Tools and Conditions met in Counselling

1. Tools and Conditions met in Counselling A brief look at some of the tools and conditions of counselling

2. What is the point of counselling? The following cannot be substantiated. It is only a seat of the pants observation and opinion as to what is going on.

3. Without any counselling • In this first situation is shown a graph of Well Being against Time. It indicates a reasonably held conviction that generally -in time – people improve, and with no counselling to help them. This is not always the case, but in general as Life continues, so time heals or the situation is weathered, overcome or by passed. You can see from the range of results that some people do not improve at all, but actually get worse.

4. With counselling • In the second graph, also of Well Being against Time, the results are shown of people who do receive counselling. Notice that the average sense of improvement IS THE SAME AS IF NO COUNSELLING TAKES PLACE. • So what is the point of counselling? • What is taking place is that the range of Well Being is far larger than in the first instance. This means that some counselling is very effective, enabling the client to improve much more quickly and radically. It also means that some clients are hindered in their development, counselling making them more entrenched, guilty, embittered etc.

5. In other words, the Counsellor does have a considerable impact on clients. Counselling is not a matter of just filling an hour with words or agreeing with the client. That might make the Counsellor feel worthwhile and useful but, in fact, is doing the Client more harm than good. The Counsellor needs to know exactly what he or she is doing.

6. What is Counselling? • Counselling is NOT passive but ACTIVE. • It is not merely a matter of listening to someone talk nor simply enabling them to talk. It MAY be a help for someone to pour out their troubles with no interruption from the counsellor to get it off their chest, but that is NOT counselling and little or no counselling gets done that way. Counselling tools need to be applied – with knowledge. • Counselling is the use of certain skills and techniques for helping people who are confused, unsure or worried. By their use it is intended to gain a clear insight into what is troubling the person, and to help draw on the person's own resources to find a solution.

7. Counselling Isn’t..... Counselling is not:- • Prescriptive - "Go and tell your mother what really happened." • Sympathising - "Yes, it's hard. I had that experience. I know exactly what you are feeling. I feel sorry for you." • Practical help - "You go to bed and I'll look after him for you." • Teaching - "Life is like this...." • Preaching - "You should not have done that." • Advice giving - "If I was you I would ....“ • It is not an academic indulgence for the counsellor. From time to time any of the above may be required in a given situation, especially if the context is not a formal counselling session, but in that instance it is NOT counselling.

8. Counselling Is...... Counselling for ALL models is:- • A relationship between the counsellor and client that is SAFE, confidential, trusting, empathic, honest, genuine, accepting, etc. • Where the client explores the situation for him or herself, understands the situation for him or herself, decides for him or herself, and acts for him or herself. • It is a process with a beginning and targeted [possible] end. There are several models or schools of psychological understanding such as Freudian, Jungian, etc, but these are not models of counselling. You do not have to be a psychologist to counsel. It may help throw light on a problematic situation, but it is not counselling. A counsellor does not have to understand ANYTHING of how the mind works. A counsellor counsels and not therups!

9. Counselling Conditions Think Safety A person cannot look at an insecurity if they are feeling insecure. The client needs to feel sufficiently accepted and confident to be able to think clearly about him or herself without having to feel defensive. The relationship is one of growing trust and professional intimacy that is essentially SAFE.

10. Core Conditions For all models of counselling the core requirements of the counsellor are genuineness, empathy and acceptance. Other words might be used to describe these three, especially within certain schools of counselling, so the buzz words might be congruence, rapport or non-judgemental attitude, or again ‘being real’, ‘being alongside’ and compassion. What is in a name?

11. Core Conditions Genuineness Genuineness – realness – congruence – sincerity etc. The more the counsellor is him or herself in the relationship, putting up no front or façade, the greater is the likelihood that the client will be the same. The invitation by the ‘expert’ is there by example. There is no need to be afraid and hide. There is also no need for the counsellor to constantly speak of their inner feelings for the non-verbal signals will be confirming the words all along. If the offer of help, respect, etc is not genuine it is probable that the client will very soon pick up the various clues as to the counsellor’s real feelings.

12. Core Conditions Empathy Empathy – rapport – ‘being alongside’ etc. As the counsellor endeavours to show that he or she understands the client’s reality from the viewpoint of the client, then the client suddenly feels supported, listened to and validated.

13. Core Conditions Acceptance Acceptance – non-judgemental attitude – unconditional positive regard – compassion - respect etc. Accepting the person, but not necessarily the ethic or moral code of the client, whatever the client is at that moment, is a demonstration of care and support. It shows the willingness of the counsellor for the client to live whatever the immediate feeling is for them – confusion, resentment, fear, anger, love, etc. Without this acceptance the client will never trust the counsellor and explore their inner self.

14. Stages of Counselling As the professional counselling relationship grows, so different stages of the counselling process can be seen to be entered into. These can be thought of as the preliminary stage or initial stage of assessment; stage 1 – exploring; stage 2 – understanding; then if appropriate - decision making; and acting upon, stages. If several issues are being tackled then it may be the stages are blurred, as the process back-tracks or suddenly moves forward.

15. Stages of Counselling Preliminary/Initial stage of Assessment • This is VITAL. What is the presenting problem? Will counselling help ? Perhaps the contract can be established in this first session. • By the preliminary work involved in setting up the clinical situation such as the welcome, ‘cup of tea’, immediate engaging of the person, setting of interview etc, the counsellor lets the client know that the counsellor is human, a professional, experienced, and they are both there to focus on the problem. • The scene setting for this stage is to enhance comfort, safety, confidentiality, a human face etc. • The client will be anxious [possibly extremely so] at the first interview. There will be a ‘testing of the waters’ and an initial unwillingness to enter into a helping relationship, characterised by the phrase “Please help me – but just you try!” He or she might not realise this, but they are doing so at a subconscious level all the time. • Barriers at this stage are more an issue of commonsense. They are such things as too cold; too hot; uncomfortable seats; interruptions by child, phone, music, callers etc; tiredness; hearing difficulties; unsuitable clothing; unsuitable room; being overlooked; etc; - i.e. There needs to be professionalism and a professional approach. NB a clinic is not always the best setting to facilitate counselling.

16. Stages and Tools of Counselling • Different tools are used at the different stages of the counselling process. It usually means more tools can be employed as the counselling process unfolds. • The tools are generally the same for whatever model of counselling undertaken. They are just used in different ways or for different purposes. • Some specialist tools, however, are not appropriate for some models, for they have been developed for a particular model. These tend to be tools or techniques such as sculpting, visualisation or guided imagery, ‘homework’, art work etc.

17. Stages and Tools of Counselling Stage 1 - Exploring • This is getting the client to start to talk. It may involve many false starts but the client begins to explore the presenting problem. • The presenting problem might not be the underlying problem, but this first stage is essential. • The suggested tools used in this stage are: Paraphrasing, Reflecting, Questions, Summarising and Use of Silence - ONLY. Anything else is probably deemed to be too premature - the relationship takes time to grow.

18. Stages and Tools of Counselling 1 - Paraphrasing A paraphrase is the pith/core/kernel of the story that is given back to the client. It may be in your own words or those of the client. • It is brief. • It is hard work and tiring. • It is not a parroting back. • It is usually understood as being just the facts of the story or experience. • It is not an addition to what was said. • It is not an interpretation of what was said. • It is not judgemental. • It is not a request for more information. • It does not distort what was said. • It is an immediate ‘action replay’ situation. • It may be a paraphrase concerning behaviour, a last word or a key word.

19. Stages and Tools of Counselling 1 - Paraphrasing Why use a paraphrase? • It shows the client that the counsellor IS listening. • It enables the client to check that the counsellor does understand. • It enables the counsellor to check that the counsellor understands. • IT ENABLES THE CLIENT TO CHECK THAT THE CLIENT UNDERSTANDS. • It hones the story to the essential truth.

20. Stages and Tools of Counselling 1 - Reflecting • For some people ‘Reflecting’ includes paraphrasing facts and emotions together. To differentiate the two let us conclude that ‘Reflecting’ is reflecting back the main emotion of the story, and the right emotional temperature as well, to the client. • It is usually given in the counsellor's words for the emotions are invariably not spoken of explicitly by the client but have to be inferred or guessed by the counsellor. • Of all the counselling tools paraphrasing and reflecting are the two most important. They lessen the chance of misunderstanding, avoid hassles and argument and only use the information that is supplied by the client in one form or another. • In any piece of counselling, it is good practice to use 3 or 4 reflections to 1 paraphrasing, for the process of counselling is to explore the deeper issues that motivate and enable an individual i.e. their subconscious psyche rather than their rational processes.

21. Stages and Tools of Counselling 1 - Reflecting Why use Reflection? • Once again it shows the client that the counsellor IS listening. • It enables the client to check that the counsellor does understand. • It enables the counsellor to check that the counsellor understands. • IT ENABLES THE CLIENT TO CHECK THAT THE CLIENT UNDERSTANDS.

22. Stages and Tools of Counselling 1 - Questions Asking questions is the most natural form of finding out something. Questioning is also the most powerful and quick way of investigating deeply into a situation. Questioning is also the most dangerous way of proceeding for it is:- • The easiest way of putting your foot in it! • Taking initiative and control of the flow of conversation away from the client. • Dis-empowering the client in the longer term. It shows more about the Counsellor’s thinking and curiosity rather than the Client’s willingness to explore the situation.

23. Stages and Tools of Counselling 1 - Questions Questions to avoid: • Curiosity on your part!!!! It is not your business unless you are invited to share. • The overwhelming "why?" • "What is your problem?" • Can be too challenging or too challenging too soon. • Too intrusive. • Closed questions - yes/no answers. Questions to ask: • Focusing - "Can you say more?" - "How did you feel about that?" • Focusing further or Concreting - "Can you give me an example please...?" • Clarifying - "I am sorry I do not understand. Could you go over that again please?“

24. Stages and Tools of Counselling 1 - Summarising When to summarise: • At the beginning of a subsequent session. • At the end of the session. • At a natural end of a subject before moving on. • When panicking!! A summary should ideally include the main themes of factual story together with the main feelings expressed or discovered by the counselling. It enables the counsellor and client BOTH to take a breath and to step backwards to review the progress to date. It may be right to lead on with a question in a continuing session or present some homework or thoughts for the next session if the summary is at the end of the counselling session.

25. Stages and Tools of Counselling 1 - Use of Silence Silence can be comforting or threatening. It is rarely neither. Silence needs to be owned by either the counsellor or client. Inexperienced counsellors often take responsibility for filling any gap, regardless of whose it is. If the counsellor can let the client own it, then the client can fill it by reflection about the topic in hand. If the silence is prolonged then it might well be safer for the counsellor to intervene.

26. Stages and Tools of Counselling The mistake of the inexperienced counsellor is to move to the Second Stage of the counselling process far too early. That shows an anxiety of the counsellor rather than a willingness of the client to progress.

27. Stages and Tools of Counselling Stage 2 - Understanding The revelation for the client that the client is responsible for the client’s life can be traumatic. As the counselling series proceeds it should become clearer that there are themes that run throughout the life of the client, e.g. inability to make decisions, inability to sustain relationships, inability to accept responsibility for their own actions, a desire to blame external events or people etc. Acceptance of these themes by the client is largely dependent upon their willingness to engage in the process and the skill of the counsellor in presenting challenge with the right level of support. The pace of understanding needs to be set by the client so the client feels in control. Although many challenges are set by the counsellor, the counsellor needs to be extremely aware of the ability of the client to accept them, consolidate the incremental progress and integrate the whole in the unfolding revelation.

28. Stages and Tools of Counselling Stage 2 - Understanding Tools for Second Stage are: • All those of the First Stage to continually engage with the client plus: • Advanced empathy, alternative frames of reference, specific challenge, self-disclosure, immediacy. • Additional tools might be used where and when appropriate.

29. Stages and Tools of Counselling 2 - Advanced Empathy This includes all the skills of Paraphrasing, Reflecting and Summarising in the First Stage of counselling but may seem to be intuitive at times. It is taking a quantum leap of assimilation, almost a subconscious appraisal of the information and presenting a hypothesis for evaluation. This comes over as a much deeper rapport between the client and counsellor.

30. Stages and Tools of Counselling 2 - Alternative frames of reference • A different frame of reference can enable the client to see that his or her view is not the only one possible. • An intervention that presents an alternative frame of reference might not be accurate or truthful. It might be quite erroneous. It just gives another view to measure understanding against. • It may not be immediately accepted by the client but it provides an alternative which a client may consider or test their appreciation of reality against at a later time. • People view the world in different ways and two people can give totally different interpretations of the same event because of the different context in which they view the world. This is not the same as focusing upon different aspects of the same event and coming to a different interpretation. The context dictates the understanding. So if he loves her – she is generous to a fault, or if he hates her – she is a fool with money.

31. Stages and Tools of Counselling 2 - Specific Challenge • Challenge is not necessarily confrontational. • Although an alternative frame of reference, empathy and reflection can be challenging in their own right, a specific challenge takes these to another level of presentation. Discrepancies, distortions and hypothesis of games being played present an ‘up front’ challenge. • Too strong a challenge will be seen as confrontation, but if the relationship between the counsellor and client is strong then the challenge will be seen as a positive move towards understanding. A strong challenge is hard to refute. • Confrontation can be disastrous for the counselling process.

32. Stages of Counselling

33. Stages and Tools of Counselling 2 - Self Disclosure • Take great care here, for although it can be used helpfully in terms of sharing a feeling or experience, the client is not really interested in knowing the counsellor’s feelings and life events. The client is there to understand their own. • Positive disclosure encourages the client to share more deeply, knowing the counsellor DOES know what this is all about, but if over used it can be a justification for giving opinions, back-door advice or a ‘me too’ unhelpful comment.

34. Stages and Tools of Counselling 2 - Immediacy • This is a much reduced form of gestalt. It is an opportunity to present the situation in the ‘here and now’ and explore how the client might be holding back emotion or presenting an ‘over the top’ response. • For example the counsellor might say something along the lines of “I feel as if what you have been saying about yourself for the last few minutes is not really what you are truly feeling. What do you see happening at the moment?”

35. Stages and Tools of Counselling 2 - Additional Tools • There are many additional tools, but these depend upon the model used and the acceptance or protocol within that model. • Such techniques as ‘The Empty Chair’, The Letter’, ‘Identification with characters from literature’, ‘Fantasy’, ‘Personal Construct Theory’, ‘Sculpting’, ‘Gilmore’s Square’, ‘Visual Metaphors such as “The Shield”’ and ‘Visualisations or Guided Imagery’ etc can be used when and where appropriate.

36. Additional Tools • ‘The Empty Chair’ – used in psychodrama – spontaneous reaction to fictional confrontation – subsequently often thought of as an example of Gestalt. • The Letter’ – thought out consideration of what to say to recipient without necessarily sending it. Gives time to examine response. • ‘Identification with characters from literature’ – examine qualities of fictional character to evaluate desired qualities in client. • ‘Fantasy’ – extrapolation of previous technique. • ‘Personal Construct Theory’ – thought out consideration and description of client by client in the third person. More objective by slight distancing from self and immediate emotional content.

37. Additional Tools • ‘Sculpting’ – describing relationships using cards, stones, people etc in a tableau or diagram. It can be examined by altering arrangement or participants viewpoint. • ‘Gilmore’s Square’ – thought out consideration using spreadsheet of Gilmore’s three areas of concern – activity, relationship and aloneness in the advancing approach of ‘I ought..’ ‘I want...’ ‘I can...’ ‘I will...’. • ‘Visual Metaphors such as “The Shield”’ – spontaneous symbols of important aspects of client. • ‘Visualisations or Guided Imagery’ – detailed symbolism that can be used in a diagnostic and therapeutic capacity. Needs specialist knowledge.

38. Many counsellors stop at this point!!! The client understands the problem or situation but is often left high and dry. Even the client may expect nothing more for has not the client learnt that counselling is NOT giving advice and it is the client’s responsibility to decide and take action for themselves?

39. Stages and Tools of Counselling Stage 3 – Deciding and Planning • Many counsellors never get to this stage. They leave it to the client to decide and act in their own way and time. Indeed in an ideal case, once the client understands the need for action, he or she goes out and acts on their own initiative. • In most cases the client and counsellor need to collaborate, both forming the ideal solution to the presenting problem – e.g. Egan model. • Conversely some counsellors try to start with this stage and wonder why their clients are not cooperative! Failures are then blamed on the client! • Tools to be used include not only those for First and Second Stage but also Cooperation and Forming Action Plans & Strategies.

40. Stages and Tools of Counselling 3 - Cooperation • Not that there has been no cooperation up to now in the process, but to highlight the activity at this stage is pertinent. If the ground work has been done, the client now sees his or her role in the helping process and do not consider themselves as a puppet. It is a far greater partnership in responsibility within the counselling session and a working for the future.

41. Stages and Tools of Counselling Stage 4 – Acting • This is the stage that might never end! The relationship often needs to be gently loosened, but ultimately there is no substitute for action – even if that is to accept the situation with no apparent change! • Remember that life is usually not so clear cut as these notes suggest, so part of the third and fourth stages for some issues might overlap with the second stage of an ongoing or greater issue. • Tools used here are all of the above but include: Support, Evaluation & Assessment, Generalising from the Particular.

42. Stages and Tools of Counselling 4 - Support • Risk is a fact of life, so although there will have been support in the clinical situation and process up to now, now support needs to be emphasised in the acting out of the decisions made.

43. Stages and Tools of Counselling 4 - Evaluation & Assessment • There needs to be a check as to where the counselling process has taken the client. The reasons for counselling contract needs to be mutually agreed upon as being fulfilled and personal growth has been facilitated. • Self respect is a great enabler!

44. Stages and Tools of Counselling 4 - Generalising from the Particular • The most valuable part of the process is to see that the counsellor can be redundant. The client has not only altered their understanding of the present problem but has learnt an effective method of problem solving generally. • This is not a sticky plaster job but a more fundamental shift.

45. Listening The person who is listening the hardest at any time of a clinical counselling situation is the CLIENT – NOT the counsellor, as the client has the most emotional investment in the counselling session. This is not a ‘trained’ ability as much as an instinctual one. In the clinical counselling session, and using any model at all, by listening to what is said the client checks as to whether the counsellor really understands the situation. In turn the counsellor, by reflecting and paraphrasing etc, also checks as to whether he or she understands the client and situation. Above all, by comparing what is said by both client and counsellor and by what he or she understands the ‘truth’ to be, the client checks as to whether the client understands the situation! Progress – Growth is made. That is the point of counselling.