COUNSELLING SKILLS

Dewi Martha Indria

The British Association for Counselling
(BAC), 1986
Counselling is the skilled and principled use of relationship to
facilitate self-knowledge, emotional acceptance and growth
and the optimal development of personal resources. The
overall aim is to provide an opportunity to work towards living
more satisfyingly and resourcefully. Counselling relationships
will vary according to need but may be concerned with
developmental issues, addressing and resolving specific
problems, making decisions, coping with crisis, developing
personal insights and knowledge, working through feelings of
inner conflict or improving relationships with others.

The counsellor’s role is to facilitate the clients work in ways

that respect the client’s values, personal resources and
capacity for self-determination.
 Poon, 1997
• Counseling as the process of assisting people
to overcome obstacles to their personal and
interpersonal growth and to achieve optimum
development of their personal resources and
goals in life.

Counseling Motivation
 The Aim of Counseling
• Increase doctor’s rapport with patients
• Patient can understand better about himself and
his medical problem  change the bad one to
the good one
• Increase patient’s confidence to face their
medical problem
• Make patients feel competent to manage their
own lives while connected to the caregiver
• Not always to solve the problem
 General stages of counseling

Ask &
Greet Tell
Assess

Treatment Explain Help

 Stages of Counseling

Relationship Building

Exploration &
Understanding

Rational Discussion
Stage I. Relationship Building
Counselor must be ready & willing to
ATTEND to the counselee

Listening  understand the feelings 

thoughts conveyed

Structuring  paraphrasing reflecting of

feelings  summarising
Stage II. Exploration & Understanding

Applying the skills of probing

Information giving

Clarification to ascertain the meaning of messages & feelings

For counselee  helped to deal with himself & be motivated

to engage in rational discussion for problem-solving
Stage III. Rational Discussion

Problem definition & assessment

Therapeutic goal setting & implementation

Termination & evaluation

 (a) Problem definition & assessment
• Defining a treatable problem
• Example:
– Coping with a chronic illness
– Grieving the death of a loved one
– Dealing with an alcoholic parent
– Overcoming psychological aspects of depression
while also taking antidepressants
 (b) Therapeutic goal setting &
implementation
• Define target symptoms for improvement/specific
outcomes as the patient expect (hopes) to
achieve
– Counselor-counselee can negotiate to modify
unrealistic expectations  lead to mutually agreeable
goals
• Establish a therapeutic contract
• Involves patient in exploring new ways of thinking
& behaving  to attain the therapeutic goals
 (c) Termination & evaluation
• Mixture of consolidation of change achieved &
recognition of the need  do further work /
accept unchanging situations
LISTENING
Taylor Caldwell

Man’s real need, his most terrible need, is

for someone to listen to him – not as a
patient but as a human soul. He needs to tell
someone of what he thinks, of the
bewilderment he encounters when he tried
to discover why he was born, how he must
live and where his destiny lies.
 Usefulness of listening
• Release of tension
• Draining of anger, aggression, frustration
• Clarifying thinking
• Helped through more realistic understanding
of himself and his situation
• Sharing the burden
• Establishing a relationship
A good listener Barriers to good listening
Accepting Impatience
Patient Form premature opinions
Caring Implying judgment
Sympathetic Criticisms
Concerned Lack of understanding
Discreet Jumping to wrong conclusion
Understanding Give a glib solution
Respectful Giving impression that the
problem is not serious
Knowledgeable
Wanting to talk
Encouraging
Passive
Tolerant
Inability to concentrate
Warm
Interruptions
Kind
Lack of time
Trustworthy
 Stuart & Lieberman’s
“15-minute hour” primary care counseling
 • Assessing what’s the background situation
• Ask about likely areas of psychological problems:
Background • How are things at home/work?
• What’s the different in your life between now and
before?

• The patient’s affect

• Ask about common areas generating strong feelings:
Affect • How do you feel about your home life / work /
school?
• How do you feel about your life in general?

• The problem that is most troubling for the patient

• Ask how much the patient’s problems bother him:
Troubling • What most worries you about your life?
• What do you think that this problem means to you?
 • The manner in which the patient has been handling the
problem
• Problems are often mishandled life difficulties:
Handling • How are you handling the problems in your life?
• What have you tried to solve the difficulty?
• How much support are you getting at home/work?
• Who gives you support for dealing with problems?

• Response that conveys empathy

• Express understanding of the patient’s distress:
Empathy • I can understand that you would feel angry.
• That must have been difficult.
• This is a tough situation to be in.
 S Support

Objectivity O Using
Soap to
Bathe
A Acceptance

Present
focus P
 S = Support
• Normalize problems as common dilemmas
– “Lots of people struggle with similar problems”
• Help the patient focus on strengths
– “What resources could you use to deal with this?”
 O = Objectivity
• Encourage patient to ask themselves how
realistic their thoughts & feelings are
– “What’s the worse thing that could happen?”
– “How likely is that?”
 A = Acceptance
• Be as nonjudgmental & accepting as possible
– “That’s an understandable way to feel.”
• Encourage patients to feel better about themselves,
their parents & other family members
– “I think you’ve done real well considering all the stress.”
– “Sounds like your parents did the best they could under
tough circumstances that were hard for them to survive.”
• Coach patient to think differently about themselves
more realistically if they are overly self-critical
– “I wonder if you are being too hard on yourself.”
– “How much time & energy are you putting into worrying
about this?”
– “what else could you do with all that time & energy?”
• Urge patient to develop more of a sense of
humor about their issues
– “I wonder if you could see the humor in this
sometimes.”
• Acknowledge the patient’s value & priorities
– “It sounds like family is more important than work to
you.”
• Acknowledge the patient’s readiness for changes
– “Sounds like you are not quite ready to change.”
• Acknowledge the difficulty of making changes
– “Changes is real hard & usually pretty scary.”
 P = Present focus
• Encourage focusing more on the present, less
on the past and future
• Help patients identify, explore, evaluate
different behavioral options
– “How could you cope better?” (reframe problem)
– “What could you do different?” (leave/change the
situation)
– “What are the likely consequences of A vs B?”
• Express guarded optimism that the patients can
& will do better  try to set up a positive self-
fulfilling prophecy for the immediate future
– “My guess is that if you set your mind to it now, you
can do much better & feel a lot better & I think you
might just do that.”
• Suggest a homework assignment for the patient
to carry out
– Practice sending “I” messages  “I think our vacation
plans are too hectic.”
– Practice asking for what you want, rather than just
hoping for it  “I would like more help with the
children.”
– Practice telling others how you are responding to their
behavior  “I feel very angry when you go on trips by
yourself so often.”