
the
work
abilit
y of
a
speci
al
diet.
Whe
n the
perso
n
make
s
choic
es
from
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hospi
tal
menu
,
provi
de
socia
l
guida
nce
inapp
ropri
ate
meal
plann
ing.
Disc
uss
comp
arati
ve
food
value
s.
19.
Inter
pers
onal
Cou
nseli
ng
Chan
ges
in
life
event
s.
Sour
ces
of
persi
stent
distre
ss in
the
famil
y or
place
of
work
.
Curr
ent
diffic
ulties
in
relati
onshi
ps .
Patie
nts
are
enco
urage
d to
consi
der
whet
her
there
may
be
bette
r
ways
of
copin
g
with
these
diffic
ulties
.
20.
Bere
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ent
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selin
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