An Analysis of Counselling Skills - Essay Example

Introduction Counselling involves giving advice on practical problems to by a trained person who assumes a supportive and non-judgemental role (Palmer & MacMahon, 1997). Counselling is based on communication, listening and interpersonal skills (Palmer & MacMahon, 1997). A broad-based definition of counselling also includes consultation and training, family counselling, group counselling, social work, teaching, supervision and administration (Manthei, 1997). Counselling and counselling skills There is a difference between counselling in the formal sense of the term and the use of counselling skills. Counselling skills involve the use of a range of specific skills by the counsellor to help the client. The core of counselling skills includes the skills of listening, reflecting and empathy (Corney, 1995.) There is no universally accepted single definition for counselling skills. Counselling skills differs from listening skills and counselling on the basis of the intentions of the user (Palmer & MacMahon, 1997). The intention is to enhance the performance of their functional role, as nurse, tutor, social worker etc., and in turn, the recipient will, perceive them in that functional role (Palmer & MacMahon, 1997) In other words, it can be said that a person using counselling skills is enhancing communication with someone without assuming a role as their counsellor (Palmer & MacMahon, 1997). The recipient perceives this as an action within a professional/caring role (Palmer S, MacMahon G, 1997) Counsellor Not every one who uses counselling skills can be called a counsellor. A counsellor uses counselling skills as a distinct profession (Sutton & Stewart, 2002). Others might use counselling skills as part of their other skills. This might be only temporary (Sutton & Stewart, 2002.) Counselling, advice, persuasion and undue influence There is a difference between counselling, advice, persuasion and undue influence. Advice involves telling a person what to do or not to do. Counselling involves telling a person what is possible, and not what to do (Sutton & Stewart, 2002.) Persuasion involves overcoming a person’s wishes to do something, whereas counselling is a self-directed course of action (Sutton & Stewart, 2002.) Exerting undue influence or manipulation is done against a persons will, making the person feel uncomfortable or angry. Counselling on the other hand involves exploration of all the alternatives (Sutton & Stewart, 2002.) There is also a difference between counselling and other forms of helping. The primary difference is the way in which the counsellor actively listens. It also involves being aware of the client’s non-verbal communications, body posture, gestures etc. (Sutton & Stewart, 2002.) Attributes of an effective counsellor In order to be an effective counsellor it is essential to posses certain attributes (Burnard, 2005.) 1. Interpersonal skills-a competent counsellor needs to have appropriate skills of listening, empathy communication, presence, awareness of non-verbal communication, response to emotion, turn taking, structuring time and use of language (Burnard, 2005.) 2. Personal beliefs and attitudes-a counsellor should have the capacity to accept others, believe in change, and have an awareness of ethical and moral choices (Burnard, 2005.) 3. Conceptual ability- a counsellor should have the ability to understand and assess the client’s problems, anticipate future consequences of action, remember all information about the client, and show cognitive flexibility and problem solving skills (Burnard, 2005.) 4. Personal soundness- a counsellor should not have any irrational beliefs, social prejudice, ethnocentrism and authoritarianism. A counsellor should have ample self-confidence (Burnard, 2005.) 5. Mastery of technique- a counsellor should have the knowledge of when and how to carry out specific interventions, have the ability to access the effectiveness of interventions, and understand the rationale behind techniques (Burnard, 2005.) 6. Ability to work and understand social systems- a counsellor should have awareness of family and work relationship of the client, have the capacity to use support networks and supervision, and be sensitive to different ethnicity, gender, sexual orientations and age of the client (Burnard, 2005.) 7. Other essential qualities include: being genuine and not hiding behind a mask of professionalism (also known as congruence, realness or authenticity); accepting the client as it is without judgement or conditions (also known as caring, valuing, respect) (Sutton & Stewart, 2002.) The counsellor and the counselling relationship Both the counsellor and the client share a dynamic relationship through counselling. The counsellors’ knowledge of themselves is as vital as the knowledge of their client and of counselling principles (Manthei, 1997.) This dynamic relationship that the counsellor and the client share is a constant process of defining and redefining the specific roles that both play. Although the counsellor’s reasons for helping are seldom pure or unselfish, all counsellors should be open to and aware of their motivations (Manthei, 1997.) Application of counselling/counselling skills in a clinical situation The most well established type of counselling in a medical setting is genetic counselling. Other than this counselling may also be practiced in a rehabilitation centre, pain clinic, for pregnant women, HIV patients, prior to transplant surgery, angioplasty etc. (Thomas, Davison, Rance, 2001.) Counselling can also be given to relatives, especially those of paediatric patients. Counselling is also used to educate patients. Some examples being in diabetes, post-myocardial infarction etc. (Thomas, Davison, Rance, 2001.) There has always been an issue of who should perform the counselling and where it should be done. Traditionally, the role of counselling has been carried out by health professionals. But now, this role is more frequently being carried out by specialist nurses or nurse practioners (Thomas, Davison, Rance, 2001.) Counselling in the healthcare context takes place mainly in hospitals and clinics providing specialist services. However, it would be better to offer counselling in alternative environments for more general emotional problems (Thomas, Davison, Rance, 2001). Counselling in a health care environment has several advantages. It facilitates communication between all the healthcare professionals involved with a patient (this is vital for good medical practice, especially in sensitive areas like HIV care). Any misunderstanding or manipulations in the doctor-nurse-counsellor-patient interactions can be avoided (Thomas, Davison, Rance, 2001). An active collaboration between all the involved professionals gives an awareness of different working practices and allows better links to develop between services, like in psychiatry. This makes it easier and more acceptable for psychiatric patients to receive counselling for different aspects of their illness (Thomas, Davison, Rance, 2001). Since all the professionals working with the same patient have personal interaction with each other, mutual respect and understanding develops between them. This in turn improves the services (Thomas, Davison, Rance, 2001). Self-awareness Self-awareness is a very important component in the counselling process. Self-awareness allows the counsellor to differentiate between their problems and that of the client (Burnard, 2005). Without self-awareness, the counsellor might imagine that every other client has the same problems as they have. In this way, the counsellor projects individual problems onto the client (Burnard, 2005.) Self-awareness allows the counsellor to clearly mark out their ego boundaries and successfully distinguish between what belongs to them and what belongs to the client (Burnard, 2005). Without this clear demarcation of ego boundaries, all the emotion put in the relationship by the counsellor leads to a burnout, i.e., a physical and emotional exhaustion due to work-related stress (Burnard, 2005.) A burnout will manifest as an inability to cope, feeling of hopelessness and disillusionment with the job (Burnard, 2005.) Supervision Registered counselling practioners need to have regular supervision and continuous professional development to maintain their registration (Bryant-Jefferies, 2005.) A regular supervision of the counsellor helps to explore the dynamic relationship with the client, to know the impact of the work on the counsellor and on the client, and to receive support. Supervision also provides an opportunity for an experienced colleague to monitor the counsellor’s work with respect to maintaining ethical standards and codes of practice (Bryant-Jefferies, 2005.) The function of a supervisor is to help the counsellor to improve their skills and to help in developing an understanding of their feelings and that of the client (Sutton & Stewart, 2002.) Supervision gives the opportunity for the counsellor to acknowledge any difficulties and weaknesses that they might have, and to realise their strengths and achievements. The nature of relationship between the supervisor and the supervisee has to be of a collaborative nature. Supervision not only provides a method of reviewing the content of counselling but also the processes that emerge from counselling (Bryant-Jefferies, 2005.) Personal Counselling for Counsellors-in-training A question has been raised if counsellors would benefit by undergoing counselling themselves during their training (Manthei, 1997.) The benefits are that it would promote self exploration and self understanding; it would enable counsellors to better understand and empathise with the client’s experience of counselling; it would enable counsellors to tackle any problems or conflicts of their own, which might compromise their work with the client; it would allow counsellors to get an actual experience of counselling and learn from their own counsellor (Manthei, 1997). However, the trainee should decide whether to receive personal counselling or not. It should not be a course requirement (Manthei, 1997.) Information giving and counselling It is important to realise the difference between information giving and advice giving. Information giving involves sharing facts, theories, statistics and other information procured from a variety of sources, with others. Advice giving suggests an opinion, i.e., the counsellor’s opinion (Burnard, 2005.) Information given during counselling should be: accurate, appropriate, and told in a simple manner so that the client will understand it. It should be sufficient enough to satisfy the current needs of the client. It is important for any health professional to give information, using words that are unambiguous and clear (Burnard, 2005.) Confidentiality in counselling In most circumstances, what the client tells the counsellor should remain strictly between the two. Sometimes, a situation might arise when the counsellor feels that information obtained from the client must be disclosed to another person (Burnard, 2005). Some examples include: the client talks about committing suicide, the client discloses about abusing children, or when the client, in the counsellors opinion, is showing signs of mental illness (Burnard, 2005.) There are various options to deal with the issue of confidentiality. The counsellor may offer total confidentiality, offer partial confidentiality, or avoid discussing the issue of confidentiality and consult the client as to how much can be disclosed to other professionals (Burnard, 2005.) Transference and counter transference Transference is the client’s view of the counsellor as an all-forgiving person with exceptional positive qualities (Burnard, 2005). Counter transference is the feelings that the counsellor develops for the client (Burnard, 2005). There are two ways to deal with transference and counter transference. One way is to encourage the client to become aware of this dependence, and make the counselling relationship itself a subject of discussion. Another approach is to ask an experienced colleague to act as a supervisor during the counselling process (Burnard, 2005.) Termination of counselling Termination of counselling is inbuilt in the initial contract. If the counselling has taken place for along time, than a ‘weaning off’ period is recommended before the actual termination of counselling (Sutton & Stewart, 2002). Termination should be well planned and not sudden. It should be approached with as much sensitivity as other parts of the counselling process (Sutton & Stewart, 2002.) In addition, a terminal evaluation is also performed. This identifies the various problems and how they were tackled; how the goals were achieved; and additional areas of growth that is required (Sutton & Stewart, 2002.) Research into the effectiveness of counselling Several studies have examined the effectiveness of counselling, and they conclude that counselling is generally effective. Studies examining the progress and outcome of clients undergoing counselling therapy, show that the majority of clients improve, a minority show no change, while a few actually deteriorate (Lambert & Cattani-Thompson, 1996). Rowland et al (2000) in their study of data from follow up patient’s show that counselled patients are more likely to have recovered than non-counselled patients. Other than individual counsellor variables and counselling, the client outcomes are most likely to be determined by client variables such as severity and chronicity of disease, motivation, defences, acceptance of responsibility for change, and complexity of symptoms (Anderson & Lambert, 1995.) In a meta-analysis of 475 psychotherapy trials by Smith, Glass, & Miller (1980), it was shown that psychotherapy was effective. The majority of these trials occurred in education (56%) and hospital (12%) settings instead of a general practice setting. Case Study Mr. Robert is 55-years old and is single, and owns a house, which he is forced to sell because of the amputation. He is worried about losing his job as an engineer in the film industry, which requires him to stand most of the time, and worried that his friends might not want to mix with him because of the amputation. He is generally feeling helpless, angry, and frustrated. The amputee is likely to be worried about self-consciousness of a changed body image. It is important to give them simple, honest and accurate information (Muzumdar, 2004). They are likely to be worried about how others would react and the effect that the amputation will have on their interpersonal roles and occupational and financial status (Muzumdar, 2004). Education and support, in a group format helps. Reviewing the job requirements and involving mentors can be both reassuring as well as reduce fears and anxieties about the future (Muzumdar, 2004. ) Psychosocial issues are of great importance. For optimal rehabilitation to take place, it is important to involve a psychologist or social worker expert in the process of adaptation to limb loss and change in the body image. Psychological counselling enhances the coping mechanisms in the amputee (Atkins & Meier, 2004.) The optimal rehabilitation of an amputee requires the combined skills of physicians, prosthetists, therapists (PT, OT, recreational), nurses, social workers, psychologists, and vocational counsellors (Kohl.) It is important to acknowledge that the person has changed, both physically and emotionally. Therefore, both physical and emotional adjustments have to be made. Amputees with negative self-images may require intensive psychological support to cope with their changed bodies (Kohl.) For many amputees the loss of a body part causes a psychic pain that leads to stigma, with the fear of being ostracized. These fears and feelings need to be acknowledged (Kohl.) Over a period of time, the person’s ability to look at and touch the amputation site should be increased (Kohl.) The fear of rejection is a psychological sequelae to the fear of revulsion. It is important to identify those people who are emotionally valuable to the patient and facilitate the maintenance and continuity of the relationship (Kohl). Some amputees consider themselves as worthless, dependent, and unneeded. Other than acknowledging these feelings, the patient is told that this is only situational and that a sense of worthiness can be obtained from other pursuits (Kohl.) Sometimes specific counselling for these feelings needs to be provided later on. After completing a functional rehabilitation program and attaining proficiency in the use of prostheses, the amputee is referred for a full vocational evaluation (Kohl.) At this time, it is determined if it is possible to resume the previous job, if any job modifications are required, or if a transfer to another job within the same company is possible (Kohl) Since extreme physical labour is no longer possible, a more cerebral type of occupation might be preferable (Kohl.) In the case study, Mr. Robert requires psychological counselling because he has a negative self-image along with feelings of helplessness, and anger. He also needs a functional rehabilitation and vocational evaluation. He needs to be counselled on taking a job not involving much standing, and advised to pursue a desk-bound job. Conclusion Counselling involves giving advice on practical problems to clients by a trained person who assumes a supportive, non-judgemental role, and is based on communication, listening and interpersonal skills. Counselling also includes consultation and training, family counselling, group work, social work, teaching, supervision and administration. Counselling skills involve the use of a range of specific skills by the counsellor to help the client. A counsellor needs to have certain attributes like interpersonal skills, good personality, conceptual ability, genuineness etc. There are also differences between counselling, advice, persuasion and undue influence. Counselling also differs from helping. The relationship between the counsellor and the client is a dynamic one. The counsellors’ knowledge of themselves is as vital as the knowledge of their client and of counselling principles. In the medical setting, the most well established type of counselling is genetic counselling. Other than this, counselling may also be given in a rehabilitation centre, pain clinic, during pregnancy, HIV patients, prior to any surgery, for diabetes, and for relatives of patients. Although health professionals have traditionally given counselling, specialist nurses or nurse practioners is increasingly giving it. Counselling in healthcare takes place mainly in hospitals and clinics providing specialist services, and has numerous advantages. For more effective counselling it is mandatory for the counsellor to undergo supervision. It is also essential to posses a certain degree of self-awareness. It is also important to be aware of factors like confidentiality, transference and counter transference. The termination of a counselling relationship should be gradual, and should include terminal evaluation. Numerous studies have examined the effectiveness of counselling, and have found that counselling is generally an effective process. The majority of the clients have been found to improve after counselling. Other than individual counsellor variables and counselling, the outcomes are most likely determined by the severity and chronicity of the disease, motivation, defences, acceptance of responsibility for change, and complexity of symptoms in the client. The optimal rehabilitation of an amputee requires the combined skills of physicians, prosthetists, therapists, nurses, social workers, psychologists, and vocational counsellors. The amputee is likely to be worried about self-consciousness of a changed body image or have a fear of rejection. Some amputees consider themselves as worthless, dependent, and unneeded. They require psychological counselling, functional rehabilitation and a full vocational evaluation and counselling. After a functional rehabilitation and a vocational evaluation, it is determined if it is possible to resume the previous job, if any job modifications are required, or if a transfer to another job within the same company is feasible. References Anderson, E. M, & Lambert, M. J (1995). Short-term dynamically oriented psychotherapy: A review and recta-analysis. Clinical Psychology Review, 9, 503- 514. Atkins, D.J, Meier, R.H (2004). Functional Restoration of Adults and Children With Upper Extremity Amputation. Demos Medical Publishing, LLC. Burnard, P (2005). Counselling Skills for Health Professionals. Nelson Thornes. Bryant-Jefferies, R (2005). Person-centred Counselling Supervision: personal and professional. Radcliffe Publishing. Corney, R.H (1995). Counselling in General Practice. Routledge (UK) Kohl, S.J. The process of psychological adaptation to traumatic limb loss. Retrieved November 28 from, www.utaharm.com/pdf/adaptation.pdf Lambert, M. J. & Cattani-Thompson, K. (1996). Current findings regarding the effectiveness of counselling: Implications for practice. Journal of Counseling & Development, 74(6), 601-609. Manthei, R (1997). Counselling: The Skills of Finding Solutions to Problems. Routledge (UK) Muzumdar, A (2004). Powered Upper Limb Prostheses: Control, Implementation and Clinical Application. Springer. Palmer, S, MacMahon, G (1997). Handbook of Counselling. Routledge (UK). Rowland, N, Godfrey, C, Bower, P, Mellor-Clark, J, Heywood, P, & Hardy, R (2000). Counselling in primary care: A systematic review of the research evidence. British Journal of Guidance & Counselling, 28(2), 216-233. Smith, M, Glass, G. & Miller, T (1980). The Benefits of Psychotherapy. Baltimore, MD: John Hopkins University Press. Sutton, J, Stewart, W (2002). Learning to Counsel. How To Books Ltd. Thomas, P, Davison, S, Rance, C (2001). Clinical Counselling in Medical Settings. Psychology Press (UK) Read More