The Counseling Process

COUN 540 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 goalsa blend of art and of science Applies in all theoretical orientations

Six Stages
Stage One: Stage Two: Stage Three:
Stage Four:

Stage Five: Stage Six:

Relationship building Assessment and diagnosis Formulation of counseling goals Intervention and problem solving Termination and Follow Up Research and evaluation

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

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 Dont 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 clients 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 clients 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 clients 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
Actiondirected in accord with new perspectives Talked aboutbut 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 planis clients motivation and willingness to follow it

Prochaskas 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-ofChange-Model/Page1.html

Crafting a Treatment Plan

Begins with clearly articulated problem and priority from clients 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