Counselling: Principles,

Modern concepts and approach

Class note
Definition of counseling
• Counseling is a means of helping people to learn how
to solve their own problems.
Willimson
• Counselling is essentially a process in which the
counselor assists the counselee to make interpretation
of facts relating to a choice, plan or adjustment which
he/she needs to make.
• Glenn F. Smith
Characterists of Counseling
• Counseling involves two individuals one
seeking help & the other a professionally
trained person who can help the first.

• Should be a mutual respect between the two

individuals.
Cont..
• If counselee is a student, counseling helps him
to take a decision, make a choice or find a
direction in matters related to an educational
programme or career.

• It helps the counselee acquire independence &

develop a sense of responsibility.
Scope of Counseling
• Counseling for personal needs/ problems
• Counseling for physical, emotional, social ,
moral and marital problems.
• Career advancement
• Educational needs/ problems
• Vocational, occupational& professional needs
• Holistic individual development
• Situational problems
Need of counseling in medical Education

• To help students adjusting with the new

environment of the medical institute.
• To help in developing qualities required for a
successful for a medical practice.
• To help students in getting adjusted with the
clinical environment.
• To help students keeping in touch with latest
trends in medical science .
Cont..
• To help students in developing positive learning
habits, especially skill learning.
• To help in the development of appropriate coping
strategies in order to deal with stress in a
productive manner.
• To help to overcome period of turmoil & and
confusion.
• To help student in developing their leadership
qualifies.
Cont..
• Helps them make advantages of technological
advancement in patient care.
• To carryout responsibilities as a health team
member
• Helps them to proper selection of career.
• Motivate them for higher studies.
Role of the counselor
• Arrange orientation programmes.
• Prepare up to date list of resources,
information, referral etc.
• Set up an educational& occupational
information centre.
• Disseminate information through educational
& career talks, group discussion &so on.
Cont..
• Organize career days, career conferences, parents day
& so on.
• Educate students regarding proper study habits and
assist them
• Maintain an active relationship with colleges and
Universities.
• Maintain an active liaison with club like Lion club etc.
• Refer serious psychological cases to mental health
expert like clinical psychologist/psychiatrists.
Quality of Counsellor
• C = Confidentiality maintain
• O = Observant
• U = Unbiased
• N = Nonjudgmental
• S = Sensitive to the need of the patient/client
• E = Empathetic
• L = Listens actively
• L = Lets the client make decisions
• O = Open minded
• R = Respects the right of the clients(add source/reference)
Specific skills
– Cognitive
– Emotional
– Behavioral
– Interpersonal
– Motivational
• Cognitive Skills: Sound theoretical background and
understanding, Skillful in transforming theory to
practice

• Interpersonal Communication Skills: Assertiveness

Skills, Problem solving skills,

• Non verbal Communication Skills: Body language,

Quality of speech (tone, pitch, volume)

• Personality: Pleasant, Trustful, Curious, authoritative

(reliable, trustworthy, dependable, respected,
respectful)
• SOLLER(BASIC SKILLS)
• Sitting Arrangement: L position, with privacy and
escape,
• sensitivity to cultural norms, expectation and
situation
• Openness
• Leaning toward ‘C’(Client/Patient):meaning- show
interest to them
• Listening Skills : Active, Reflection, paraphrasing,
Empathy, do not pretend
• Empathy: Put your feet into the client’s shoes
• Relax: Keep you on natural position, welcoming
manner
Questioning Skills
• An open question: to gathering more of
relevant information intention is to get along
with detailed answer

• 4 W ( Who, What, When and Where) + 1 H

(How)
Observation Skills
• Verbal
• Non verbal
• Observe the client’s behavior:
– Break eye contact
– Change voice
– Cross their arms/legs
– Stammering
– Speech hesitation
– Inappropriate smile
Reflection Skills
• Reflecting acts like a mirror

4 different reflecting skills

1. Reflecting feelings
2. Restating/ reframing
3. Affirmation
4. summarizing
Cont..
1) Reflecting feelings: Reflect what the client is
feeling. Focus on feelings, NOT the details of
what is said.

2) Restating/ rephrasing: This is saying what you

understand the client to be communicating.
Cont..
3) Affirmation: Encourages the client in the
choices has made. Affirmation can be for
choices, knowledge or behavior.

4) Summarizing: highlights the most important

areas, feelings or themes of what has been
saying.
Principles of Counselling
According to Mc Dainel and Shaftal;

i) Principle of acceptance:

ii) Principle of permissiveness: Counselling is

such a relationship which develops optimism
and the environment shapes according to the
person
Cont..
iii)Principle of respect for individual

iv)Principle of consistency with ideals of

democracy: It is a process with accepts
individual differences.
Counselling Process
According to ( Kagan,Evants & Key,year)
a) Explore: i) Establishing relationship
ii) Assessment
b) Understand: Setting Goals
c) Action: i) Interventions
ii) Termination & follow Up
Types of Counselling

• Directive Counselling

• Non – Directive Counselling

• Eclectic Counselling
Directive Counseling (prescriptive
counselling).
• E.G WILLIAMSON

• Counsellor play vital role

• Client subordinate to the counsellor
• Stress more on the person intellectual aspects then emotional
aspect
• Counsellor owns entire responsibility of solving problem.
• Counsellor leads the interview
Non- Directive Counseling( client centered)

CARL R. ROGER .

•  It revolves around the client

• Client leads the conversation
• Open ended question are asked
• The entire responsibility is of client
• Client can act with his own intellect
Eclectic Counseling
‘F.C.Thorne’.

• Eclectic counseling is neither counsellor-centered nor client

centered; but a combination of both.

• Here the counsellor is neither too active as in directive

counselling nor too passive as in non-directive counselling,
but follows a middle course.
Psychodynamic Approach to Counselling

Sigmund Freud (1856-1939).

• This led him to believe that the origin of such

illnesses lay in the unconscious mind of the patient.

• Freud’s idea that true knowledge of people and their

problems is possible through an understanding of
three particular areas of the human mind.
Cont..
• The Conscious – feelings or emotions, such as anger,
sadness, grief, delight, surprise, and happiness.
• The Subconscious – below our conscious awareness
but fairly easily accessible. Eg- events that we have
forgotten, but will easily remember when asked an
appropriate question.
• The Unconscious – memories suppressed and is
very difficult to access. Extremely traumatic events
that have been blocked off and require a highly
skilled practitioner to help recover.
Humanistic Approach to Counselling

 Carl Rogers (1902-1987)

• Humanistic counselling recognises the uniqueness of every
individual.

• It assumes that everyone has an innate capacity to grow

emotionally and psychologically towards the goals of self-
actualisation and personal fulfilment.

• Humanistic counsellors therefore aim to help clients to

explore their own thoughts and feelings and to work out their
own solutions to their problems.
Behavioural Approach to Counselling

• It focuses on the assumption that the environment

determines an individual’s behaviour.

• Behaviourists believe that behaviour is ‘learned’

and can therefore be unlearned.

• Behaviour therapy focuses on individual

behaviour and aims to help people to modify
unwanted behaviours.
Modern Approaches
COGNITIVE BEHAVIOR THERAPY (CBT) (CBT)
was developed by Aaron T. Beck, Albert Ellis,

• CBT is based on the Cognitive Model of Emotional

Response.

• CBT is based on the idea that our thoughts cause our

feelings and behaviors, not external things, like people,
situations, and events
Essentials of Counseling
CBT uses the Socratic Method:
• Therapists want to gain a very good
understanding of their clients’ concerns. That’s
why they often ask questions.

• Encourage the clients to ask questions of

themselves, like, “How do I really know that
those people are laughing at me?” “Could they be
laughing about something else?”
Cont..
CBT is structured and directive:
• A specific agenda for each session. Specific
techniques/concepts are taught during each
session.

• CBT focuses on the client’s goals.

• CBT therapists do not tell their clients what to do

rather, they teach their clients how to do
Cont..
CBT is based on an educational model:
• CBT is based on the scientifically supported emotional and
behavioral reactions are learned.

• The goal to help clients unlearn their unwanted reactions and to

learn a new way of reacting.

• CBT benefit leads to long term results.

• Client understand how and why they are doing well, they know
what to do to continue doing well.
Cont..
CBT theory and techniques rely on the Inductive
Method:
• A central aspect of rational thinking is that it is
based on fact.

• Inductive method encourages to look at our

thoughts as being hypotheses or guesses that
can be questioned and tested.
Cont..
Homework is a central feature of CBT:

• CBT therapists give assignments and

encourage to practice the techniques learned.
Conclusion
• There are different approach of counselling
• Modern and evidence based approach is CB approach
- preferred to use in this setting
• Process: Explore-Understand-Action-Termination
• At the end of counselling the client can able to accept
the problem, cope better with the problem, solve the
problem
• Sometime it can take longer time/many sessions
References

• Rogers, C. (1957). The necessary and

sufficient conditions of therapeutic personality
change. Journal of Consulting Psychology,
21(2), 95-103.
• Schofield, M.J. (2008). Australian counsellors
and psychotherapists: A profile of the
profession. Counselling and Psychotherapy
Research, 8(1), 4-11