Counselling Skills - 2021 Student Version (PDF)

Counselling Skills Assoc Prof Tan Bhing Leet Director of Programmes Singapore Institute of Technology Communication Style in Mental Health  Very different from the ‘psychoeducation’ approach that occupational therapists tend to use in physical rehabilitation setting.  We seldom ‘tell’ clients (unl...

Counselling Skills Assoc Prof Tan Bhing Leet Director of Programmes Singapore Institute of Technology Communication Style in Mental Health  Very different from the ‘psychoeducation’ approach that occupational therapists tend to use in physical rehabilitation setting.  We seldom ‘tell’ clients (unless clients have limited ability or running skills training/education sessions).  We keep in mind what are the possible ‘answers’ or ‘solutions’, then ask appropriate questions or make comments to steer clients to articulate these answers/solutions themselves. Why is this communication style more effective than providing the answers to clients?  Receiving information from therapists involves largely superficial information processing.  Figuring out answers involve deeper encoding and processing. How Do We Position Ourselves? Option 2 Option 1 Option 3 Setting Guidelines Confidentiality  What information is confidential?  Who has access to the confidential information?  What information needs to be disclosed?  How do we set the understanding with clients? Giving Structure  State frequency of seeing client.  State exceptions.  State mode of communication. Counselling as an Approach Used in Occupational Therapy  Several counselling approaches available:  Rogerian  Solution Focused Therapy  Motivational  Interviewing Used by occupational therapist as an approach to communication or a frame of reference that supports an Occupational Therapy model of practice. Rogerian Counselling Approach Carl Rogers  Founder of humanistic approach to psychotherapy.  Believed that people are inherently good and have an innate desire to become better.  Personality development centres around ‘self concept’. Self-Concept  One’s opinion of oneself and how one is being treated by others.  Everyone has the need for positive regard, such as approval, warmth, love and respect.  The key to developing a healthy personality is through developing a positive self concept. Humanistic Therapy  Client-centred and directed.  Therapist provides unconditional positive regard, so that client can eventually reveals his true self as well as his ideal self.  Psychological problems are due to discrepancy between real self and ideal self.  Goal is to facilitate the client to achieve his ideal self.  Rogers (1986) described 3 facilitative conditions to achieve ideal self : 1. Genuine: does not distort communication or operate from hidden agendas. Actions and words match feelings both verbally and non-verbally. 2. Acceptance, caring or unconditional positive regard 3. Empathic understanding: “You feel frustrated because your boss doesn’t trust you to run the operations when he is out of town”- identifies feelings and the content of the situation. Non-Verbal  Face the client  Open position (no crossed arms)  Lean  Eye towards client contact  Relaxed Counselling Techniques  ‘Openers  Encouragers  Reflective listening-Paraphrasing  Reflective listening-Clarifying responses  Reflecting feelings  Confrontation  Silence Openers  Give description of the client’s body language “ You seem to be looking a little bit down today”.  Invitation to talk “How have things gone for you today”.  For children: through play. Encouragers  Head nods  “Mmm…”, “Alright, I see” , “ Oh, I get what you mean”.  Infrequent questions: deliver open questions only when necessary.  Be comfortable with silence. Reflective Listening-Paraphrasing  Paraphrasing responses: state in your own words what the client has actually said: “What I hear you are saying is…” “In other words…” “So basically now your feeling is…” “Let me understand what is going on with you which is……..” “Do you mean…….” Uses of paraphrasing: Clients Stop will appreciate being heard. anger from escalating. Prevents miscommunication. Helps counsellor remember and digest what is being said. Prevents judging on the part of counsellor. ACTIVITY Practise the following: Opener Encourager Reflective listening-paraphrasing  In groups of 3 s ( 1 ‘therapist’, 1 ‘client’ and 1 evaluator), choose one of the following topics: 5 minutes each person The My best thing that happened to me last week. favourite hobby.  Therapist: to start the conversation with an ‘opener’  Client: to talk about this topic.  Therapist: to use ‘encourager’ and ‘reflective listeningparaphrasing’.  Evaluator: give suggestions on areas to improve. Reflective Listening-Clarifying Responses  Complements paraphrasing by asking questions to clear vagueness within client’s statements  “What do you mean when you say you feel like a frozen chicken?” Reflecting Feelings   Help client to identify and name feeling- “It seems like you are feeling very disappointed with your boyfriend” Reflecting counsellor’s feelings: useful in showing empathy, evoke new perspectives in viewing a situation and promote self-reflection within client. “It makes me feel sad when you say….” “I feel confused by your account of how you handled the situation..”. Activity: Reflecting Feelings  Get into pairs  One person to describe an incident.  The ‘therapist’ to reflect and name the feeling.  Can refer to the ‘List of Feelings Words’. Activity: Reflective Listening-Clarifying Responses and 10 minutes discussion: what are the good and not so Reflecting Feelings good reflecting statements? Acknowledgement: Dean Richardson Counselling: https://www.youtube.com/watch?v=2aRq1LC05-A Analytical Listening  Look at the intention behind client’s behaviour and feelings:  “What need is this self-defeating behaviour fulfilling?”  “What this?” does he want when he says Feedback  Provides an opportunity for client to gain another perspective of a certain situation.  Feedback should be non-judgmental, supportive and in the here & now.  Counsellor may need to be balance transparency and non-judgement (when counsellor feels angered by client’s words). “As I hear what you have just said, it seems like you have been stressing yourself trying to please various people. Is this something you feel that is worthwhile to do?” Confrontation  The ability to tell client about his/her behaviour and its impact without being aggressive, critical, judgmental or defensive.  Also highlights discrepancies between how client thinks and feels and what he actually does.   “You say you want to learn to face the panic attacks, yet you have stopped taking the MRT. What may be preventing you from trying to face it?” “I feel rather disturbed by your frequent put-downs on others and myself. What does it mean to you to want to do this?” Example of Confrontation Acknowledgement: Nursing Education Research https://www.youtube.com/watch?v=iNHIGD9prus Confrontation Exercise Jane is a high functioning 24 years old client who has been diagnosed with schizoaffective disorder for 8 years. She has been seeing you for 2 years as an outpatient. You have good rapport with her. She has not been experiencing any psychotic symptoms for the past 2 years. Her current goal is to be punctual for her daily vocational training, as well as to require less prompting in her daily routine. She is 30 minutes late for your morning review session with her. This is the second time that she is late.   Jane: I’m sorry xxx (your name). I woke up late today because my mother forgot to wake me up on time. Practise using a Therapist: what would you say?? confrontation statement.   Jane: Oh, I have actually bought an alarm clock yesterday, thinking that I should stop relying on my mother to wake me up. But I realized last night that my batteries were dead. So I ask my mother for help instead.  Therapist: what would you say? Practise using an empathetic statement.  Using Silence – By Therapist Some Thoughts On Use of Silence in Counseling Sessions. Dr Nina Spadaro, Walden University https://www.youtube.com/watch?v=4jNZejN5yDI Activity: Using Silence  Jane: I don’t know what to do. I think my vocational training is going nowhere. I guess I should just give up on it.  Therapist: practise using silence, then use one of the appropriate technique. Getting Client to Use Silence Some Thoughts On Use of Silence in Counseling Sessions. Dr Nina Spadaro, Walden University https://www.youtube.com/watch?v=4jNZejN5yDI Practise this…. Therapist: I don’t want you to answer right away. I want you to stop and think before you answer, but I want to point out to you that every single time I talk to you, you have said a different thing about your interest and commitment to the vocational training. Some days, you are positive and hopeful and other days you are not. It seems as though there are fluctuations. Now before you say anything, stop for a moment and think what could be the reason. Some considerations when using the various technique  Any cognitive impairment?  What occupational therapy model or frame of reference you are using.  What are the client’s goals?  At what phase of therapy is the client?  What do you hope to achieve from your chosen technique? “LEARN YOUR THEORIES AS WELL AS YOU CAN, BUT PUT THEM ASIDE WHEN YOU TOUCH THE MIRACLE OF A LIVING SOUL” Carl Gustav Jung THANK YOU!