COMPS: 5 Intro to Counseling Skills

Establishing consent, psychosocial history, formulating homework assignments

10.01 Informed Consent to Therapy (a) When obtaining informed consent to therapy as required in Standard, psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers. (b) When obtaining informed consent for treatment for which generally recognized techniques and procedures have not been established, psychologists inform their clients/patients of the developing nature of the treatment, the potential risks involved, alternative treatments that may be available, and the voluntary nature of their participation. (c) When the therapist is a trainee and the legal responsibility for the treatment provided resides with the supervisor, the client/patient, as part of the informed consent procedure, is informed that the therapist is in training and is being supervised and is given the name of the supervisor.

How to conduct specific components of counseling sessions, including the introduction

A certain air of mystery surrounds therapeutic sessions like counseling and psychotherapy. Many people believe this form of one-to-one therapy will leave them feeling exposed and uncomfortable; whilst others assume confidence will not be strictly maintained. Although there are many different counseling approaches and disciplines available, there are however, strict guidelines that a counselor, psychotherapist or other therapeutic professional must adhere to at all times. *In the Beginning* At the start of every counseling relationship some form of client assessment must be made. This evaluation may be done during one appointment with the counselor or therapist, or over a number of arranged sessions. The reason for this evaluation is to allow the counselor the opportunity to clearly understand the problems the client wishes to address and improve. Once a counselor has been able to evaluate the client, and the presented issues and problems, the counselor will be able to allocate an agreed time for subsequent counseling appointments. The counselor, or therapist, will also be able to review various situations, issues and concerns, throughout the course of their counseling relationship with the client. *During the Session* Each meeting with a counselor is an opportunity for the client to express emotions, feelings and thoughts in a safe, confidential environment. The client will be encouraged to use free-association and free-thinking to explore whatever problem they are experiencing. The counselor can offer guidance and encouragement, and provide additional support when needed. They can also set the client homework, so that they continue to experience empowerment after the counseling session has finished. The counselor will also set an agenda for each one-to-one session, so that the client can identify and acknowledge the progress that is being made week-to-week and session-to-session. Each session will also be reviewed, and discussed with the client at the subsequent counseling appointment. *What Sometimes Happens* At the evaluation session a potential client may realize a number of things: A client may find that they are unable to express themselves freely, due to fear, lack of confidence or other overwhelming feelings. Some clients realize that all they needed was one session, with a counselor, in order to clarify thoughts and feelings. They may decide to return for counseling at a later stage, or may opt not to at all. With a counselor's supportive help, a client may also identify and understand that the form of counseling they are seeking may not be the most suitable or appropriate counseling option for them. If this is the case the counselor may suggest another type of therapeutic counseling and also provide further information resources. *What the Counselor Does* Effective counseling requires careful review and planning. Because of the personal nature of the counseling relationship between a counselor and client, each one-to-one session is an opportunity to explore free-thinking, and therefore each of the counseling sessions cannot be too structured. It is also the counselor's job to provide effective non-verbal communication and to translate the client's body language. They must also encourage and empower the client to make steady progress. This must be done in a caring, supportive and safe environment, at all times.

The skills of attending, listening, and reflecting client experience through focusing the client, questioning techniques, and interpreting client report data.

Active listening and responding appropriately are two of the key skills a counselor or therapist must apply during one-to-one counseling sessions with a client. Being able to communicate effectively is an important requirement, in any type of therapeutic counseling work. Understanding the importance of these skills, and being able to apply them accordingly, is a valuable asset for a career in counseling. Quality and Quantity To help clients to improve the quality of their lives, by working through their problems and issues and making positive changes, a counselor must demonstrate an interest in the client's life - their wellbeing, problems and difficulties. It is the counselor's responsibility to give their client their full, undivided, attention throughout the duration of the one-to-one counseling session. The Importance of Listening Listening makes the person who is talking feel worthy, appreciated and respected. When we give someone all of our attention the speaker responds positively by interacting on a deeper level, perhaps by disclosing personal information or by becoming more relaxed. When a counselor pays particular attention to what the client is saying they are encouraging the client to continue talking, as well as ensuring communication remains open and positive In order to build a firm foundation in any supportive or caring client-counselor/therapist relationship strong, clearly defined attending skills must be in evidence. These are skills that require being in attendance in the present, in any situation, and means that a counselor is giving their full attention, and listening, to the client at all times. The Meaning of Attending Attending means being in the company of someone else and giving that person your full attention, to what they are saying or doing. In a one-to-one counseling relationship this is the supportive service that a counselor must provide. Failure to do this will mean the client is not being supported fully, and may not feel able to disclose or make progress. Attending also means a counselor must pay attention to everything a client says and does. This includes reading the client's body language and also taking into consideration all the silences and pauses in the conversation. Actively listening not only conveys information, but also encourages the client to continue talking. Using open-ended questions during a counseling session encourages a client to provide more information to the counselor. Open-ended questions allow the client to only respond in complete sentences. When answering in an open-ended question format, clients will generally disclose deeper information that includes feelings, thoughts, attitudes and understanding of the subject being discussed. These questions can help the therapist and client work through a treatment plan by discovering any flawed beliefs or unresolved feelings. Paraphrasing is a counseling technique that allows a therapist to summarize a client's statement to demonstrate that she was actively listening. As a questioning technique, paraphrasing can be extremely effective as it gives the client an opportunity to clarify any information that may have been missed by the therapist. Paraphrasing also encourages clients to expand on any previous statements as it allows them to reflect on information they have relayed and add to it if necessary. Close-ended questions should typically be discouraged during a therapy session, as they do not allow a client to expand on statements or provide deeper information about themselves. Close-ended questions can be useful to clients that are experiencing loose associations. Loose associations occur when a client cannot logically connect one thought to the next. Close-ended questions can therefore act as a great therapeutic tool, as they bring the client back to the present and reduce the chance of responding with loose association. The miracle question is a solution-focused therapy technique that allows a client to discuss with the counselor how they envision the future. Solution-focused therapy, or brief therapy, allows the client and counselor to focus on what achievements they want to make in therapy rather than the problems that exist. The miracle question asks clients what would be different if they woke up in the morning and all of their problems had disappeared. This questioning technique helps motivate clients and begin working with the counselor to meet treatment plan goals during the therapeutic process.

An understanding of social, cultural diversity and how that effects assessment and the counseling process.

Basic to a multicultural perspective is the belief that clients from diverse cultures require different approaches to counseling and subsequently different skills and behaviors used by counselors to establish effective helping relationships. Yet, lack of research findings to verify specific skills for particular populations has led some authorities to posit that the helping professions need to consider therapeutic behaviors and skills with universal characteristics applicable across cultures. Others challenge this perspective about universal approaches, noting that to broaden the multicultural focus too much may diminish the cultural diversity that truly exists. The counseling profession continues to search for treatment modalities and interventions that are appropriate with all client groups. Much more research will be required to identify timely and appropriate treatment methods and other interventions to apply with varied clients in counseling relationships. Information and education also have an important role in counseling with diverse clients. Too often, counselors and therapists neglect these vital processes in deference to more clinical and therapeutic ones. Counseling clients without supplementing the relationship with pertinent and relevant information might prove frustrating for both client and counselor. In becoming competent as culturally effective counselors, we ultimately must know ourselves, understand variances in the rich cultures of the clients we serve, and appreciate the sometimes subtle and sometimes obvious biases inherent in popular approaches to counseling.

An understanding of professional/ethical issues such as confidentiality, informed consent, duty to inform and other common issues found in counseling.

Disclosures (a) Psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client/patient, or another legally authorized person on behalf of the client/patient unless prohibited by law. (b) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to (1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose.

The ability to accept and act on feedback from others through the supervision process.

Feedback is the process of sharing information with another person for the purpose of reinforcing or changing his or her behavior. Effective feedback builds trust, removes inter-personal barriers, and guides others toward improved performance. Giving or receiving feedback can be hard, but of the two, receiving feedback can be harder. Whether you get a sinking feeling in your stomach or a raging bull in your head, receiving job performance feedback is never easy. Unless you know how. Here are 7 tips for receiving feedback gracefully, allowing you to learn from it and quickly move on. *Do Welcome Constructive Feedback* Your powers of self-perception only go so far. People around you notice things, both good and bad, which you don't and you might learn from their input. There is a "virtuous circle" of feedback whereby the more you actively seek it out, the less you can hide bad behavior, and generally your feedback is better. E-bay seller feedback is an excellent example of a transparent feedback process, encouraging positive behaviors. *Don't Justify Your Position* Telling the person why their feedback is wrong will not work. Ever. Arguing, justifying your position or denial are all powerful negative emotions, making the conversation more challenging than it needs to be. The only way for the conversation to go is downhill, with tempers flaring and insults flying. *Do Accept Feedback At Face Value* Although the feedback might feel like a personal insult, challenging your whole identity, keep some perspective. The feedback relates to specific instances, in one part of your life AND now that you know about it, you have the opportunity to do something about it. *Don't Ruminate On Feedback* Only cows need ruminate before they digest. Chewing over feedback again and again will not make it clearer or easier to understand, particularly if the feedback is less than glowing. Avoid the temptation to re-enact the conversation to a friend as this only makes you feel ten times worse. Do talk about it with someone else, but make sure you're emotionally detached first. *Do Evaluate Feedback Before Responding* Feedback often tells you more about the person saying it than it does about you. For example, a person who says you never praise their work might have difficulty evaluating their work themselves. Teaching this person to give themselves "marks out of ten" for their own work may be a better approach than simply praising them ad naseum. In the long run, you'll be giving them a more powerful boost to their self-esteem. *Don't Throw Your Toys From The Push-chair * Sulking, stonewalling or withdrawing from the person giving the feedback is childish. If need be, give yourself some space from the person, allowing you to calm down and deal with the feedback, and person, as a rational adult. *Do Make Your Choice How To Use The Feedback* Feedback can be a gift allowing you to grow and develop as a person, in a job or in a relationship. But some feedback is downright useless and best ignored. Yes, ignored. It is ultimately your choice how to act, or not, upon feedback received.

Termination

People enter counseling for a variety of reasons. Everyone that participates in counseling is there to get guidance and learn skills to cope with the problems or dysfunctions that brought them there. During the course of these sessions, a relationship develops between the client and the counselor. It can be a challenge for both participants to decide how and when to end the counseling relationship. Clarify how and when your counseling will terminate. Counselors are not always certain about how to approach ending counseling. According to a study in the Journal Academy of Psychoanalytic Dynamics Psychiatry," only 40% of clients felt therapy ended at the right time, with 37% believing it ended too early and 23% saying it ended too late." The process of termination can be difficult for both the counselor and the client. Set specific treatment goals with your counselor at the first session. Make a list of these goals. Many counselors have the philosophy that termination begins at the first counseling session. Be prepared to actively participate and be open to get the most out of each session. Make sure to obtain information on your mental health insurance coverage prior to the first session. Help clients review the success they had in counseling. Allow clients to discuss their feelings of loss surrounding termination and the counselor must process your own feelings surrounding the process as well. Discuss termination with clients early in the counseling process. Initiate discussion of how you view your progress in achieving your treatment goals in each session. Ryan Howes, Ph.D, describes the termination phase as, "the period of time between realizing you're leaving and the final goodbye. How long does it last? It depends on how long you've been in therapy, what type of therapy it's been, the nature of your issue, and ultimately---whatever you and your therapist determine." Follow this checklist for items to cover in your final session. 1. Review what you learned about yourself. 2. Discuss what goals you were not able to accomplish in therapy and what to do about them. 3. Develop your "aftercare plan": everything you will do post therapy. 4. Reminisce about the therapeutic relationship; when you felt cared for, what made you mad. 5. Discuss and grieve the end of your therapeutic relationship. 6. Talk about the other feelings and memories this ending brings up. 10.10 Terminating Therapy (a) Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service. (b) Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship. (c) Except where precluded by the actions of clients/patients or third-party payers, prior to termination psychologists provide pretermination counseling and suggest alternative service providers as appropriate.

An understanding of counseling skills in the context of the student's specific emphasis, i.e., school, community, and marriage and family counseling.

The four themes that encompass the ASCA National Model are the skills that professional school counselors must develop to implement their programs. These skills are leadership, advocacy, collaboration/teaming and systemic change. Many school counselors have already mastered some or all of these skills because they use them daily. These skills have a positive result for school counselors as they work with all students.

An understanding of how research and the scientific method contributes to our ability to evaluate counseling outcomes.

The scientific method is a process for experimentation that is used to explore observations and answer questions. Scientists use the scientific method to search for cause and effect relationships in nature. In other words, they design an experiment so that changes to one item cause something else to vary in a predictable way The METHODS OF SCIENCE are only tools, tools that we use to obtain knowledge about phenomena. The SCIENTIFIC METHOD is a set of assumptions and rules about collecting and evaluating data. The explicitly stated assumptions and rules enable a standard, systematic method of investigation that is designed to reduce bias as much as possible. Central to the scientific method is the collection of data, which allows investigators to put their ideas to an empirical test, outside of or apart from their personal biases. In essence, stripped of all its glamour, scientific inquiry is nothing more THAN A WAY OF LIMITING FALSE CONCLUSIONS ABOUT NATURAL EVENTS. Knowledge of which the credibility of a profession is based must be objective and verifiable (testable) rather than subjective and untestable. SCIENCE is a mode of controlled inquiry to develop an objective, effective, and credible way of knowing. The assumptions one makes regarding the basic qualities of human nature (that is, cognitive, affective, behavioral, and physiological processes) affect how one conceptualizes human behavior. The two basic functions of scientific approach are 1) advance knowledge, to make discoveries, and to learn facts in order to improve some aspect of the world, and 2) to establish relations among events, develop theories, and this helps professionals to make predictions of future events. A THEORY is a large body of interconnected propositions about how some portion of the world operates; a HYPOTHESIS is a smaller body of propositions. HYPOTHESES are smaller versions of theories. Some are derived or born from theories. Others begin as researchers' hunches and develop into theories. The PHILOSOPHY OF SCIENCE decrees we can only falsify, not verify (prove), theories because we can never be sure that any given theory provides the best explanation for a set of observations.

How to efficiently and succinctly document counseling sessions in a typical chart format, i.e., dap (description, assessment, and plan)

Writing an effective progress note is essential, especially in the field of health-care management. Progress notes are used to communicate essential information about the progress of a patient's health as well as any issues they may have. This is a "best practice" strategy used in most health-care institutions because progress notes are used to ensure the best possible care of the patient. They also help to mitigate the cost of insurance and litigation by providing a documented trail of patient progress should the treatment or diagnosis be questioned Clearly label your file as a progress note. Only document concerns relevant to the illness or issue. This is not where you record client/patient dissatisfaction. Always start with vital information first. For instance, for health-care professionals, this might include daily weight or temperature. Provide a brief comment on the appearance of the client. For health-care professionals, this means commenting on whether or not the patient appears ill or well. Give a conclusion and comment on status. Provide a diagnosis and comment on whether it is getting worse or better over time. Include a quick summary of your suggested course of action. Summarize tests or therapies recommended. Always provide a rationale for each recommendation. Include a quick note on the latest action for complex issues. Provide a quick overview on the working diagnosis for the patient and how she is responding to therapy.