Process of Counselling

Counselling typically helps in bringing the change. The process begins with exploring the challenges a client faces before assisting them in resolving developmental and situational difficulties.

Counseling is not a one session process, where you meet your client once and provide solutions for all their problems. This is just a common man’s understanding of the counseling sessions. Counseling is a step by step process involving several sessions ranging from a minimum of 8-12 sessions to more, depending upon the intensity of the problem and the response of the client to the interventions planned by the counselor.

Process of Counselling

The following are the five main steps involved in counseling:

• Relationship building
• Assessing the problem
• Setting goals and agreeing upon a time frame
• Identifying and choosing the most appropriate strategy to the presenting problem
• Termination and follow-up.

Let us now look into details of each of these steps and study the skills that need to be practiced to become a seasoned counsellor.

Rapport Establishment and History Taking

Rapport Establishment

In any relationship, it is important to build a trusting bond between two individuals. So also, in the process of counseling, it is essential that respect and mutual trust is established between the counselor and the counselee. Being compassionate, empathetic and non-judgmental is easier said than done.

But once these are established, the counselee would feel emotionally safe and cared for, which is crucial for the counselee to open up and discuss their issues without any inhibitions and self doubt. It is the compatibility established that determines the achievements of the goals set for each stage in the counseling process.

Communication Skills in Counseling

Expression

This is related to how the counselor puts across their thoughts to the client in a neutral and balanced manner. This involves presenting the facts related to the presenting problem of the counselee, without appreciating or criticizing the client for what they are.

At the same time, the counselor also has to understand both verbal and non-verbal expressions of the client, which may vary in proportion, but have important implications in the area of counseling.

• The facial expressions such as smile,biting or twitching of lips, biting nails, animated, alert or deadpan expression, twitching nose, raising eyebrows, widening eyes and lips could tell us a lot about the feelings of the client.
  
  
• Body posture, movements and gestures
  
  
• Tone of voice, pitch, pace, loudness, spacing and choice of words, language, pauses, fluency and silence.

It is also important to remember that the client can reveal significant information only when they trust the counselor. Thus, strength and effectiveness of the counseling sessions invariably depends on the level of trust and feeling emotionally safe and this happens when rapport is established.

Listening

Any conversation or communication involves one or more persons speaking one at a time to one or more listeners, to convey the message and build healthy bonds. The counselor-counselee bond is also of a similar kind. In all communications, listening is a significant part.

There are three different types of listening:

• Superficial listening – When the listener listens to the speaker preoccupied with their own issues, and paying only partial attention to the speaker, it is superficial listening. In such a scenario, there is some discomfort and lack of trust on both sides.
  
  
• Selective listening – In this type,the listener listens and grasps only the information they are keen to hear. The receiver may also add their own conclusions and interpretations to the information, based on their past experiences and heuristics.This is superficial listening and is harmful especially in the counseling settings.
  
  
• Attentive or active listening- Here the listener or the receiver of information stays neutral in intent and tries to understand the content from a neutral perspective, without drawing conclusions or taking sides. Voice tone, gestures, silences, pauses and pace of speech all these are the observable part of listening. These give us an insight into the thought process of the client and their state of heightened emotions.

Responding

Most times, when people listen, they are simultaneously trying to frame a reply to whatever they are hearing. This creates a communication gap, since the listener is not actively listening, since they are busy thinking about how to respond or what to reply.

In a counseling relationship, this could be detrimental. A counselor has to listen to the client, to understand the problem from the client’s perspective and not to spurt out a few sentences of general advice. A crucial necessity in the process of counselling is responding.

People generally use five kinds of responses:

• Evaluative Response: In this, a judgment or an opinion is conveyed. “I do not want you to behave the way you do. I want you to behave better and do what I say.”
  
  
• Interpretative Response: This intends to convey the meaning of the information shared by the speaker. “You mean to say that your behavior is justified in the given situation?”
  
  
• Supportive Response: In this, there is an attempt made to comfort or reassure the speaker by “Have patience, this too shall pass!”
  
  
• Probing Response: Responses that tend to gather more information through follow-up questions, leading to a discussion with the speaker to get the details of the event or the situation. “Can you please tell me what actually happened immediately after they left?” “What else do you think about it?” “How do you think that we can plan to resolve your problem?”
  
  
• Understanding Response: This happens when the response comes after reflecting on what is said. The responder communicates to the respondent that their feelings are well-taken and understood in the truest sense. “I understand the pain you are going through, when you are unable to achieve your goals, in spite of putting in your best efforts. I hope things get better soon.”

Generally people respond in the order: Evaluative, Interpretative, Supportive, Probing and understanding. But in a counseling relationship, it is essential to follow the reverse order – Understanding, probing, supportive, interpretive and evaluative. It is important to respond in such a way that the client feels understood and cared for, their feelings validated.

Reacting

As important it is to respond to the client, it is equally important to know and understand how the client is responding. Especially reactions to the probing questions or evaluative questions. Close attention needs to be paid to the facial expressions, gestures, voice intonation and body language of the client. This helps in encouraging the client to become vocal with their thoughts and fears, and confront them, with the help of the counselor.

Silences and over explanation are enough cues to understand the discomfort of the counselee, if any.

• Defensive reaction: The client may become overtly explaining, feels that they are being judged, the counseling sessions might lose effectiveness.
  
  
• Withdrawal reaction: In situations when the client feels threatened or misunderstood, they may withdraw and choose not to share information, that could be crucial to the case. Even in this situation, the counselling sessions may go ineffective or reduce effectiveness.

It is therefore important that the counsellor carefully observes the client, and listens attentively to the client and at the same time notices every detail of the non-verbal cues given out by the client and note them down, for the purpose of further analysis.

Developing Empathy

Differing from sympathy, empathy involves seeing the problem from the client’s point of view, however trivial it might appear to the counselor. Expressing empathy provides assurance to the client that there is someone who can understand what they are going through. Empathy is all about sensing the client’s world and feeling the emotions they are experiencing at that point of time.

Communication of empathy involves attentive listening, paraphrasing information the client has shared, asking for details and clarifications.

• Attentiveness – Listening attentively, paying attention to all the details including pauses and silences, which convey a lot of subtle information.
  
  
• Paraphrasing – This ensures that the counselor understands exactly what the client is trying to say, without any adulteration and misinterpretations.
  
  
• Reflecting- Rephrasing the feelings as put forward by the client,and look for any underlying messages to seek further clarifications,
  
  
• Pacing- Keeping in pace with the client’s way of experiencing when they share information or issues related. This also involves matching the language of the client and conveying the message, so that the client understands exactly what the counselor is trying to say and vice versa.

Genuineness

This implies showing genuine concern and care towards the client and the problems faced by them. This can be expressed by a nod, leaning forward to listen with more involvement, facial expressions, hand gestures, occasional Hmm.. and eye-contact.

• Self disclosure: The counsel or may choose to share some of their life experiences, to make the client feel at home and that a trust is established. But at the same time, it is to be kept in mind that too much self-disclosure might put off the client and there is always a chance that the information can be misused.
  
  
  Self disclosure is effective only when shared at the right time, in relation to the appropriate content and context, which the client is mentioning about.
  
  
• Immediacy: A skill to convey genuineness, immediacy is used to describe the present feelings as experienced by the counselor and the client during the session, and bring them up during discussion. This skill is used to bring the conversations back to track, when the client seems to digress from the main point.
  
  
  This can be used during the later part of sessions when due to reasons best known to the client, they might withdraw and choose not to share any more information. In this situation, the counselor might feel stuck up and use immediacy as an icebreaker to move further in the counseling process. “I am disappointed with your silence. And we are going nowhere trying to stay silent.” could be a statement made to bring the client to open up during the sessions.

Unconditional Positive Regard (UPR)

• Verbal behaviors: A word of appreciation, encouragement and enhancing responses tend to build self confidence among the clients and they feel unconditional regard for them.
  
  
• Non-verbal behaviors: A smile, grin, and well-intended touch, speaking in a soft voice, facial expression, eye contact, relaxed posture are all welcoming and calming gestures, where the client feels at home and feels free to discuss their issues.

Effect of building rapport with clients

It is when the counselor and counselee find each other in harmony with each other, the client feels safe to disclose the underlying issues behind the presenting problem. Building trust and remaining unconditionally positive towards the client, helps clients to retrospect and reflect upon their core issues which need urgent attention and intervention.

Becoming aware of the core issues, the counselor and client can together work out the ways and means to overcome them and enable clients to work on becoming the best version of them. All this is possible when the counselor and counselee are related with mutual respect, understanding, liking, warmth, caring bond and a sense of emotional security.

Ensuring confidentiality is utmost important to help clients look into their issues with a non-judgmental perspective and get a hang of the conflict seeded deep within and minimize this conflict.

Consent Signing, Testing, Interpretation

There are times when as a counselor, you might face situations where the parents or caregivers might approach you to counsel their ward, without revealing that it is actually a therapeutic process that is going on. Such cases are unethical.

It is essential that the client, be it minor or an adult, has to be fully aware of the counseling sessions and agree to be a part of it, willingly. Taking consent from the client and parents and primary caregivers – in case of minors is an important and ethical part of the counseling process.

Professional counseling differs largely from elders giving some advice or providing readymade solutions to the problems a client is facing. It is therefore essential that there is no deception in the process and that the client is willing to receive the therapy.

It is only when the client recognizes their problem as a problem, a counselor can help them find ways and means to handle their issues and emerge safely out of it, physically, emotionally, and mentally.

Obtaining consent and maintaining a record of it is mandatory before the start of any counseling session.

Obtaining self consent

A proforma to obtain an informed consent from the client as well as their caregivers or parents, incase of minors, is given below. Please note that this is just a sample profarma, and it can be changed to include other clauses which you wish to add.

Consent for minors

Proforma for obtaining consent from parents/primary caregivers Parents, primary caregivers/referring teacher/self, consent must be obtained from all the people involved before the start of the session. However, conversation between the client and counsellor is completely confidential and in case any sort of disclosure is inevitable, it has to be done only with a written permission from the client, even if the client is a minor.

Psychological Testing

After obtaining the necessary consent and having the first meeting with the client, during the intake interview, a counsellor is now equipped with all the information needed to look closely into the presenting problem of the client. A critical analysis of the information, might show some patterns of certain behaviors and additional information to understand the underlying problems which project as presenting problems.

For example, if the client is a bully and is referred by the teacher for counseling, bullying is the presenting problem – which needs to be described in all relevant yet minute details. The underlying problem might be that the child was once a victim of bullying and the feelings of resentment and insecurities are projected in their act of troubling others.

Once inferred, this has to be confirmed through some psychological psychometric tests which have to be necessarily tested and standardized. What tests are to be administered completely depends upon the observations made and needs of the counselee, as decided by the counselor and agreed upon by both.

Selecting appropriate tests and strategies

Selecting psychological tests that provide insights into the client’s core thoughts and emotions plays an important role in interpreting the client’s disposition and overall presentation of self. Tests need to be carefully selected and administered only if it is absolutely inevitable.

Administering tests for sake of them, might just prove detrimental to the counselee. Selection of strategies to be used in the intervention is to be planned well in advance and explained to the client. The progress at each stage of the intervention is to be reported, interpreted and conclusions drawn therein would help to plan further course of action. If the strategy appears working and the client shows signs of improvement, this can be continued and if not, the counselor has to use some other strategy to help the client.

Precautions to be taken while conducting tests

• Age and culture appropriate tests must be administered otherwise the results might be incorrect.
  
  
• The complete test must be administered in one session, keeping the time as per the requirements of the tests.
  
  
• The client needs to be fully aware of the fact that the psychometric tests are to know the client better and that there are no right or wrong answers.
  
  
• The client must be encouraged to respond as per the first thought that comes to their mind, without thinking much logically about any items.
  
  
• The success of the test is indicated in identifying the core issues and once this is done, the healing becomes a natural process, with some pain involved.
  
  
• This is to be conveyed to the client.

Interpreting the results

The next important step in the counseling process is interpreting the results of any psychometric test administered to the client. Since the main purpose of any psychological testing is to get a better understanding of a person’s behavioural disposition.

Once the relevant test is administered, interpretation of the test scores comes into play. In this process, the test scores are analysed to draw meaningful conclusions that help the counselor draw a conducive plan of further action for the client. Once the interpretation is done, the next step is conveying these results to the client.

Conveying Results, Further Support

Interpretation of results of the psychological, might not be of much use in isolation, but they start to make more sense when interpreted with reference to the information collected during the intake interview. A complete analysis and detailed study of all the information has to be made by the counselor before drawing any conclusions.

The conclusions need to be supported by factual data as provided by the client and other people who work in close proximity to the client. The assessed parameters in the historical and biological context of the client help counselors to identify the strategies that can be used for intervention.

The results have to be put across to the client in the most subtle manner, neither normalizing them nor highlighting them. The language has to be a more neutral language and conveyed with utmost care. It has also to be conveyed to the client where they stand and what is the scope of their improvement or moving towards making a positive progress, in handling their issues.

Importance of conveying results

It is the responsibility of the counselor to convey the results of the psychometric tests and the interventions planned for the client. The intervention is always planned by the client, under discussion and guidance of the counselor.

This makes the process more effective as the client is completely involved in the process of getting better, and most importantly, the client is aware and is acceptable of the issues they deal with. This awareness and acceptance makes the counsei]ling interventions more receptive and hence yield effective and long term outcomes.

All the reports and the time to time progress of the client, at the end of each session, has to be conveyed to the client and follow-up action must be charted out in agreement with the client.

Termination

However good and useful the sessions might seem to go on, there is always a need to bring it to an end and close the counseling loop. It is mandatory that the client does not become dependent on the counselor. In a counseling relationship, most times the client starts enjoying the attention they get.

So, at a later phase, they might just prolong the sessions, just to get to talk and feel listened to and cared for. This dependency is undesirable in the counseling process. It is therefore important that the counselor plans the sessions in such a way that the case is terminated as soon as the client starts reflecting and develops self dependency.

What is termination?

The last and final stage of the counseling process is termination. It marks the end of the counseling alliance made with the client. The aim of the counseling process is to help and guide clients to GET BETTER and not just FEEL BETTER. So, once the client shows signs of coming to terms with their issues and learns to accept and deal with them, it is important that the client gets time to sit with their learnings, reflections and feelings and process them.

Termination happens when the counselor is satisfied about the progress of the client. Termination can also happen when something unexpected takes place, like the client suddenly decides not to turu-up for the counseling sessions, or due to some reasons, is not able to continue with the sessions and in the worst case, an abrupt ending or even death.

Informing the client and gradually spacing out the sessions

The criterion for a successful counseling is successful termination of the case. As soon as the clients report some significant gains from the counseling process, termination needs to be planned. The process starts preparing the client for closure, spacing out the sessions.

For example, if initially, you had three sessions per week, you can slowly reduce it to two or one per week. A 40 minute ideal session can be cut down to 20 to 25 minutes per session. You can also start telling the client that we are now close to completing the process and can stop them altogether soon.

Providing closure

Sometimes the client may not be ready for the closure and might start developing some projective symptoms when close to termination. In such cases, it is advisable to provide closure with occasional followup sessions, once a week or two, before terminating the sessions altogether.

Providing closure is essential so that the counselor-counselee relationship comes to an end and they part their ways. Goodbyes are essential along with the assurance that, in case the client needs some help in future, you, as a counselor, would be available to them, providing them a healthy closure.