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Theory and Practice of Counseling - PSY632

Lesson 19

COUNSELING PROCESS

Link to the Previous Lecture

Table 1: Microskill Usage according to Theoretical

Orientation

Microskill

Client-center

Psychodynamic

Cognitive

Expression

Expression Questions

Expression

Attending &

Reflecting feeling

Behavioral/

Listening

cognitive

deficits

individual client

Individual and

Focus

Past

environment

Feedback

Interpretation

Directive

Influencing&

Reflection of

Advice

Challenging

meaning

Feedback

One of the main tasks of counseling is to assist clients to work through, resolve, or learn to live with

incongruities. Most counseling theories have as their main focus the resolution of incongruities. Reframes

from other theoretical approaches can also be helpful. Psychodynamic theory may be useful and can help

clients see how their histories and past experiences relate to their present stories. Cognitive-behavioral

reframes will often help clients think more effectively about their stories and provide action narratives for

the future. The existential-humanistic reframe may help clients focus on their self-value. The point of

reframing is to tell the story in a new way, one that is more functional and valuable to the client. The use of

various skills by different approaches is as under:

Attending and Listening skills:

Client-centered approach makes a minimum use of questions while the major emphasis is on reflecting

feelings. The therapist attempts to minimize influence on client's constructions and meanings. In

psychodynamic approach questions and encouragers are especially important to facilitate exploration or

unconscious processes. The cognitive approach focuses on noting cognitive distortions.

Focusing skills:

Client-centered approach focuses primarily on the individual client. The problem will often be conceptualized as

one

understanding

one's

own

unique

needs

and wishes. The major goal is self-actualization of the client. The psychodynamic focus is also on individual

client. The problem is to understand how past experience affects what occurs in the present. A major goal is

to understand unconscious mental processes.

Influencing skills:

All influencing skills are oriented in different ways toward the same objective: finding new ways to think

about, and then act on, old narratives and stories. Rogerian person-centered counseling employs very few

of these influencing skills. Cognitive-behavioral theory, however, uses an extensive array of influencing

change strategies. You as a professional counselor or therapist will want to find the balance and blend

listening and influencing that you believe to be most appropriate

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Theory and Practice of Counseling - PSY632

Counseling Process

Factors Influencing the Counseling Process

In counseling process we will discuss factors affecting the counseling process. In addition to that, we will

study about the first interview, middle phase (working in a counseling relationship) and finally the last

interviews or termination of counseling process.

The counseling process is influenced by several characteristics that help it become a productive time for the

client and counselor. Not all characteristics apply to all situations, but generally, the following help bring

about positive results.

The process of counseling develops in definable stages with recognizable transitions. The first stage

involves building a relationship. It focuses on engaging clients to explore issues that directly affect them.

Two struggles take place at that time:

1. Battle for structure, which involves issues of administrative control, by counselor (scheduling, fees, and

participation in sessions)

2. Battle for initiative which concerns motivation for change and client responsibility. It is important that

the counselor wins the first battle and the client wins the second.

Let's discuss all of the important factors influencing counseling process:

· Structure

· Initiative

· Setting

· Client Qualities

· Counselor Qualities

1. Structure

· It refers to the "joint understanding between the counselor & client regarding the characteristics,

conditions, procedures, and parameters of counseling" (Day & Sparacio, 1980, p.246).

o Structure helps clarify the counselor-client relationship. This give form to what the formal

process will look like. Many clients come to counseling with no idea what to expect.

Counseling moves forward when client and counselor know the boundaries of the relationship

and what is expected.

o Structure protects the rights, roles, and obligations of both client and counselor.

o Practical guidelines are part of building structure. They include time limits, action limits,

procedural limits, specific goals and needs, fee, audio- or video-recording, permission to record,

etc. this is therapeutic in itself.

o Structure is more important when a client has unrealistic expectation.

o Structure is especially important in the beginning but is provided throughout all stages.

o To help client new directions to their life, constructive guidelines are provided as clients are in

a static state.

o The counselor needs to stay flexible and continually negotiate the nature of the structure with

their clients.

A sample client-counselor contract, provided by Witmer & Remley from University of Florida, is given

below to enhance students' understanding:

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Theory and Practice of Counseling - PSY632

Example: Counselor-Client Contract: (Witmer & Remley, 1994)

Introduction: Our profession is becoming more attuned to client rights as well as to counselor

accountability. Both give their addresses here. Please feel free to change the contract......

· Qualification/ Experience

· Nature of counseling (the emphasis is on the professional relationship)

· Referrals

· Fee cancellation & insurance

· Records & confidentiality

· Signatures

2. Initiative, Reluctance & Resistance

Initiative can be thought of as the motivation that the client brings into the session.

Majority of the client are reluctant to some degrees. However, Reluctance is generally seen in those clients

who are referred for help by a third party and are unmotivated, e.g., school children, and court-referred

clients. In such a situation, some counselors become impatient, irritated and insensitive, and may ultimately

give up. Counselor needs to understand the dynamics involved in working with difficult clients.

Resistance is unwillingness to change. Resistant clients bring a motivation to cling to their issues through

various sorts of actions like those with "I don't know" statement. Resistant clients want to cling to the

certainty of present and do not want to face the pain that change demands.

Four broad categories of resistant clients (Otani, 1988):

Otani has pointed out 22 forms of resistance which can be categorized into 4, as described below:

· Amount of verbalization: shown by silence and minimum talk.

· Content of message: intellectual talk, emotional display, future/past preoccupation, symptom

preoccupation, etc.

· Style of communication: false promising, thought editing, last-minute disclosure, externalization,

thought editing, false promising, etc.

· Attitude toward counselor and counseling session: poor appointment keeping, payment delays, favor

asking, etc.

Ways to let client win the battle for initiative:

To anticipate the anger and defensiveness

To show acceptance and understanding

To use persuasion

Through confrontation; client can respond by:

o Denial

o Accepting confrontation as true

o Developing a middle position.

Using pragmatic techniques: Roloff and Miller have mentioned two pragmatic persuasion techniques:

door in the face, and foot in the door. Other pragmatic techniques could be silence, reflection,

questioning, sharing, etc.

3. Physical Setting

· Counseling can happen anywhere, but a professional counselor generally prefers to work in a place that

provides privacy, confidentiality, and quietness.

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Theory and Practice of Counseling - PSY632

There is no universal quality that a room should have "except it should not be overwhelming, noisy, or

distracting" (Benjamin, 1987, p. 3). Room should facilitate rather than distracting the client. In this

reference, Shertzer & Stone (1980) indicated that the room should be comfortable and attractive.

Features of a counseling room:

o Soft lighting

o Quiet colors

o An absence of clutter

o Harmonious and comfortable furniture

o The spatial features of the environment;

Optimum distance: A distance of 30-39 inch between counselor and client has been

found to be the average range of comfort.

Desk: Pietrofesa et al. (1984) note the symbolic and physical barrier of a large desk.

Auditory and visual privacy is mandatory for maximum client-disclosure.

4. Physical Arrangement

· Different layouts of the therapy office

Cultural and gender preferences may exist, but individual differences are the most important variation to

observe. Positioning is expressed by the clinician in the layout of the therapy office.

o a large desk is positioned between client and clinician

o a small desk is positioned between client and clinician

o the clients and clinicians chairs are directly across from each other without obstacles in

between

· Arrangement of chairs should be arranged in relation to each other

o face-to-face arrangements

o side-by-side seating

A therapy office that is set up so that a desk is positioned between client and clinician will communicate

something very different from a therapy room in which the clients and clinicians chairs are directly across

from each other without obstacles in between. Similarly, the decision about how a client's and counselor's

chairs should be arranged in relation to each other communicates different things to different clients. For

some, face-to-face arrangements may suggest an attempt at emotional sharing; for others, only side-by-side

seating may be acceptable. Benjamin (1987) suggests two chairs and a nearby table. Observation about how

clients react to the layout may be helpful in making necessary revisions

5. Client Qualities

· Clients come in all shapes and sizes, personality characteristics, and degrees of attractiveness (Warnath,

1977). Counselors' interaction is influenced by the physical characteristics of the client (Goldstein,

1973)

· The most successful clients tend to be YAVIS (Young, attractive, verbal, intelligent, successful)

compared to HOUNDs (homely, old, unintelligent, nonverbal, and disadvantaged), or DUDs (dumb,

unintelligent and disadvantaged).

· These observations show that ironically disability and age provide invisible but powerful barriers.

· Total liking is determined by verbal, vocal, and facial liking. However, in a study nonverbal behavior

was shown to be more important (Facial expressions = 55%) than either vocal (38%) or verbal (7%)

cues (Mehrabian et al., 1971).

· Counselors generally like to work with clients who are most like them. It is important to be aware of

cultural differences in nonverbal messages (Sielska, 1979)