Module 1

Introduction to Health Counselling

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Learning objectives:
After studying this material, you should be able to:
- define health counselling
- understand the need for health counselling
- overview theoretical considerations in health counselling
- overview common topics and settings for health counselling

What is health counselling?

Health counselling involves an action-oriented process to reduce health risks or change
lifestyle in order to obtain better health. It combines physical and psychological health.
The relationship between the health counsellor and the client is a partnership (Lewis,
1993).
The aim of health counselling is to empower people to self-manage their own health with
the application of counselling skills. This includes health in all its aspects: biological,
psychological and social well-being. The focus is on the person as a whole.

Biopsychosocial Approach to counselling:

The term biopsychosocial refers the roles of the biological, psychological, and social
factors that affect peoples general health. Each biological illness affects psychological
and social factors to certain extend. According to Uchino, Cacioppo and Kiecolt-Glaser
(1996), people with no family history of cancer can still be at risk if they maintain healthrisk behaviour such as smoking. People who have good social support and/or strong
coping mechanisms can manage stressful ill health. Davy (1999) suggested that effective
health care requires emotional support, mobilizes supportive networks including family
and medical resource. The impact of psychological and social factors determines an
individuals adaptation towards a change in health. Health counselling combines the
concepts of physical, psychological as well as sociological health and all three areas have
to be assessed (Donnelly, 2003).

Psychological

Biological

Social

Theoretical considerations in health counselling:

To assist clients in learning to adjust their physical health, to manage stressors that are
associated with the physical environment, and to understand the clients resistance to
change, basic counselling theories of development are needed to providing frameworks
(Colledge, 2002). Basic counselling theories are formed around different schools of
thought. The psychoanalytic school facilitates the understanding of the factors that affect
personality development and psychosocial well being. The humanistic school stresses the
free will of human beings and helps people to find their own meaning in life. The
cognitive-behavioural school focuses on how people think, feel, and act. The theories of
the three schools have been generated through research. Theorists have used animals to
study different types of behavior, such as Pavlovs classical conditioning experiment with
dogs, Thorndikes study of operant conditioning with cats, and Skinners study of
reinforcement with pigeons and rats.
The primary focus emphasised in each counselling theory is derived from different
domains. They include the affective, cognitive, and behavioural domains. The affective
domain emphasizes feelings and emotions. The counsellor provides emotional support to
the client who is undergoing treatment. Affective theories include client-centered and
gestalt theories. The cognitive domain emphasizes beliefs, attitudes, and thoughts. The
counsellor helps the client to think differently/positively about a situation or person.
Theories that emphasize the cognitive domain include transactional analysis, cognitive
therapy, rational-emotive therapy, and reality therapy. The behavioural domain focuses
on the modification of habits and patterns of interaction with others. The counsellor helps
the client to develop new behaviour, eliminate any health-risk behaviour, and institute
lifestyle change. The theory of operant conditioning belongs to the behavioural domain.
During interviews with clients, data from all of these domains helps the health counsellor
to determine the type of therapy that should be used (Belar & Deardorff, 1995).

Different approaches of helping:

Whats wrong with you? Any fever? Any running nose?

Whats the colour of the sputum?. A physician, who is going to diagnose

your illness, asks you a whole string of questions. This is an effective way to identify
physical problems very quickly. (Manipulation)

You have to stop drinking and smoking! Dont you understand what I mean? (Telling)
Your blood pressure reading is still on the high side. I suggest you take the medications
that the doctor gave you the other day. (Advising)
Your blood pressure reading is still on the high side. Would you like to share with me
your management of your blood pressure? (Counselling)

Eggert (1999) suggested that counselling is more client-focused instead of problemfocused. It intends to achieve effective, permanent changes in an individuals behaviour.
During the counselling, the client will be included in the process. The client is supposed
to enjoy more control over her or his problem.

The counselling partnership

Who does the health counselling?

Health counsellors are the ones that assist clients in exploring difficulties that they are
experiencing related to health problems. S/he assists the client in building up self
efficacy and to identify own resource in achieving healthy changes in lifestyle that can
enhance their physical well-being with the use of counselling skills.

Who is being counselled?

An individual who recognizes that s/he is in a situation that s/he wishes to improve or
change and demonstrates a commitment to personal action.

Every client has his or her personal strengths to overcome his or her physical health
problem. The role of the health counselor is to help to explore the clients potential,
personal and social resources to fight or cope with physical health problems.

Who benefits from the process?

The important factors to determine who could benefit from the counselling process are
the aptitude of the counsellor and the attitude of the client to the offer of counselling. As
a health care provider who interacts with client every day, s/he should know the skills to
facilitate client to understand his or her problem and to make use of the unused resources
to empower client in identifying coping strategies, changes in health risks behaviour and
the maintenance of health during the process. Also, the client has to obligate to the
process to make the counselling possible. Both the counsellor and the client benefit from
the counselling process.

Settings:
Health counselling can be carried out wherever a client has a need to improve her or his
state of well-being. According to Nelson-Jones (2003), helpers use counselling skills in
locations that represent their primary work role. For nurses, the settings can range from
home settings, hospitals, clinics and wards. That is in primary, secondary and tertiary
health care settings.

Common topics related to health counselling:

Common health counselling topics include coping with acute and chronic illness, pain,
weight control, sleep, exercise, and smoking cessation and so on. A survey done by
Clark, Hook & Stein (1997) found that clients with anxiety, depression and bereavement
are the most common issues referred for counselling. Overall speaking, there is need to
employ health counselling skills whenever there is client whose requires change in
relating to health-related problem or health risks behaviour.

References:
Belar, C. D. & Deardorff, W. W. (1995). Clinical health psychology in medical settings:
A practitioners guidebook. Washington D. C.: American Psychological Association.
Clark, A., Hook, J. & Stein, K. (1997). Counsellors in primary care in Southampton: A
questionnaire survey of their qualifications, working arrangements, and case mix. British
Journal of General Practice, 47. pp.613-617.
Colledge, R. (2002). Mastering counseling theory. New York: Palgrave Macmillan
Davy, J. (1999). A biopsychosocial approach to counselling in primary care. In Bor, R.
& McCann, D. The practice of counselling in primary care. New Delhi: SAGE
Publications.
Donnelly, J. (2003).
Health counseling: Application and theory.
Wadsworth/Thomson Learning.

Belmont:

Eggert, M. (1999). Perfect counselling. London: Random House Business Books.

Lewis, J. A., Sperry, L. & Carlson, J. (1993). Health Counseling. California:
Brooks/Cole Publishing Company.
Nelson-Jones, R. (2003). Basic counselling skills: A helpers manual. London: SAGE
Publication.
Uchino, B. N., Cacioppo, J. T. & Kiecolt-Glaser, J. K. (1996). The relationship between
social support and physiological processes: A review with emphasis on underlying
mechanisms and implications for health. Psychological Bulletin, 119. pp. 488531.

Further reading:
Frankel, R. M., Quill, T. E. & McDaniel, S. H. (2003). The biopsychosocial approach:
Past, present, future. Rochester: University of Rochester Press.