COUNSELING Interpretation

Dr. Agnes Segunda Gerasmo Confrontation

Information Giving
Counseling Summarizing
To give advise or opinion on what to Goal setting
do.
Dr. Rakel Family Practice emphasizes CIA- Client Centered
knowledge in such areas as Family Counseling
psychodynamics, interpersonal Catharsis- Ventilation Stage
relationship, counseling and Insight
supportive psychotherapy. Action
Dr. Engel- Biosphychosocial Model Based on Carl Rogers
Also called Client-centered
2 Types of Counseling counseling or patient-centered
couseling.
1. CIA- (Catharsis, Insight, Action)
Individual counselling, with Carl Rogers Basic Premise
psychosocial issues based on Carl Rogers Human Beings are essentially
rational, constructive, positive,
2. CEA- (Catharsis, Education, Action) independent, realistic, cooperative,
Individual or group counseling usually trustworthy, accepting, forward-
done on clinical consult moving and full of potential.

2 things necessary in counselling When there is a discrepancy between

actual self (described above), and the
1. Characteristic of a good counselor: perceived self- creates Misperception
Empathy Tension, Internal Confusion---ill
Unconditional Positive Regard Health.
Genuineness
The 3 main conditions can promote
Characteristic of Good Counselor: growth towards actual self and
improve communication.
a) Genuineness-
transparency, absence of Active Listening Skills
pretense. Skills used by the doctor-counselor to
b) Unconditional Positive regard- understand how the patient sees the
we can care for and accept the world and how he perceives the
confusion, fear, anger, loneliness, problematic reality for which he is
resentments of our client. consulting.
c) Empathy
ability to put oneself in the Active listening skills (Opening
situation of another. skills)
Attending Skills
2. Active Listening Skills Bracketing
Opening skill Leading
Attending Skills Reflecting
Bracketing Focusing
Leading Probing
Reflecting Summarizing
Focusing
Probing 1. Attending skills- paying attention,
Summarizing maintaining eye contact, nonverbals or the
verbals like saying yes or go on indicating
Closing skill that you are listening to the patient.

2. Bracketing -not so much a verbal or non-
verbal skill as it is a mental skill.
3. Reflecting Skill- mirror reflecting back
the image of the person gazing at it. A
patient who is emotionally burdened is also
unable to see himself clearly.
Example Reflecting skills:
(45/M walks in the office, sits down,
stands up again and looks out the door
to where his wife is sitting. He shuts
the door and sits down again.)
Patient: Doctor, a month ago, I had
this sore throat, so I went to a doctor
and he gave me penicillin for it. So I
took it for 7 days and it went away.
But a week later, I had sore throat
again.
(patient shifts in his seats and looks
down at the floor.)
The doctor gave me amoxicillin this
time and I took it and the sore throat
went away. But a few days ago
( patient takes his handkerchief and
crumples it and pulls at it repeatedly)
The sore throat came back.
(Voice becomes softer; patient shakes
his head).
I just cant understand what is
happening.
A. Reflecting content
verbal content is repackages or
rephrased to become clearer.:
a. Paraphrasing- putting to clearer
words and
summarizing what the patient is saying.
b. Perception Check- use same words
with that of the patient but putting is that it
at the end to confirm the counselors
perception.
Example:
Paraphrase: This is the 3rd time you
have had a sore throat within a month
and you dont understand why it keeps
on coming back.
Perception check: This is the 3rd
time you have had a sore throat within
a month and you dont understand
why it keeps on coming back. Is that
it?
B. Reflecting Feeling
articulate into words patients emotions.
Giving name to feelings makes pt. more
aware of emotions.
Feelings not articulated and
acknowledge have a way of taking
control of behavior.
When feelings accurately reflected
back,
patient feels understood, rapport
improves.
Example:
Reflecting feeling: You seemed so anxious
about your sore throat?
C. Reflecting Experience
pointing out the non-verbals in order
for the patient to become aware of how he is
behaving.
Example:
Reflecting Experience: I noticed that a
while ago you looked out at the door at your
wife and you shut it? Could you tell me
behind the action?
Leading
2 Kinds of Leading:
1. Indirect Lead- open invitation. Choice of
what to talk about depends on the patient.
Indirect leads take the form of words or
phrases such as: Yes, Go on, And then?
2. Direct Lead- requires that the doctor-
counselor make a judgment call to where the
patient should go.
Example:
P: You see, we have been married for 5 yrs
and we were okay most of the time but
several months ago, I noticed she had been
less talkative and irritable and I got a hard
time because she keeps on cutting me off.
D: Tell me more about how she cuts you off?
Focusing
Asking the patient to prioritize his emotions
or identify which one is heavier or
troublesome for him.
Example:
D: You have financial difficulties, your wife is
nagging you, your daughter is rebellious, and
your son had an accident. But of this 4 which
one gives you the most pressure.
Probing
Probes are questions asked to elicit more
information.
They must be open-ended. You can
probe by beginning the questions with
What, Where, and when and how
Probe for the feeling rather than
content.
Probe where the emotional content is
greatest, and watch out what the patient
decides to mention last or when patient
often repeats it.
Active Listening skills (Closing
Skills)
Interpretation
Confrontation
Information Giving
Summarizing
Goal setting
1. Interpretation
An active process of explaining the
meaning of events that happened in
the patients life from the Doctor-
counselor Frame of Reference.
Interpretative Statements
Interpretative questions
Metaphor
A. Interpretative statements.
It involves sharing your hunches
with the patient in declarative form
Example:
P: I hate the way I am being treated in this
hosp. Just because I dont have enough
money everyone feel they can bother me
anytime and insert all these needles.
Sometimes I just feel like yelling at them all
to get lost.
D: You feel very angry of the way you are
being treated with less respect simply
because you cannot pay.
B. Interpretative questions
The counselor who wants to confirm his
hunch uses questions.
Example:
D: When are you going to be concerned
about yourself too?
P: Thats selfish attitude.
D: So whats wrong with that?
P: I dont like selfish people.
D:Because?
P: Selfish people arent so popular
D: (I.Q.): So popularity is important to you;
and if you are self-centered, people wont
like you. Is that getting close to where you
are now?
Interpretation as Fantasy or metaphor
Another form of interpretative
statements using fantasy or metaphor.
Example:
Metaphor: I perceive you are like a puppet
with strings who conforms to what ever you
are told to do.
2. Confrontation
This skill enables the doctor-counselor to
challenge, discrepancies, distortions that the
patient is using knowingly or unknowingly.
a. Challenging Discrepancies
b. Challenging Distortions.
a. Challenging Discrepancies
Confrontation can be 0 in on
discrepancies between what the patients
thinks or feels and what he says and
between what he says and what he does,
between his perception of himself and the
perception of others regarding who he is,
between what he is and what he dreams to
be between his expressed values and actual
behavior.
Example:
Jenny says she feels happy and is contented
with her current job and yet expresses that it
would be a lot better if she gets paid more
and her boss would cut her some slack. She
occasionally complains of the long hours.
(She has this tired and faraway look and a
forced smile.)
Challenge: Jen you say you are happy and
content with your work yet I have listened a
lot of your complaints about it. Also when
you say your happy your eyes still have this
tired and sad look. Im not truly certain if you
are contented and happy.
b. Challenging Distortions
Some patients find reality as harsh and very
hard to face so they distort it in various
ways.
3. Information Giving
A. Advice Giving
 Giving suggestions and Opinions based on
experience. Useful in crisis situations when
several people must cooperate to prepare
patient for major readjustment.
B. Informing
Giving valid information based on
expertise.
Advise must be clear and relevant.
4. Summarizing
Tying together into several statements
ideas and feelings to close the discussion.
Summaries are good way to close a
session.
It is useful to the doctor to check if he has
grasped the full spectrum of the patients
message.
Example:
D: Youve been discussing about your
ideal jobs and what things you have liked
and disliked about your work; Youve also
talked about your plans of getting more
training. Are you ready to take a look at
some options in planning for a new
career?
D: Try to put it together briefly. Lets take a
look at what we have accomplished so
far. How does that appear to you?
5. Goal Setting
As a result of earlier processes both
doctor and patient has a clearer view of
what is happening and possible solutions
to the problem. This is a vital part of the
counseling process since it enables the
patient to explore new behaviors to cope
and deal with the circumstances.
Specific and measurable
Realistic
Hierarchical
Desired by the person and tailored to
him.
Frequently evaluated.
___________________________________________
CEA
Dr. Agnes Segunda Gerasmo
Catharsis
Education
Action
Active listening skills used in clinical
practice.
Correcting of emotionally critical
misperception, and medical misperceptions.
2 reasons for consult
1. Physical illness
Biomedical aspect
2. Impact of illness or consequence of
impact of illness or psychosocial aspect
of illness.
3 Reasons why we have to deal with
Impact of illness:
1. Biopsychosocial Approach
-gives importance to the unity of body,
mind and social context.
Holistic Approach- addressing
both the illness and impact of illness.
Conventional method-
pathophysiology and pharmacology.
2. We cannot be cerebral when we are
emotional.
When our patients are anxious they find
it hard to listen to us.
3. Emotions have their roots in the
patients perception.
Perceptions of patient incongruent
with the reality as the physician
perceives it is a misperception.
ECM- Emotionally Critical
Misperception- are
misperceptions that are most-
anxiety provoking.
CEA
Catharsis- purgation ventilation of and
emotions.
Education
Action
CEA Principles:
George Engel Biopsychosocial
model
Motivation for consult may be due to
physical illness or the impact of that
illness.
So we must address both the physical
and emotional impact of that illness.
Sir William Osler The good
physician cures sometimes, palliates
often, but comforts always.
 2. What feelings came out when did thoughts
1. The doctor plays as a doctor counselor. came to your mind?
2. The doctor detects or identifies 3. What consequences of your illness makes
misperception on the diagnosis, disease you feel this way most?
process, treatment or prognosis. What is the worst thing that your illness
3. The doctor gives name or reflects back to can do to you?
the patient, what the patient feels for What is the result or outcome your illness
him/her to be aware. that you dread most? ( Emotionally Critical
Misperception)
Goal of CEA 4. Summarize the ECM and the emotions
Not to make patient fear the disease associated with it.
process, but rather for them to understand
and make clear the disease process. Education
He will have articulated and ventilated
When to use it: his emotions
If you perceive the patient to be anxious He has now enough space in his mind
or with medical misperceptions. to be able to listen.
Address the ECM or medical
Characteristic of Good Counselor: misperceptions.
1. Genuineness- Explain and discuss to allay emotions.
transparency, absence of pretense. Make comparison to make things
2. Unconditional Positive regard- clearer for the patient.
we can care for and accept the
confusion, fear, anger, loneliness, Tips in Educating:
resentments of our client. 1. Speak the language of the patient.
3. Empathy 2. Use the power of analogy.
ability to put oneself in the situation of 3. Use of anecdotes and personal
another. testimonies.
4. Misperceptions hidden under emotions
Active Listening Skills should be explored and corrected.
Skills used by the doctor-counselor to 5. Allaying of anxiety.
understand how the patient sees the world
and how he perceives the problematic reality Action
for which he is consulting.
Therapeutic Plans
1. Attending skills- paying attention,
Pharmacologic and non-pharmacologic
maintaining eye contact, nonverbals
Schedule date and other plans.
Catharsis
Feedback
1. Medical Knowledge- as a doctor
Ask how the patient feels.
a. Explore the patients health
understanding.
b. Identify medical misperception if
TEAM FIEL AND CO.
present (on diagnosis,treatment or
disease process.)
c. Identify Health Framework.

2. Emotional/Psychological aspect
Ventilation- as a counselor
a. Probing the patients feelings.
b. Identify the Emotionally Critical
Misperception

Steps in Catharsis
1. What came into your mind when you
started feeling your symptoms?