Counselling - A Study on the Process and Challenges

Counselling is an active process. We don't give advice because its subjective and because our biases become apparent, and because you will be blamed if it doesn't work. If you give advice there are legal consequences, it is not our scope Self-reflection =============== Naturally we get quite defen...

Counselling is an active process. We don't give advice because its subjective and because our biases become apparent, and because you will be blamed if it doesn't work. If you give advice there are legal consequences, it is not our scope Self-reflection =============== Naturally we get quite defensive when we have our biases pointed out to us. Always try and accept what they say, not how they say it. How do you not get defensive when they're telling you stuff that's wrong with you? Acknowledge it, never ignore it, Self-reflection =============== Often, we respond instinctively - Learnt behavior - Past history - Current personality When we have time to think and consider, we might feel differently - Learnt knowledge we have different learnt knowledge than those form other universities - Clinical reasoning we may think we have the best clinical knowledge but others may be better - Experience we have to make sure that we don't change our behavior or act inappropriately according to our experiences. This is why we have to/ need to reflect? Why we need to know self. We need to keep these things in check, we have a reputation and we need to make sure that its not negative. Have to reflect on what our behavior is saying the whole time. Our immediate reaction is to be defensive when we don't know something. Don't be afraid to stand up for what you believe is right in the appropriate way To understand: - Our responses to the feelings/situations - The impact that the feelings could/would have on our behavior - Have to understand our 'buttons' -- we can even make set responses, easiest way to shut down a person is to compliment them... they don't know what to do - Defense mechanisms and coping skills - To ensure appropriate behavior -- never want to be generalized as *wits students* - To ensure that we do not consciously or sub-consciously respond to our feelings - To ensure objectivity -- our ability to understand complexities and ambiguities is removed by past experiences, have to understand our triggers - This is to ensure that we are effective and ethical - Even working in government you can be sued Over-identification ------------------- - Affect your ability to listen objectively, you think you know the story - Interpret according to your own understanding, emotions and experiences - Decrease ability to think of the client as a unique being -- think that this is what has worked before so it'll work again - You might facilitate the client to use the solution which helped for you - Remember: everyone's experience is different and so needs different methods As OTs we have the **need** to make it better, the **need** to act, we don't always listen, absorb and think clearly. - This leads us to get over involved - And to lose neutrality or objectivity -- we keep them in therapy because we want to see what happens and to make sure its better Consequences - Dependency - Impact on IPR - Non-effective solution - Tend to give advice - If we do this for every single client -- we may get burnout (where we need leave, apathy, we do superficial work) Transference ============ Refers to the feelings towards and the perceptions of the therapist by the client. As the relationship develops, the client may equate the therapist with someone in their lives because the feelings produced are now reminiscent of that relationship. Its difficult because you can't change people's feelings. You can make them aware of it but can't change it. Transference and counter transference can be positive or negative. Negative can be when someone has a very bad reaction, someone says things about you that aren't true. Counter-t is the same thing. Can be positive when you give positive feelings. Or negative when they pick up on your biases and respond to them. **Managing transference** - Identify the feelings behind the behavior - Contain the feelings **Interpreting transference** - There is usually more to it than you think Counter-transference ==================== The only way to deal with all of this is to reflect. Kawa Model - A new conceptual model of practice that brings an important shift in the discourses of theory and culture in occupational therapy - Professions first substantial theoretical work to emerge outside of the West impels occupational therapy beyond its familiar bases of individual autonomy and agency, toward collective-oriented, interdependent views of human occupation - The Kawa (Japanese for river) model uses a familiar metaphor of nature as an effective medium to translate subjective views of self, life, well-being and the meanings of occupations - It is an exposition of the profound relationship between culture, theory and knowledge - Raised from occupational therapy practice, by practitioners, for practitioners, through qualitative research methods - Once the client finishes it, you have to interpret it - **Origins** - Peoples lives can change, and it depends on where you get the snapshot of them from - The whole theory -- our lives are a river from birth until death -- yuch parts in the middle, narrow or wide parts, full parts or empty parts, waterfalls etc. - So what we want to know is just a cross section -- see their *river* **today** - This model attaches meaning to the different things you put in your river - More blockages decreased OP - But there's still the gaps to consider that's the point where you can intervene - Rocks = problems, depends on how big it is. Rocks are harder to remove -- they are things that are harder to intervene with. - Logs = can either be assets (to build rivers) or a liability. The client's things -- what they have -- characteristics that can positively or negatively affect the flow - Grey part at the bottom -- things that affect them but is out of their control like community, family, NHI for example - We need to understand where we can intervene to reduce the amount of problems. This is the clients perspective. Application to practice ======================= There is a process 1. Appreciating the client in context -- get them to draw their river, explain it to them, explain what each thing means 2. Clarifying the context -- make sure you understand their river 3. Identify and prioritise the issues according to the client 4. Identify whether it's a point where OT can intervene 5. Intervene 6. Evaluation Link to counselling ------------------- - Identifies the problems for us straight away -- drawing and explanation of elements - Empowerment -- client is responsible for finding solution - Culturally appropriate -- client provide context - Create opportunity for change -- increase the flow of the river Can be used progressively -- get the client to draw it again to see if the problems have changed. It's completely their own -- the client has the power, they have to explain, you can't decide for them, you cant dictate for them. Looking after ourselves Counselling =========== Therapists are notoriously bad at getting help for themselves -- leads to burnout **Factors contributing to burnout** - Nature of our clients - Lack of supervision - Lack of rewards - Lack of professional identify - Lack of support - Lack of continuing education - Lack of stimulation Counselling with children Trauma counselling with children ================================ Trauma is the exposure to an exceptional mental or physical trauma Children don't necessarily know that they've gone through a trauma, they don't know what to do with it - They don't really understand **Consequences of trauma** Depends on the type of trauma and phase - Impact phase - Shock - Numbness - Disorientation - Confusion - Irrational and disorganized thought patterns - Numerous emotions or they might appear blunted - A need for guidance - A helplessness or regression - Emotional consequences - Anxiety, fear, withdrawal, anger, insecurities, unsure about self or skills and abilities, relationships, environment or safety - Due to immature coping skills they might use inappropriate coping and defense mechanisms and ways to express their emotions. It could cause inappropriate behavioural problems: aggression towards peers or siblings or carers. It could cause a decrease in participation in all OPAs as well as IPRs and a lack of willingness to explore due to fear. **Phases of trauma** Impact phase - When it fresh, happened recently - Support - OT to be calm - Provide structure and security - Practical assistance - Do not force them to talk about it Recoil phase (reality sets in) - Validate and normalize emotions - Debriefing if appropriate so refer if needed as not in our scope exactly - Create a safe environment - Give them opportunity to express emotions that they are experiencing. Could be done with the following occupations: - Use occupations as a means - Art drawing, colouring - Narrative story telling - Puppetry/dolls - Clay - Drama - Collage - Depends on age of child - Create opportunity for the child to: - Express their emotions in a socially appropriate way - Identify the emotions Reorganizing/ recovery phase - Redefining concepts like 'safety' - Redefining their boundaries - Getting their feet wet in terms of following their normal pattern - Start to develop: - Acceptable coping skills - Appropriate defense mechanisms - Social skills - Should focus on the child themselves as well as the support or carers - Environment for treating/counselling -- that they're going back to an environment that will support your treatment