COUNSELLING PROCESS counselling ppt 2.pdf

Counselling process- establishing structure and therapeutic environment

1. ESTABLISHING
STRUCTURE
&
THERAPEUTIC
ENVIRONMENT
COUNSELLING PROCESS

2. ESTABLISHING STRUCTURE
WhatisStructure?
Clientssometimeshavedifferentperceptionsaboutthepurposeand
natureofcounseling.Theyarrivewithseveralfeelings,attitudesand
expectationsandareoftennervousandwonderswhatisgoingto
happen.
Therefore,manyclientsentercounselingreluctantlyandhesitantly.
Thisuncertaintycaninhibitthecounselingprocessunlesssome
structureisprovided.
Itisessentialthatthecounsellormakesitverycleartotheclient
regardingwhatmaytakeplaceinthecounsellingsituation.Thisis
called'structuring'.
Structureincounsellingisdefinedasthe“jointunderstanding
betweenthecounsellorandclientregardingthecharacteristics,
conditions,procedures,andparametersofcounselling.”

3. ImportantFunctionsofStructuring
AccordingtoBrammer,Abrego,&Shostrom,(1993)
1.Structurehelpsclarifythecounsellor-clientrelationshipandgive
itdirection.
2.Itprotecttherights,roles,andobligationsofbothcounsellorsand
clients.
3.Itensurethesuccessofcounselling.
Structuringconcernsthepracticalmechanicsofthecounselling
relationship.Itdispelsmanyinitialmisconceptionsabout
counselling.Thiskindofinitialunderstanding,couldbeofgreat
valuetotheclients.Itisgoodiftheclienthassomeunderstanding
andgraspofthematter.
ForExample:
a)Whatdoesheexpectfromthecounsellingrelationship?
b)Whatwouldbetheresponsibilitiesandcommitments?
c)Whatistheamountoftimethatwouldbeavailabletohim?
d)Whatfees,ifany,doeshehavetopay?
Whenaclientdoesnotknowanythingaboutsuchmatters,heis
obviouslygoingtofeeluncomfortableandanxious.

4. ImportantpartofEstablishingStructure
Practicalguidelinesareveryimportantpartofbuildingstructure.
Theyinclude
1.timelimits(suchasa50-minutesession),
2.actionlimits(forthepreventionofdestructivebehavior),
3.rolelimits(whatwillbeexpectedofeachparticipant),
4.procedurallimits(inwhichtheclientisgiventheresponsibilityto
workonspecificgoalsorneeds).
Guidelinesalsoprovideinformationonfeeschedulesandother
importantconcernsofclients.
Hence,Structuringpromotesthedevelopmentofcounsellingby
providingaframeworkinwhichtheprocesscantakeplace.
Structureisprovidedthroughoutallstagesofcounsellingbutis
especiallyimportantatthebeginning.
Itsimportanceismostobviouswhentheclientarrivesfor
counsellingwithunrealisticexpectationsorwithnoideawhatto
expect.

5. Counsellorsneedtomovequicklytoestablishstructureatsuch
times.
Onewayisforcounselorstoprovideinformationaboutthe
counselingprocessandthemselveswithprofessionaldisclosure
statementsthatincludedetailsaboutthenatureofcounseling,
expectations,responsibilities,methods,andethicsofcounseling.
Tohelpclientsgainnewdirectionsintheirlives,counsellors
provideconstructiveguidelines.
Theirdecisionsonhowtoestablishthisstructurearebasedon
a)theirtheoreticalorientationtocounseling,
b)thepersonalitiesoftheirclients,
c)themajorproblemareaswithwhichtheywilldeal.
Counsellorsneedtostayflexibleandcontinuallynegotiatethe
natureofthestructurewiththeirclients.

6. SAMPLE
Professional Disclosure Statement
SamuelT.Gladding,Ph.D.-LicensedProfessionalCounselor
Iamgladyouhaveselectedmeasyourcounselor.Inconsideringour
professionalrelationship,Ihavewrittenthisdocumenttodescribemy
backgroundandmyclinicalapproach.
ProfessionalBackground
IholdaMasterofArtsdegreeincounselingfromWakeForest
University,aMasterofArtsdegreeinreligionfromYaleDivinity
School,andaPh.D.fromtheUNC-Greensboroinfamilyrelations
withcognatesincounselingandpsychology.Inaddition,Ididapost
doctorateatUNCG(18semesterhours)inpsychology.Ihaveworked
inapublicmentalhealthcenter(RockinghamCounty,NorthCarolina)
andinaprivateclinicalpractice(Birmingham,Alabama).Ihavealso
taughtcounselingatthegraduatelevelinConnecticut(Fairfield
University),inAlabama(UniversityofAlabamaatBirmingham),and
inNorthCarolina(WakeForestUniversity).
IamaLicensedProfessionalCounselor(#636)inthestateofNorth
Carolina,aNationalCertifiedCounselor(#334),andaCertified
ClinicalMentalHealthCounselor(#351).

7. CounselingServicesOffered
Asalicensedprofessionalcounselorwithaspecialtyinmentalhealth,I
aminterestedinthegrowth,development,andwellnessofthewhole
person.Irespecttheuniquenessofeachper-sonandhis/herlifejourney
whereapplicable.Myresponsibilityistofacilitateandempoweryouruse
ofthoughts,feelings,andbehaviorstoachievehealingandwholenessin
yourlife.Ihaveofferedoutpatient,fee-basedcounselingservicessince
1971,althoughnotsequentially.Ihaveworkedwithindividuals,couples,
families,andgroupsinareassuchasdepression,anxiety,grief,abuse,
careerexploration,situationaladjustments,lifedevelopment,andcrises.
Counselingpresentsyouwiththeopportunitytoinvestinyourpersonal,
emotional,cognitive,behavioral,andspiritualwell-beingandgrowthin
thecontextofahelpingrelationship.Yourgoalsforseekingcounseling,
whichIwillexploreandupdatewithyoufrequently,willgivedirectionto
ourworktogetherandwillinfluencethetherapeuticapproachesthatIwill
use.Mystyleofcounselingisbasedonperson-centered,gestalt,
existential,familysystems,andcognitive-behavioraltheories.Although
somecounselingchangesmaybeeasyandrapid,othersareslowand
deliberate.Theselatterchangeswillrequireconsiderableproactive
commitmentonyourpart.Thiscommitmentmayinvolveworkoutsideof
oursessionssuchasreading,reflecting,journaling,andworkingon
cognitive-behavioralassignments.

8. AttheoutsetIwilllistencarefullytoyourstoryandtakeahistoryto
learnthespecificinitialtherapygoalsthatemerge.Iwillworkclosely
withyoutoevaluateandfine-tunetogetherthesegoalsastheprocess
unfolds.Atanysessioneachofusmayevaluatehowtheprocessis
unfoldingandwherewemayneedtomakerevisions.Attheendofthe
counselingprocess,youwillbeprovidedwithanevaluationformto
reflectonourworktogether.Comingtoknowyourselfingreaterdepth
andmakechangescanbeinspiringaswellaspainful.Youmay
experienceamyriadofthoughtsandfeelingsduringthisprocess,
includingbutnotlimitedto,frustration,sadness,anxiety,guilt,and
anger.Iwilltypicallymakeadiagnosisregardingyoursituation,which
willbecomeapartofyourrecord.
ProfessionalEthics
Forourrelationshiptoberespectfulandeffective,confidentialityisa
must.Iwillnotdiscussthecontentofourworkoutsideofoursessions.
Statelawandtheethicalprinciplesofmyprofessionalorganizations
(theAmericanCounsellingAssociation,theNationalBoardforCertified
Counselors,andtheNorthCarolinaBoardofLicensedProfessional
Counselors)mandateconfidentialityexceptundertwocircumstances:
(1)whenIbelieveyouintendtoharmyourselforanotherperson,
(2)whenIbelieveachildorelderlypersonhasbeenorwillbeabusedor
neglected.

9. Inrarecircumstances,acourtoflawcanmandatemetorelease
informationonyou.Otherwise,Iwillnotdiscloseanythingaboutyour
history,diagnosis,orprogress.Iwillnotevenacknowledgeour
professionalrelationshipwithoutyourfullknowledgeandasigned
ReleaseofInformationForm.Suchaformmustbesignedtorelease
informationtoyourinsurancecarrieraswell.
Ethicalandlegalstandardsmandatethateventhoughourrelationship
mightbeintenseandintimateinmanyways,itmustremain
professionalratherthansocial.Youwillbeservedbestinoursessions
andrelationshipconcentrateexclusivelyonyourconcerns.Thus,Iwill
notattendsocialevents,receivegifts,orrelatetoyouinanywayother
thanintheprofessionalcontextofoursessions.
LengthofSessions
Myserviceswillberenderedinaprofessionalmannerconsistentwith
theacceptedclinicalstandardsoftheAmericanCounseling
Association,NationalBoardforCertifiedCounselors,andtheNorth
CarolinaBoardofLicensedProfessionalCounselors.Sessionswilllast
fifty(50)minutes.Weshallschedulesessionsbymutualagreement.
Oftenpersonsprefertomaintainastandardappointmenttime.A
twenty-four(24)-hournoticeisrequiredforcancellationunlessthereis
asicknessoremergency.

10. Withouttheseexceptions,paymentformissedsessionsisrequired.
Everyeffortwillbemadetostartandstopsessionsontime.Eachofus
hastheresponsibilityofbeingprompt.
FeesandMethodsofPayment
Thefeeforinitialintakesessionsis$115.00witheachsubsequent
sessionbeing$95.00.Sessionsarepayablebypersonalcheckorin
cashatthebeginningofeachappointment.Ourofficewillprovideyou
withasuperbillforyourrecordsortosubmittoyourinsurance
carrier.Someinsurancecompanieswillpayforcounselingservices;
otherswillnot.Pleaserememberthatyouandnotyourinsurance
companyareresponsibleforpayinginfullthefeesagreedupon.
ComplaintProcedure
Ifyouhavedifficultywithanyaspectofourwork,pleaseinformme
immediatelysothatwecandiscusshowwemightworkbetter
together.Thisdiscussionisanimportantaspectofourcontinuous
evaluationofthisprocess.
Shouldyoufeeltreatedunfairlyorunethicallybymeoranother
counselor,youmaymakeaformalcomplainttothefollowing
licensureboardandassociations.

11. NorthCarolinaBoardofLicensedProfessionalCounselors
POBox2105
Raleigh,NC27619-1005
919-661-0820
NationalBoardforCertifiedCounselors
3TerraceWay
Greensboro,NC27403
336-547-0607
AmericanCounselingAssociation
5999StevensonAvenue
Alexandria,VA22304
1-800-347-6647
Pleasesignanddatebothcopiesofthisform.Acopyforyourrecordswillbe
returnedtoyou.Ishallkeepacopyinmyconfidentialrecords.
SignatureofClient/Parent/Guardian Date
SignatureofCounselor Date

12. THERAPEUTIC ENVIRONMENT
AccordingtotheAmericanPsychologicalAssociation'sDictionary
ofPsychology,TherapeuticEnvironmentisanenvironmentof
acceptance,empathicunderstanding,andunconditionalpositive
regardinwhichclientsfeelfreetoverbalizeandconsidertheir
thoughts,behaviors,andemotionsandmakeconstructivechanges
intheirattitudesandreactions.
TheconceptofTherapeuticEnvironmentstemsfromthefieldsof
a)environmentalpsychology(thepsycho-socialeffectsof
environment),
b)psychoneuroimmunology(theeffectsofenvironmentonthe
immunesystem),and
c)neuroscience.
Agoodtherapeuticenvironmenthasaprofoundeffectonfeelings,
behavioursandgeneralhealthofclients.

13. HenceCounsellorshouldknowhowtocreateatherapeutic
environmentthatwillfacilitatepsychologicaladjustmentand
independenceoftheclient.
Inorderforthecounsellingtobeeffective,theprocessthroughwhich
counselingtakesplaceneedstobeeffectiveandfulfillcertain
conditionstocreateapropertherapeuticenvironmentsothatthe
counsellinggoalscanbereached.
Theultimateaimofthecounsellingisthewell-beingoftheclient.
Itisveryimportanttocreateatherapeuticenvironmentinthe
counselingsituationwhichwillhelpcreatetrustandconfidenceinthe
client,andencouragehim/hertoexplorethingsfromdifferent
perspectives.
Therearecertainbasicorcoreconditionswhichareimportantfor
creatingthetherapeuticenvironmentinwhichcounselingwilltake
place.
Inabsenceofthistherapeuticenvironment,counselingwillnotbe
effective.

14. Thesecoreconditionsaretrust,acceptance,genuineness,
unconditionalpositiveregardandempathy.
i)Trust:Thecounseloraimsatcreatingatrustingandsafe
environmentfortheclientsothatthelatterfeelsassuredenoughto
sharehis/herthoughtsandfeelingswiththecounselor.Theclientis
inastateofanxietyanddisturbedfeelings,withalackofconfidence
andtrust.Theforemostrequirementinacounselingrelationshipis
tobuilduptrustintheclientforthecounselorandthecounseling
situation.Thisshouldbeestablishedinthefirstsessionitself.As
clientsperceivethecounselorastrustworthy,theywilltakegreater
emotionalrisksofexpressingtheirinneranxieties,worries,and
fears.
ii)Acceptance:Theclienthascometothecounselingsituation
feelingrejected,devaluedandabandonedofhis/herperceptions,
feelingsandvalues.Counselorconveystotheclientasenseof
acceptanceirrespectiveoftheclient’sviews,behavioursandactions.
Theclientisacceptedashe/sheis,withoutanyjudgementor
criticism.Thisconveysrespectfortheclientasanindividual.Trust
andacceptancearethestartingpointsinanycounselingrelationship.

15. iii)Unconditionalpositiveregard:Thecounselorhaspositive
regardorrespectfortheclientwhichshouldnotbebaseonany
condition.Theclientisacceptedandrespectedforwhathe/sheis.
Therearenoconditionsputontherelationship.Thecounselor
acceptstheclientintotal.Unconditionalpositiveregard
communicatescaring,worthanddignitytotheclient.Itisan
attitudeofvaluingtheclientasauniqueandworthwhileperson.
Beingrespectedforwithoutanyconditionsorjudgementsattached
freestheindividualandopensuppossibilitiesofchangewithinthe
individual.
iv)Genuineness:Itreferstobeinggenuineorrealaboutwhowe
are.Thecounselorcomesacrosstotheclientasbeingapersonwho
isgenuinelyinterestedintheclient’swelfare.He/shedoesnotput
upamask.Thisiscrucialtocreatetrustintherelationship.The
counseloralsoneedstobecongruentwithhis/herfeelings;
expressinghis/herfeelingsandattitudesatthemoment.Thereis
consistencyinthecounselor’swords,actionsandfeelings.Such
transparencyalsoencouragestheclienttogetintouchwithhis/her
ownrealfeelings.

16. v)Empathy:Thecounselorisabletoshowempathytowardsthe
clientbyexperiencingtheclient’sworldashe/sheexperiencesit.It
communicatesarealunderstandingoftheclient’ssituation,thus
fosteringtrustintheclient.
Theabovearethekeyelementsofacounselingrelationship
whichleadstoaneffectivecounselingenvironment.
AccordingtoRogers(1957),unconditionalpositiveregard,
genuineness,congruenceandempathyarethenecessaryand
sufficientconditionsforallgoodinterpersonalrelationsandforall
therapeuticchange.
Thesearealsothebasicskillsforeffectivecounseling.