Phares

Individual counselling

Group counselling

Couple counselling

Individual counselling

Individual counselling is a one-to-one helping relationship in which the counsellor helps the client to accept, own, solve or cope with the problem.

Features of individual counselling includes client comes on his/her own or he/she is referred from another counsellor/source.

Client coming for counselling may be an adult, youth or child who is:

Able to talk rationally

Mentally distraught – unable to think/talk rationally

With varied life experience

A helping relationship may be one, a few or many sessions.

The setting in which the relationship occurs whether it is a counselling centre, VCT centre/hospital.

The nature and duration of individual counselling cannot be determined until the nature of the problem is clarified.

In most cases the initial session begins in a similar way of staying with a client for 45 minutes to 60 minutes per session.

Counselling relationship may terminate when a counsellor and client conclude a successful counselling relationship or client referral is made.

Group Counselling

Group counselling is a one-to-group helping relationship in which the counsellor works with the group in seeking a solution to their common problem. Example couples is considered as group

Group Counselling is designed to help clients in a group to achieve increased mutuality, integration, and acceptance of reality, socialization, realistic goals, adaptability and responsibility for self.

The general aim is to help members appraise themselves so that they may gain understanding, and broad perceptive of themselves in relation to others.

Features of Group Counselling

A group of clients must have the following features;

Clients in the group must have a common problem.

There must be dynamic integration among members.

Members must be reasonably mature and mentally sound to be able to talk about and tackle their common problem.

Members must have capacity for self-direction.

Members should be as compatible as possible.

Couple refers to two people, usually of opposite sex, who may be

Married

Cohabiting (not married but a man and woman are staying together)

Friends

Couple counselling occurs when two individuals who have had or who intend to have sexual relations wish to discuss issues concerning HIV together and look for ways to cope with the situation.

Usually two people come in for couple counselling if

They intend to get married

One or both member/s is/are sick

They intend to have children

They are having conflicts in the home around being honest about sexual practices and safer sex

The couple has a sick child; or the child dies of AIDS related complex

They have been referred to the clinic by a doctor

Homosexual male and homosexual female couples are also at risk of transmitting HIV to one another. Couple counselling can also be offered to them just as to heterosexual couples.

There are many methods/techniques of counselling.

The three major/most commonly used methods used are: –

Person/client centred/non-directive/Rogerian method

Clinical/counsellor centred/directive method

Eclectic method

This is a method in which the person or client seeking counselling becomes the main speaker during counselling.

Features of this method include

The Client comes willingly for help and accepts specific conditions for counselling.

For example: He/she agrees to talk openly and freely about the problem.

He/she agrees to own her/his problems

He/she should not expect instant solutions to the problem from the counsellor.

The counsellor and the client talk freely and extensively about the presenting problem.

The counsellor is the main speaker.

In this method

The counsellor draws his/her competence and experience and prescribes solutions to his/her client.

He/she directs the client to do what a counsellor feels can help in solving the client’s problem.

The counsellors do not believe that the client has within her/himself the means necessary to solve the problem effectively.

Stages in counsellor – centred method

The counsellor has to collect information about the client and his/her environment from variety of sources, including the client himself/herself during the initial counselling interview.

Then the counsellor organizes the collected information so as to get a clear picture of the client’s problem.

The counsellor is to formulate their conclusion regarding the nature and cause of the client’s problem.

The counsellor predicts the treatment of the client’s problem.

The counsellor interprets the collected data to him/her and provides a plan of action to be followed by the client.

Finally the counsellor fellows up the client’s implementation of the given plan of action with two actions:

Did it work?

If not what next?

The counselling process applying this technique may include the following procedures

Building relationship with the client.

Counsellor interpreting the collected data to the client

Planning a program of action with the client

Helping the client to carry out the plan of action

Making referrals to another counsellor if the counsellor feels unable to handle the case.

Follow-up to determine the effectiveness of the counselling. Should results indicate that the plan did not work as planned the counsellor may device another plan or revise the plan.

This method is a combination of several counselling techniques (methods) adopted by a counsellor during counselling session, resulting for better results.

Example

A counsellor may be non-directive to staff where the client has to make a choice between alternative solutions.

If the client chooses a less effective alternative solution, the counsellor may direct him/her to choose the most effective alternative solution

In so doing the counsellor combines and uses two techniques “Non Directive and Directive Techniques”.

He /she become eclectic in practice.

Basic counselling skills are tools a counsellor/healthcare provider uses in order to get information from a patient/client in order to build a relationship, assess the presenting problem, understand the problem and be able to lead a patient/client reach a solution.

Basic counselling skills include

Attending behaviours

Empathizing

Questioning

Summarization

Self-disclosing

Paraphrasing

Confronting

Interpreting

Probing

Reflection of feelings/minimum encouragers

Attending

Showing concern and interest in the patient through verbal and non-verbal actions.

We remember this with the acronym ‘SOLER’.

S = squarely face the person

O = use open posture

L = lean toward the person

E = use eye contact

R = relax, be natural

Restating the patient’s statements briefly using some of the same words.

It can be used to gather information or to ask a question

Patient: My daughter is having fever and chills, she is sweating at night, it worries me.

Counsellor: Fever, chills, night sweats, has she had any other symptoms?

Patient: A sharp pain in her right side for the last two days

Counsellor: Tell me more about this sharp pain

Carefully selecting questions and probing statements directed to the patient in order to gain more information or clarification about something the patient has said, and to keep a dialogue with the patient. Such as:

Tell me more about that.

And what happened next?

And then what did you do?

How did that make you feel?

Who, What, When, Where, How, Why

‘Why’ questions should be used carefully in counselling sessions, because they can be asked in a way so that it seems the person asking is judging the patient.

Open-ended questions are the most effective questions to probe patients and the key to knowing one’s patient and his/her problems.

Open ended questions are questions which cannot be answered with just one word, such as ‘yes’ or ‘no’.

Open-ended questions

Form the foundation of good counselling

Invite the patient to talk and lead conversation

Invite longer, more explanatory answers

Help the counsellor obtain more information from the patient

Examples of open-ended questions

How can I help you today?

Tell me about your family.

Closed-ended questions are sometimes called ‘Yes or No questions’, they request short or one-word answers.

They are very useful for collecting information like demographic data and medical information.

When a counsellor uses them too much, it may seem as if he or she is interrogating the patient rather that counselling him or her.

The use of closed-ended questions should be limited in counselling.

Examples of closed-ended questions

Do you want to be tested?

Do you understand how to use this drug?

Can you ask your partner to use a condom?

Putting together the information that a counsellor has learned through probing, open-ended questions, and paraphrasing.

Using the information to draw conclusions

Presenting this information to the patient in the form of a statement, or as a question for more clarification.

Examples of Interpreting

Patient: Well, on two or three days I was drinking. Sometimes in the evenings I have family visit, and they want to drink together. I always take my medicine in the evening. After I drink, I forgot to take the pills.

Words of encouragement that increase patients’ beliefs in themselves and their abilities

To ‘affirm’ is to acknowledge the positive in someone else in order to support and encourage that person to build upon his or her successes.

Affirming patients’ achievements encourages them to build upon their successes.

Directly affirming and supporting the patient during the counselling process is another way of building rapport and reinforcing open exploration.

This can be done in the form of compliments or statements of appreciation and understanding.

Patient: Yesterday I took all of my pills.Counsellor: Great! I knew you could do it.

Patient: I took my pills this week, but I didn’t always eat when I was supposed to.Counsellor: That’s still really good that you took all of your pills.

Patient: I tried to take all of my pills this week, but it was hard.Counsellor: You are a strong person to put all that effort into it.

Patient: I’ve been doing better with the medications lately, but I still have doubts I can really do it.Counsellor: That’s wonderful that you’re doing better. I believe you can do it!

Thanks for coming on time today.

You’re really a strong person, to cope with such difficulties for so long.

That’s a good suggestion.

You are really important to your children and grandchildren.

I can see that you are motivated to improve your health. It really shows.

Reflection of feelings is paraphrasing or summarization except that only feelings are addressed.

Example 1

Patient: ‘I feel very isolated, my husband has no feelings towards me, my children are siding with him, my friends have of late become unfeeling and life is completely meaningless’.

Counsellor: ‘Everybody seems to be distant from you and you do not feel like continuing living.’

The reflection would encourage the patient to continue talking about her problem. The talk leads to opening up and finally to rational thinking on the part of the patient

Example 2

Patient: ‘I can’t do all of this. My husband doesn’t help me to take care of the baby when she is sick’.

Counsellor: ‘So it feels like you can’t do it all right now’?

The common element is the word ‘you’. Other forms are

So you feel…

It sounds like you…

You’re wondering if…

You…

Process of going over the main points of what a patient has said in order to capture patient’s main concerns or issues

Helps counsellor and patient make sure they understand each other

After summarizing what the patient has said, the counsellor needs to double check with the patient if that summary represented the correct picture of the issues discussed.

It is important to make the patient add or subtract any issues which were missed or added due to misconceptions.

Once the counsellor has effectively summarized what the patient is saying, he or she can move on to the next issue.

If it is the end of the session, the counsellor should make sure to summarize all the important issues in order to help the patient to make informed choices.