Psychosocial Health Support DPTT7_101652.pptx

Psychosocial services in a hospital environment. Psychology students

1. PSYCHOSOCIAL HEALTH SUPPORT SERVICES

2. UNIT DESCRIPTION   This unit standard specifies the competencies required to provide psychosocial health support. It involves identifying and assessing patients for psychosocial healthcare, caring for patients with psychosocial health needs, linking same patients to appropriate psychosocial healthcare, following–up on psychosocial healthcare support and documenting psychosocial health support services.  It applies to Health industry.

3. Elements These describe the key outcomes which make up workplace function. Active voice is used to describe elements. Performance Criteria These are assessable statements which specify the required level of performance for each of the elements. Passive voice is used to describe performance criteria. Assess patients for psychosocial healthcare need. Patient for psychosocial healthcare support is identified as per the WHO standards and Psychosocial Healthcare Standards. Rapport is created between the healthcare giver and the patient as per WHO and Psychosocial Healthcare Standards. Patient is assessed for psychosocial healthcare need as per WHO standards and work place policy. Nature and extent of psychosocial healthcare need is analysed in accordance with Psychosocial Healthcare Standards and WHO standards. 2. Care for patients with psychosocial health needs Psychosocial health needs are prioritised as per the assessment report analysis. Specific psychosocial health care is given as per Standards for Psychosocial Healthcare and WHO standards. Requirements for offering psychosocial health care suppor t are identified and gathered as per WHO standards and work place policy. Collaborative care between psychosocial and biomedical care is provided as per work policy, Standards for Psychosocial Healthcare and WHO standards Patient is linked to psychosocial services as per work policy, Standards for Psychosocial Healthcare and WHO standards

4. 3. Follow up on psychosocial healthcare support Patient condition is monitored in accordance with Standards for Psychosocial Healthcare and WHO standards. Routine patient care is provided as per Standards for Psychosocial Healthcare and WHO standards. Patient’s condition is reported to relevant personnel as per work policy, Standards for Psychosocial Healthcare and WHO standards. Faults are reported and rectified as per workplace policy. 4. Document psychosocial healthcare support Patient details are documented in accordance with workplace policy. Patient’s progress reports are prepared and disseminated to relevant authorities as per workplace policy and WHO standards. Waste is disposed in due regard to environment protection regulations.

5. Basic Concept of Psychosocial Support Disasters may result in loss of loved ones or property The emotional effects may manifest immediately or may appear later The more severe the disaster – i.e. greater the perceived threat to life, greater the exposure to destruction, hearing distressing things- the more negative the outcome

6. Survivors and personnel working in such scenarios experience stress It is important to know the signs of burnout and how we can reduce the effects of stress through psychosocial support Psychosocial support refers to the actions that address both the psychological and social needs of individuals

7. Introduction to Psychosocial Psychosocial refers to the close connection between psychological aspects of human experience and the wider social experience.

8. Introduction to Psychosocial Psychosocial support is a scale of care and support which influences both the individual and the social environment in which people live and ranges from care and support offered by caregivers, family members, friends, neighbors, teachers, health workers, and community members on a daily basis but also extends to care and support offered by specialized psychological and social services.

9. Psychosocial support is important in order to maintain a continuum of family and community-based care and support during and after humanitarian crises and to prevent immediate or long term mental health disorders.

10. The term psychosocial is used to emphasize the close connection between psychological aspects of the human experience and the wider social experience. Psychological effects are those that affect different levels of functioning including cognitive (perception and memory as a basis for thoughts and learning), affective (emotions), and behavioral. Social effects concern relationships, family and community networks, cultural traditions and economic status, including life tasks such as school or work

11. Psychosocial is based on the idea that a combination of factors are responsible for the psychosocial wellbeing of people, and that these biological, emotional, spiritual, cultural, social, mental and material aspects of experience cannot necessarily be separated from one another. The term directs attention towards the totality of people’s experience rather than focusing exclusively on the physical or psychological aspects of health and wellbeing, and emphasizes the need to view these issues within the interpersonal contexts of wider family and community networks in which they are located

12. Definition of psychosocial

13. Psychosocial domains

14. family and community as well as individual issues are addressed - there is a deliberate and explicit focus on bringing together psychological factors and social inclusion , and not focusing on material, psychological, spiritual or welfare support.

15. Vulnerable Groups for Psychological Consequences of disasters There are groups which are more vulnerable to the psychological consequences of disasters like: Elderly persons Children and adolescents Women (especially pregnant or lactating) Single-parent families Extremely poor people People with disabilities or health conditions The bereaved Rescue and relief workers

16. Psychosocial Support Needs and Role of CHW In emergencies, people are affected in different ways and require different kinds of supports A key to organizing mental health and psychosocial support is to develop a layered system of complementary supports that meets the needs of different groups. This can be illustrated by a pyramid. All layers of the pyramid are important and should ideally be implemented at the same time

17. Basic Services and Security People’s well-being is protected through meeting their basic needs and rights for security, governance, and essential services such as food, clean water, health care and shelter   A psychosocial response by CHW here might be advocating that these basic services and protections are put in place and are done in a respectful and socially appropriate way

18. Community and Family Supports A smaller number of people disrupt due to broken family and community networks as a result of emergencies   A psychosocial response by CHW here might be to involve in family tracing and reunification or it could involve the encouragement of social support networks

19. Focused Supports A still smaller number of people will require supports directly focused on psychosocial wellbeing This might be individual, family or group interventions, typically carried out by trained and supervised workers A psychosocial response here may include activities to help deal with the effects of gender-based violence e.g. support groups for victims of rape

20. Specialized Services At the top of the pyramid is additional support for the small percentage of the population whose condition, despite the supports mentioned already, is intolerable and who may have great difficulties in basic daily functioning   Assistance here could include psychological or psychiatric supports for people with mental disorders that cannot be adequately managed within primary health services

21. CHW- Qualities for basic Psychosocial Support Active listening Good communication skills Trustworthiness Approachability Patience Kindness Commitment Caring attitude Non-judgmental approach A good knowledge of psychosocial issues

22. Activities for Psychosocial Support Psychological first aid after a crisis (comforting and listening to the affected person) Discussion groups Visiting home Creating social networks Establish peer support groups School-based activities where children can play and regain trust and confidence Vocational training

23. Patient assessment for psychosocial healthcare Screening for: Distress Depression Stress Grief Anxiety Debilitating disease Burn - out

24. Specific psychosocial health care Basic counseling Drug adherence Feeding Advise for medical checkup Accompanying for medical care

25. Collaborative care support team Disaster management team Counseling psychologist Medical team: Nurses, clinician, doctors Biomedical personnel Family members Friends Religious leaders Leaders in village e.g. chief, assistant chief

26. Relevant personnel in psychosocial support services Clinical psychologist Counselor Medical clinician Social worker

27. Routine patient care Communication Social care support Feeding Dressing Washing/tidying up Visiting

28. Patient’s condition/reaction to a disaster Aggression Mourning Stressed Crying Jovial

29. Introduction to Psychology 08-Sep-22 31

30. Definition: Psychology The word ‘psychology’ has its origin in two Greek words ‘psyche’ and ‘logos’. The word ‘psyche’ in Greek language refers to ‘spirit’ or ‘soul’ and the word ‘logos’ refers to ‘discourse’ or ‘study. Psychology: is the study of behavior and mental processes and how they are affected by an organism’s physical state, mental state, and environment. 08-Sep-22 32

31. Definition: Psychology can be defined as the science of behavior and mental processes. A more elaborative definition is: Psychology is the scientific study of behavior and mental processes. Behavior includes all of our outward or overt actions and reactions, such as talking, facial expressions, and movement. The term mental processes refers to all the internal, covert activity of our minds, such as thinking, feeling, and remembering. Psychology is considered a science because it employs the scientific method to the study of human behavior.

32. Classification of psychology: Two areas Basic Psychology -concerned with theory formulation followed by research to support it e.g. developmental, cognitive Applied Psychology -concerned with application of theories from basic knowledge from the way of changing human behavior e.g. clinical, counseling, educational, forensic psychologies . 08-Sep-22 34

33. Types/Fields of Psychology Abnormal Psychology: Tries to describe, assess, predict and control those categories of behaviors which are considered as unusual and non-normative. It also deals with various categories of psychological disorders which affect the mental health of the individual. 2. Cognitive Psychology: It deals with acquisition, storage, transformation and application of information the individual uses to understand and interpret events happening around him/her. 08-Sep-22 35

34. Fields of Psychology… 3. Clinical and Counseling Psychology : Primarily concerned with diagnosis and treatment of various psychological disorders. Employed in hospitals and clinics dealing with mental health problems. 4. Educational Psychology: Mainly concerned with human learning to show how different variables influence learning outcomes. It studies the role of various factors which influence learning processes in classroom setting. 08-Sep-22 36

35. Fields of Psychology… 5. Environmental Psychology: Concerned with the study of interaction between physical environment and human behavior. It studies the impact of noise, heat, humidity, pollution and crowding on human performance. 6. Health Psychology: Focuses on the impact of various psychological factors (e.g. stress) on the onset progress and treatment of illness. Also deals with various life style diseases such as hypertension> how to help individuals stop smoking . 08-Sep-22 37

36. Fields of Psychology… 7. Organizational Psychology: Concerned with application of psychological principles and models to study the selection and performance of employees in the workplace: the concepts of leadership, motivation, job satisfaction and performance appraisal. 8. Developmental Psychology: This field is concerned with the study of various physical and psychological factors which influence the systematic changes which the individual experiences across the different stages of life. 9 . Forensic psychology: deals with application of psychology in the legal system 08-Sep-22 38

37. Personality Personality: the distinctive pattern of behavior, mannerisms, thoughts, and emotions that characterizes an individual over time Someone’s personality is comprised of various traits Traits: habitual ways of behaving, thinking, and feeling (e.g., confident, pessimistic) 08-Sep-22 39

38. Personality : An individual’s unique pattern of thoughts, feelings, and behaviors that persists over time and across situations. A person’s internally based characteristic way of acting and thinking Character : Personal characteristics that have been judged or evaluated by others . Personality: Terms 08-Sep-22 40

39. Cont… 3. Temperament : Hereditary aspects of personality, including sensitivity, moods, irritability, and distractibility. 4. Personality Trait : Stable qualities that a person shows in most situations. 5. Personality Type : People who have several traits in common 08-Sep-22 41

40. 08-Sep-22 42 Some Personality Characteristics Achievement- Doing one's best in objective or difficult tasks and achieving recognition Orderliness- Organizing one's work and habits and planning ahead systematically Exhibition- Behaving so as to attract attention to one's self by appearance, speech, and manner Autonomy- Doing as one chooses independently of others' opinions and avoiding conformity

41. Cont… Dominance- Being a leader who supervises or wields influence over others Endurance- Remaining with a task until it is completed and being able to work without being distracted Affiliation- Participating in friendships, sharing things with friends, and forming attachments to them Sensitiveness- Analyzing motives and putting oneself in other people's shoes in order to understand their behavior 08-Sep-22 43

42. Heterosexuality- Engaging in social activities with the opposite gender and being interested in related matters Aggression- Attacking contrary points of view and expressing disagreement or criticism of others openly 08-Sep-22 44

43. Theories of personality development Sigmund Freud’s Psychoanalytic and Psychosexual theories Eric Erikson’s – Psychosocial theory Cognitive theories 08-Sep-22 45

44. Sigmund Freud , M.D.,a Viennese physician who thought his patients’ problems were more emotional than physical. Sigmund Freud's psychoanalytic theory of personality argued that human behavior was the result of the interaction of three component parts of the mind: the id, ego, and superego. 1. Sigmund Freud’s Psychoanalytic and Psychosexual theories 08-Sep-22 46

45. The Mind: Personality structure Id: Innate biological instincts and urges ; self-serving, selfish & irrational Totally unconscious Works on Pleasure Principle : Wishes to have its desires (pleasurable) satisfied NOW (immediate satisfaction), without waiting and regardless of the consequences The id operates on the pleasure principle . It is regulated by both the ego, which operates on the reality principle , and the superego, which operates on the morality principle . 08-Sep-22 47

46. J udge or censor for thoughts and actions of the ego Establishes rules, restrictions, and prohibitions. Superego comes from our parents or caregivers ; guilt comes from the superego Two parts Conscience : Reflects actions for which a person has been punished (e.g., what we shouldn’t do or be) Ego Ideal : Second part of the superego; reflects behavior one’s parents approved of or rewarded (e.g., what we should do or be) 2. Superego: 08-Sep-22 48

47. 3. Ego: Executive/ mediator ; directs id energies Partially conscious and partially unconscious. Compromises between the id and superego. Works on Reality Principle : Delays action until it is practical and/or appropriate 08-Sep-22 49

48. A structure of psyche that protects the ego against unpleasant effects or impulses. Defense mechanisms are unconscious and deny, falsify or distort reality-Freud. Mainly used during threatening or painful situations-by all Regression: Ego seeks the security of an earlier developmental period in the face of stress. Repression: forcing thoughts into the unconscious and preventing painful or dangerous thoughts from entering consciousness. Defense Mechanisms 08-Sep-22 50

49. Cont… Displacement: Ego shifts unacceptable feelings from one object to another, more acceptable object/safer target. Sublimation: Ego replaces an unacceptable impulse with a socially acceptable one Reaction Formation : Ego transforms an unacceptable motive or feeling into its exact opposite. Projection : Ego attributes personal shortcomings, problems, and faults to others. 08-Sep-22 51

50. Rationalization : Ego justifies an unacceptable motive by giving a false acceptable (but false) reason for behavior Denial: One refuses to accept the existence of harsh reality Identification: unconscious modeling of oneself upon another person’s character e.g a girl behaving like the mother unknowingly. Introjection : integrating the beliefs and values of another individual into one’s own ego structure e.g children-value system of conscious formation. 08-Sep-22 52

51. Oral Stage : Ages 0-1.5yrs. Most of infant’s pleasure comes from stimulation of the mouth. If a child is overfed or frustrated, oral traits will develop. Oral Dependent Personality : Gullible, passive, and need lots of attention. Fixations create oral-aggressive adults who like to argue and exploit others. Anal Stage: Ages 1.5-3yrs. Attention turns to process of elimination. Child can gain approval or express aggression by letting go or holding on. Ego develops. Harsh or lenient toilet training can make a child either: Anal Retentive : Stubborn, stingy, orderly, and compulsively clean Anal Expulsive : Disorderly, messy, destructive, or cruel Freud's Psychosexual Stages of Personality Development 08-Sep-22 53

52. 3. Phallic Stage : Ages 3-6. Child now notices and is physically attracted to opposite sex parent. Can lead to: Oedipus Conflict: For boys only. Boy feels rivalry with his father for his mother’s affection. Boy may feel threatened by father . To resolve, boy must identify with his father (i.e., become more like him and adopt his heterosexual beliefs). Electra Conflict : Girl loves her father and competes with her mother. Girl identifies with her mother more slowly. Children who struggle here develop phallic fixations which affect their relationships with their parents adversely Stages of Personality Development….. 08-Sep-22 54

53. 4. Latency : Ages 6-Puberty. Psychosexual development is dormant. Same sex friendships and play occur here. 5. Genital Stage : Puberty-on. Realization of full adult sexuality occurs here; sexual urges re-awaken. Stages of Personality Development…… 08-Sep-22 55

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55. 2. PSYCHOSOCIAL DEVELOPMENT ERIK ERIKSON- 1902 to 1994 08-Sep-22 57

56. 08-Sep-22 58 Erikson’s work is based on five assumptions: People, in general have the same basic needs Personal development occurs in response to these needs Development proceeds in stages Movement through the stages reflects changes in an individual’s motivation Each stage is characterized by a psychosocial challenge that presents opportunities for development

57. Erik Erikson’s Eight Stages of Human Development 08-Sep-22 59

58. Trust vs Mistrust: Infancy (Birth to approx. 2 Years) The most fundamental stage in life. Infants learn to trust people by the way they are handled. If loved and protected, they develop a sense of trust. If mistreated, then they grow up having no trust for anyone. 08-Sep-22 60

59. Autonomy vs Shame and Doubt: Early Childhood (1.5 - 3 Years) Securely attached children next face the challenge of autonomy, or doing things on their own, discovering skills and abilities ‘Can I do things myself or must I always rely on others?’ 08-Sep-22 61

60. Initiative vs Guilt: Preschool (3 - 5 Years) Initiative is characterized by an exploratory and investigative attitude that results from meeting accepting and accomplishing challenges ‘I’m I good or bad?’ 08-Sep-22 62

61. Industry vs Inferiority: School Age (6 - 12 Years) Industry is the enjoyment of mastery and competence through success and recognition of one’s accomplishment(s) ‘I’m I successful or worthless?’ 08-Sep-22 63

62. Identity vs Confusion: Adolescence 13 – 19 Years In the adolescent years, youths develop a desire for independence from parents, achieve physical maturity and are concerned with the question of “Who am I and where am I going?” 08-Sep-22 64

63. Intimacy vs Isolation: Young Adulthood (20 to 40 Years) A person with a firm sense of identity is prepared for intimacy, or giving the self over to another. Exploring r/ships ‘I’m I loved or wanted?’ 08-Sep-22 65

64. Generativity vs Stagnation : Middle Adulthood (40 – 65 Years) The key characteristics of generativity are creativity, productivity and concern for and commitment to guiding the next generation ‘will I produce something of real value?’ 08-Sep-22 66

65. Ego Integrity vs Despair: Old Age (65 to death) People who accept themselves, conclude that they only have one life to live, live it as well as possible and have few regrets are seen as having integrity ‘ I’m I satisfied with my life?’ 08-Sep-22 67

66. 3. Social-Cognitive Theories Theorists-Piaget & Bandura 08-Sep-22 68

67. Piaget & Learning Cognitive development consists of mental adaptations to new observations & experiences that take place in three forms: Assimilation : using existing knowledge to deal with a new situation. Accommodation : changing existing knowledge to deal with a new situation. Equilibration : seeking to restore balance by mastering the new challenge (accommodation). 08-Sep-22 69

68. Piaget’s Four Stages: Childhood-Cognitive Development Believed that all children develop according to four stages based on how they see the world. He thought the age may vary some, but that we all go through the stages in the same order . 1. Sensorimotor (birth –2 years) 2. Preoperational (~2-7) 3. Concrete operational (~7-11) 4. Formal operations (~12-15) 08-Sep-22 70

69. 1. Sensorimotor Stage Birth to about 2 years, rapid change is seen throughout The child will: Explore the world through senses & motor activity Early on, baby can’t tell difference between themselves & the environment If they can’t see something then it doesn’t exist Begin to understand cause & effect Can later follow something with their eyes 08-Sep-22 71

70. 2. Preoperational Stage About 2 to about 7 Better speech communication Can imagine the future & reflect on the past Develop basic numerical abilities Still pretty egocentric, but learning to be able to delay gratification Can’t understand conservation of matter Has difficulty distinguishing fantasy from reality (ex: cartoon characters are real people). 08-Sep-22 72

71. …more preoperational Conservation of matter – understanding that something doesn’t change even though it looks different, shape is not related to quantity E.g.: Are ten coins set in a long line more than ten coins in a pile? E.g.: Is there less water if it is poured into a bigger container? 08-Sep-22 73

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73. 3. Concrete Operational Stage From about 7 to about 11 yrs During this stage, children begin to thinking logically about concrete events. They begin to understand the concept of conservation. Their thinking becomes more logical and organized, but still very concrete. Children begin using inductive logic, or reasoning from specific information to a general principle. 08-Sep-22 75

74. 4. Formal Operations From about 12 to about 15 yrs At this stage, the adolescent or young adult begins to think abstractly and reason about hypothetical problems. Abstract thought/reasoning emerges.(prediction) Teens begin to think more about moral, philosophical, ethical, social, and political issues that require theoretical and abstract reasoning. Begin to use deductive logic, or reasoning from a general principle to specific information. 08-Sep-22 76

75. Piaget’s Development Development happens from one stage to another through interaction with the environment. Development leads to learning Drive for development is internal The child can only learn certain things when she is at the right developmental stage Environmental factors can influence but not direct development Development will happen naturally through regular interaction with social environment 08-Sep-22 77

76. Motivation theories-Humanistic theories-Abraham Maslow 08-Sep-22 78

77. Maslow’s Theory Abraham Maslow is considered father of the humanistic movement. He observed the lives of (purportedly) healthy and creative people to develop is theory. Hierarchy of needs: the motivational component of Maslow’s theory, in which our innate needs, which motivate our actions, are hierarchically arranged. Self-actualization: the fullest realization of a person’s potential 08-Sep-22 79

78. Hierarchy of Needs 08-Sep-22 80

79. Learning –classical and operant conditioning A relatively permanent change in behavior or the potential for behavior that results from experience Results from many life experiences, not just structured ones May or may not be permanent change May or may not show up in behavior

80. Classical Conditioning: Learning Through the Association of Stimuli Research on digestive processes: Pavlov noticed that his dogs learned to associate a cue (bell) with food Dogs became conditioned to respond to the cue (stimuli) the same way as food – by salivating

81. Ucs : unconditioned stimulus U CR = unconditioned response CS = conditioned stimulus CR = conditioned response

82. Terms and Procedures 1. Unconditioned Stimulus The stimulus that automatically produces a response Unlearned E.g., Food 2. Unconditioned Response Automatic, involuntary response to the unconditioned stimulus E.g., Salivation 08-Sep-22 85

83. Conditioned Stimulus A previously neutral stimulus that, through repeated association with an unconditioned stimulus, becomes capable of eliciting a response E.g., Bell Conditioned Response The response to the Conditioned Stimulus (bell and not food) E.g., Salivating 08-Sep-22 86

84. Variables in classical conditioning Extinction Process by which the conditioned stimulus no longer elicits the unconditioned response Spontaneous Recovery When an extinguished conditioned response reappears 08-Sep-22 87

85. Cont…. Stimulus Generalization When a conditioned response occurs in response to a stimulus similar to the conditioned stimulus Probably explains how some phobias develop Stimulus Discrimination An organism learns to respond only to the specific conditioned stimulus 08-Sep-22 88

86. Operant Conditioning Learning from the consequences of behavior E.L. Thorndike Worked with cat in puzzle box Cats learned to associate behavior (pull switch) with behavior’s consequence (getting out of box)

87. E.L. Thorndike’s Law of Effect “ Law of effect ” -any behavior that is followed by pleasant consequences is likely to be repeated, and any behavior followed by unpleasant consequences is likely to be stopped

88. Positive and Negative Reinforcement Positive reinforcement Behavior leads to something pleasant (food) Negative reinforcement Behavior is rewarded by the removal of something unpleasant (pain) Negative reinforcement is not punishment “Negative” means removing something Remember that reinforcement increases behavior

89. Positive and Negative Punishment Punishment is an unpleasant consequence that leads to a decrease in behavior Positive punishment Addition of something unpleasant that decreases behavior (getting s’thing bad) Negative punishment Removal of something pleasant that decreases behavior (losing s’thing good)

90. B.F. Skinner and the Experimental Study of Operant Conditioning Introduced term operant conditioning Respondent behavior – classically conditioned behavior Operant behavior – behavior that operates on an organism’s environment to produce consequence

91. Acquisition and Extinction Acquisition – conditioning of a response Behavior increases because it is reinforced Extinction – loss of an expected reinforcement Results in decrease in frequency of a behavior Extinction burst- temporary increase in behavior in the absence of the reinforcer Practical applications

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94. Importance of Growth and Development for healthcare perdonneles Knowing what to expect of a particular child at any given age. Gaining better understanding of the reasons behind illnesses. Helping in formulating the plan of care. Helping in parents’ education in order to achieve optimal growth & development at each stage. 08-Sep-22 97

95. Principles of Growth & Development Continuous process Predictable Sequence Don ’ t progress at the same rate (↑ periods of GR in early childhood and adolescents & ↓ periods of GR in middle childhood) Not all body parts grow in the same rate at the same time. Each child grows in his/her own unique way. Each stage of G&D is affected by the preceding types of development. 08-Sep-22 98

96. Principles of Growth & Development G & D proceed in regular related directions - Cephalo-caudal(head down to toes) - Proximodistal (center of the body to the peripheral) - General to specific 08-Sep-22 99

97. Growth Pattern 08-Sep-22 100

98. Stages of Growth and Development Infancy Neonate Birth to 1 month Infancy 1 month to 1 year Early Childhood Toddler 1-3 years Preschool 3-6 years Middle Childhood School age 6 to 12 years Late Childhood Adolescent 13 years to approximately 18 years 08-Sep-22 101

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110. 08-Sep-22 113 Thanks

111. COUNSELLING

112. Definition of Counselling “Face to face communication between two people whereby one person helps another person makes a decision or plan and act on it”. “Counseling is the process of one person helping another person makes an informed, committed decision or solves a problem with an understanding of the facts and emotions involved.”

113. Definition of Counselling Counselling is the skilled and principled use of relationship to facilitate self- knowledge, emotional acceptance and growth and the optimal development of personal resources. Counseling is the application of mental health, psychological or human development principles, through cognitive, affective, behavioral or systemic interventions, strategies that address wellness, personal growth, or career development, as well as pathology. ( http://counseling. org )

114. Definition of Counselling Counseling is a process that maybe developmental or intervening. Counselors focus on their clients’ goals. Thus, counseling involves both choice and change. In some cases, “counseling is a rehearsal for action” ( Casey, 1996, p. 176 )

115. Types of counselling supportive counseling, educational counseling, Guidance counseling, career counseling, crisis counseling, grief counseling, post-traumatic counseling, Management counseling, family counseling, marriage counseling, counseling in medical settings, rehabilitative and mental health counseling

116. Benefits of counselling Counselling helps one to: feel better about self  feel more at peace, more comfortable, or more secure in the world  feel more successfully (and more joyfully) connected with others (including your spouse/partner)  reduce stress  work through problems with a skilled, and compassionate professional  identify own goals  learn new behaviors and/or responses which can help you to achieve your goals

117. Benefits of counselling  establish ways and techniques for reaching your goals  understand your own thoughts, feelings, and responses better  understand your loved ones better  have a safe and friendly ear; someone to use as a sounding board  speak with a skilled and interested professional about your fears and perceptions  talk with a compassionate professional about troubling or private concerns  work towards greater self-fulfillment and self-mastery

118. Benefits of counselling One won't have to worry about upsetting them They aren't going to judge you They will make sure that you are safe by setting appropriate boundaries such as confidentiality, setting clear goals, sharing their decisions about the direction of the counselling They will not say what they think you want to hear You can make fundamental and far-reaching changes to your life

119. Purpose of counselling The overall aim is to provide an opportunity to work towards living more satisfyingly and resourcefully. The purpose of counselling is to offer time, respect and attention to help a person find ways of living more resourcefully or finding ways of coping with problems being experienced.

120. Purpose of counselling Counselling is a  process that enables a person to sort out issues and reach decisions affecting their life. Often counselling is sought out at times of change or crisis, it need not be so, however, as counselling can also help us at any time of our life. Counselling involves talking with a person in a way that helps that person solve a problem or helps to create conditions that will cause the person to understand and/or improve his behaviour , character, values or life circumstances.

121. Principles of counselling •It is strongly dedicated to self-direction and self-realization of the client or the student. •Client’s need is to be put first. •It is preliminary a preventive and remedial process. •Avoid dictatorial attitude. •Maintain relationship of trust and confidence with the client.

122. Principles of counselling Let the client make voluntary informed decision. •The client’s family members and significant influencing personnel must be included in counselling process. •Maintain dignity of individual as individual is primary concern in counselling .

123. Characteristics of counselling According to, E.W. Failer    •It concentrates on the normal individual. •It considers breadth rather than depth. •It involves a wide range of techniques. •It must be a cooperative affair and the counsellor  must act as a point of contact. •It should not be solely based upon psychology

124. Difference between interpersonal communication and counseling Interpersonal communication : verbal and nonverbal face to face information, opinion and perceptions exchange a mange individuals and groups. Counseling : counseling is applies to the art of guiding an individual through educational activities. Given the situation this will lead to voluntary choice by individuals.

125. Difference between interpersonal communication and counseling: Interpersonal communication Counseling Face to face interactions Face to face interactions Could be verbal or non-verbal Could be verbal or non-verbal Use two way communication Use two way communication Provider with and individual or group of clients Usually between a provider and a client May inform, educate and motivate client Help the client to make an informed decision

126. Steps of effective counselling GREET the clients (establishing rapport) ASK clients (gathering information) Asking is more than medical history because other aspects of a person’s life (life stage, lifestyle, personality, etc.) often impact the client’s post-counseling behavior more than his or her medical history. TELL (provide information) Specific information, organized logically is retained longer and more fully, especially if the client is encouraged to ask questions. Avoid information overload such as reciting details on all the procedures you are discussing because there is a limit to how much information people can retain. Instead, group the information and then check for understanding.

127. Steps of effective counselling HELP the client :This is the decision-making or problem-solving moment. The provider is helping the client sort through the medical information and lifestyle and life stage issues to come up with various alternatives and helping the client consider each alternative for its advantages and disadvantages. The client makes the decision. EXPLAIN to the client : Once the client has made a choice; e.g. to use a birth spacing method, the provider uses client education material to help the client remember key information specific to that decision. RETURN/REFER : Return visits or referrals should be planned. Clients need advice concerning when to return for follow-up or re-supply. Or refer the client to higher center for more services which are not available at your health facility.

128. Counselling process Counselling is often performed face-to-face in confidential sessions between the counsellor and client(s). However, counselling can also be undertaken by telephone, in writing and, in these days of the Internet, by email or video conferencing. Counselling can and may take many different formats to bring a person to a better understanding of them self and others. It can therefore be seen that counselling can be of benefit to a person experiencing problems in finding, forming, and maintaining relationships.

129. Counselling process Counselling may take time to work, depending upon the nature and number of problems being presented by the client. Sometimes, a single or a few sessions are all that is needed. At other times, longer periods, possibly months or up to a couple of years may be needed. The counsellor is there throughout to assist the client in their development.

130. Counseling Counseling 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.

131. Role of a counselor The counselor’s role is to facilitate the clients work in ways that respect the client’s values, personal resources and capacity for self-determination. An effective counselor is aware of the imbalance of power in the relationship and maintains a sense of professionalism.

132. Effective counselor Communication - Effective counselors have the ability to encourage a client to open up and talk about their problems. They also have listening skills, an important part of communication. An ineffective counselor is one who takes over the conversation and makes it about him. Appearance - Simple, professional dress is a sign of an effective counselor.

133. Effective counselor Work Ethic - An effective, a counselor should arrive on time and work through each session without appearing to be in a rush. Asking a client whether they mind ending early is not acceptable for an effective counselor because the client may not feel comfortable saying no. An effective counselor also stays aware of her clients with good notes so that she doesn't have to spend counseling time being reminded of things she forgot.

134. Effective counselor Professionalism - Counseling is a profession. To be effective, a counselor must maintain an air of professionalism. This means following ethics rules regarding privacy, including not interacting with a client outside of the office. A counselor shouldn't eat or drink in the office unless the client is offered the same, such as water or coffee.

135. Qualities of a good Counselor Should show evidence of the following attributes (or the potential to develop them): • Self awareness, maturity and stability • Ability to make use of and reflect upon life experience • Capacity to cope with emotional demands of the work • Ability to cope with the intellectual and academic requirements of the course • Ability to form a helping relationship • Ability to be self-critical and use both positive and negative feedback • Some awareness of the nature of prejudice and oppression of minority groups

136. Qualities of a good counsellor Honest: Always tells the truth to the client and provides them with care and information desired. Understanding/empathic: Being able to put yourself in the place of the client; being able to feel what the client feels and to demonstrate to the client that you understand, and accept their feelings without bias or judgment. Non-judgmental: The counsellor should treat the clients with respect and kindness, and give information in an unbiased manner. Flexible: Counsellor should be able to recognize when he/she cannot sufficiently help a client to refer to someone who can.

137. Qualities of a good counsellor Sensitive to clients’ needs and concerns: The Counsellor should help clients to deal with rumours , misconceptions, needs and concerns by discussing fully their fears and anxieties and by providing facts in a sensitive, caring manner. Genuine: The Counsellor must be a real person and not a role model and not a role player. He/ She uses the past experience and skills to facilitate the client/provider interaction. Active Listener: Active listening facilitates communication and this will allow the client to express herself freely and adequately. Counsellor may nod and look at the client. Accepting and respectful: A respectful Counsellor treats the client in a way that the provider would like to be treated if he/she were the client.

138. Self awareness Ask yourself: • What are my most important personal values? • What are my life goals? What do I really want out of life, and why? Does my everyday behavior move me toward my life goals? • What are my career goals? If I want to be a counselor or psychotherapist, how will I achieve this goal? Why do I want to be a counselor or psychotherapist? • How would I describe myself in only a few words? How would I describe myself to a stranger? What do I particularly like and what do I especially dislike about myself ?

139. RESPONSIBILITIES OF A COUNSELOR • Treating clients with respect • Understanding personal limitations • Overcoming discomfort about sexuality • Maintaining Confidentiality • Keeping accurate records • Networking • Educating ones self.

140. NB As a health worker when dealing with patients, it is important to: • Remember that clients have inner strengths which you should build on • Identify what they have done already to overcome their problems or difficulty • Remember how they have overcome difficult situations in the past, what has worked, what did not work, and why it did/did not work • Identify a personal goal and work out a plan on how to achieve it

141. Counselling skills Essential counseling skills include Active Listening, Questioning, Paralinguistic, Reflection, Summarizing and Paraphrasing. These should be supported by appropriate body language such as eye contact and gestures to indicate attentiveness and interest.

142. CASE STUDIES FOR GROUP DISCUSSION

143. Case study 1 An adolescent who is 16 years old, arrives at the service delivery point seeking information about abortion services. She is 6 weeks pregnant, very depressed and desperate about her situation. She does not have a boyfriend. She had sexual intercourse with a guy she met during a party and got pregnant. • Explain the counselling steps you would follow to deal with the situation presented above. • List the skills and attitudes that should be applied to deal with the situation.

144. Case study 2 A female commercial sex worker (CSW), who is 28 years old, arrives at the service delivery point extremely nervous. She tells you that she has had some fever for the last 4 days accompanied by diarrhea and vomiting. She has been a CSW for the last 10 years and does not use condoms with every client as some clients will not accept them. • Explain the counselling steps you would follow to deal with the situation presented above. • List the skills and attitudes that should be applied to deal with the situation.

145. Case study 3 A homosexual couple arrives at the service delivery point to get some medicine. One of the partners is HIV positive and is under treatment. The other partner is a married man who lives with his wife and two children. The partner who is HIV positive is very depressed and extremely weak. • Explain the counselling steps you would follow to deal with the situation presented above. • List the skills and attitudes that should be applied to deal with the situation.

146. Case study 4 A woman who is 35 years old and is married with 3 children arrives at the clinic. She relies on her husband’s income from factory work to support the family. During the interview she said that she has sex only with her husband. She responded to your questions by saying that her husband often works late at the factory and that he goes drinking with friends occasionally. She can sometimes smell alcohol on his breath. She came to the service delivery point with no idea of the cause of her abdominal pain. You have already diagnosed Pelvic Inflammatory Disease. • Explain the counselling steps you would follow to deal with the situation presented above. • List the skills and attitudes that should be applied to deal with the situation.

147. Scenario A 30 year old woman calls for information about her pap test result. The result has shown mild dysplasia and the presence of the wart virus. She doesn’t understand what this means and how she could have caught this virus. She is also wondering what will happen next as the doctor is talking about another test (she can’t pronounce the name). • What issues might you talk about? • What resources could you tell her about? • What information could you offer to send?

148. GROUP COUNSELLING

149. GROUP COUNSELLING •It encourages team spirit and create a climate of harmony, corporation and understanding. •It applies in homogenous group(6-8 or below 20 members e.g. adolescents

150. Types of Groups Task Groups : A group that comes together to perform a task that has a concrete goal (e.g. community organizations, planning groups, task force). Guidance/ Psychoeducational Group : Preventative and educational groups that help group members learn information about a particular topic or issue and might also help group members cope with that same issue (e.g. support group for a suicide, transition group to prepare students to enter high school etc.)

151. Types of Groups Counseling/Interpersonal Problem-Solving Groups : These groups help participants resolve problems of living through interpersonal support and problem solving. Psychotherapy Groups : These groups focus on personality reconstruction or remediation of deep-seated psychological problems. Support Groups : These deal with special populations and deal with specific issues and offer support, comfort, and connectedness to others. Self-help Groups : These have no formal or trained group leader. (e.g. Alcoholics Anonymous)

152. Advantages of Groups It provides a social atmosphere that is similar to the real world. Members can test out and practice new behaviors. Members can practice new interpersonal skills. They are cost effective. Groups help members see that they are not the only one who has that particular problem or issue. Groups provide members with support.

153. Disadvantages of Groups Less individualized attention from the counselor. Confidentiality is more difficult to maintain. There are concerns with conformity and peer pressure. Not everyone can be in a group (e.g. those with issues too severe or those with poor interpersonal skills.) Scapegoating may occur. Group leaders are not always properly trained.

154. Stages of Group counselling Stage One (Orientation/Forming): Group members become oriented to the group and to each other. Stage Two (Transition/Storming): Anxiety and ambiguity become prevalent as group members struggle to define themselves and group norms. This stage is often characterized by conflict. Stage Three (Cohesiveness/ Norming ): A therapeutic alliance forms between group members. Trust between members has been established. Stage Four (Working/Performing): Group members experiment with new ideas, behaviors or ways of thinking. Egalitarianism develops. Stage Five (Adjourning/Terminating): This is the time when the group disbands.

155. Peer Counseling

156. Peer counseling Peer counseling refers to the provision of such support and assistance by trained peers. It differs from professional counseling in that it is very brief, less formal and not provided by professional counselors. Peer Counseling is the encouraging concerted effort to harness the capacity which group members sharing common interests may console, appease, befriend, mediate and reconcile those who are alienated from one another informally without resorting to discipline or depending on professionals or those in authority within organization or institution.

157. Peer Counseling In this context, persons are said to be peers when they share a common identity or experience. The commonality may be age, gender, career, education, social orientation or any other self-defined common experience. Peer counseling helps to create a climate in which the client feels accepted, non-defensive and able to talk freely.

158. Peer Counselling Keat (1976) used helping to label the training outcome designed or Peer Counselling . H - Is for help E - Is for empathy L - Is for learning P - Is for peers, people and problems I - Is for interests or self-image N - Is for needs G - Is for giving guidance

159. HIV/ AIDS COUNSELLING

160. HIV/AIDS counselling Patients with AIDS are not only dealing with life threatening diseases, but also the social stigmas that often accompany their conditions. The key is not to treat them as different from others. Due to the advent of highly effective antiretroviral therapy, health professionals should adjust their thinking to perceive HIV infections as a chronic condition rather than a terminal disease.

161. What is HIV/AIDS Counseling? HIV/AIDS counselling is a confidential dialogue between a person and a care provider aimed at enabling the client to cope with the stress and to take personal decisions relating to HIV/AIDS. During a counselling session, person-to-person communication is used to motivate, educate and counsel clients in every area of health, from Family Planning to HIV/AIDS prevention and management.

162. Key elements i . Confidential dialogue ii. Provision of accurate information to enable client to : • Explore his/her situation and feelings • Reach a better understanding of the problems • Make choices and take action, e.g. — Reduce risk of becoming infected or transmitting the infection to others — Adopt new approaches to safer sex and responsible relationship — Help those already infected to cope

163. Objective In HIV/AIDS counselling , the counsellor’s objective is to give the power of informed choice to a client, who is then free to choose behaviours that will reduce her/his risk of becoming infected or to manage the illness if she/he already has AIDS. HIV/AIDS counselling may use the same skills as other types of primary healthcare counselling but it requires much more awareness of personal values and preferences, the inviolable nature of client confidence and trust, and the difference between professional guidance and personal persuasion

164. HIV counselling Counselling sessions need to be well planned so that, for instance, informed consent is always sought and counselling offered before a client takes an HIV test. Counselling should be integrated into other services, including STD, antenatal and family planning clinics.

165. Attitudes of Persons living with HIV/AIDS Fear – Persons infected with HIV may have fear of dying, fear of isolation from the rest of society and fear of the unknown due to uncertainty of disease progression. Guilt - Guilt is the awareness of having done wrong and the accompanying shame and regret. Anger - which may be directed at themselves for being infected with HIV, at others who infected them or at God for allowing it to happen. Loneliness may develop due to the fear of disclosure and the feeling that others may not understand their predicament. Depression – this may be accompanied by feelings of hopelessness that may trigger thoughts of suicide. Denial especially early in the disease when the PLWHA finds it difficult to believe they have the infection

166. Types of HIV/AIDS counselling Two types of counselling , according to site, are practised . Clinic-based counselling is counselling provided in a formal session— in a hospital, health centre or clinic—by a trained professional, such as a doctor, social worker, nurse or psychologist. Community-based counselling is given in a non-formal environment, in a village or urban neighbourhood —by one community member trained in counselling to another community or family member.

167. Pre- test Counselling Such counselling helps to prepare the client for the HIV test, explains the implications of knowing that one is or is not infected with HIV, and facilitates discussion about ways to cope with knowing one’s HIV status. It also involves a discussion of sexuality, relationships, possible sex- and drug-related risk behaviours , and how to prevent infection. It helps correct myths and misinformation around the subject of AIDS

168. Pre- test Counselling Review why they have come for the test in a relaxing manner Review their knowledge of ( i ) condom use, (ii) sexually transmitted diseases, (iii) HIV/AIDS. Fill in the gaps in their knowledge Review and impress on them the consequences of risky behavior Assess the degree of risk for the client Slowly go over the nature of the test and the consequences of both a positive and negative result.

169. Pre- test Counselling In case of a positive result review the difference between HIV and AIDS. Stress the fact that the patient can still live a productive life for even as long as ten or more years and the prospects for therapy and cure are improving daily. Discuss their support system (family and friends) In case of a negative result, discuss the window period for antibody based tests and the need for retesting depending on risk assessment. Impress on them that a negative result does not imply immunity from infection, and the need for a change in behavior. Obtain informed consent prior to the test. Schedule the next meeting a week after the test date

170. PRE - COUNSELLING B – Benefits of the method R – Risks of the method A – Alternatives of the method I – Inquiries about the method D – Decision to withdraw using the method E – Explanation of the method D – Documentation that the provider has covered each of the six previous units.

171. Post-test counselling Post-test counselling helps the client understand and cope with the HIV test result. Here, the counsellor prepares the client for the result, gives the result and then provides the client with any further information required, if necessary referring the person to other services. The two usually discuss ways to reduce the risk of infection or transmission. HIV test results should always be given with counselling .

172. Post-test counselling The form of post-test counselling will depend on what the test result is. Where it is positive, the counsellor needs to tell the client clearly, and as gently and humanly as possible, providing emotional support and discussing with the client on how best to cope, including information on relevant referral services.

173. Post-test counselling Counselling is also important after a negative result. While the client is likely to feel relief, the counsellor must emphasize several points. First, because of the “window period”, a negative result may not mean absence of infection, and the client might wish to consider returning for a repeat test after 3-6 months. Second, counsellors need to discuss HIV prevention, providing support to help the client adopt and sustain any new safer practices.

174. Summary

175. Phases of counselling Phase 1: Establishing relationship Phase 2: Assessment Phase 3: Setting goals Phase 4: Interventions Phase 5: Termination and follow-up

176. Qualities of a good counselor G  – Good Technical Knowledge O – Obtains Appropriate Information From Client  O – Objectively Answers Questions D – Demonstrates Professionalism C – Confidentiality Maintained O – Observant (Non – Verbal) U – Unbiased N – Non-judgment  S – Sensitive to the needs of the clients E – Empathetic L – Listens effectively  L – Lets the client make decision O – Open minded  R – Respects the rights of the clients

177. “Don’ts” in the counseling relationship 1. Don’t tell the client what happened to him/her, let them tell you. 2. Don’t ask “why”, “value-laden” or “leading” questions. 3. Don’t use “ shoulds ” and “ oughts ”. 4. Don’t blame, criticize or embarrass clients. 5. Don’t automatically compare the client’s experience with your own. 6. Don’t become overly analytical. 7. Don’t trivialize or invalidate the client’s feelings or concerns.

178. “Don’ts” in the counseling relationship 8. Don’t offer the client explanations for their thinking, feelings or behaviors, allow them to do that themselves. 9. Don’t reduce counseling to giving advice. 10. Don’t become impatient and/or appear rushed. 11. Don’t become over-involved to the point that you feel overwhelmed. 12. Don’t continue in a counseling relationship if you feel threatened by it or inappropriately attached to the client. 13. Don’t breach the client’s confidence. 14. Don’t misrepresent your capabilities to the client.

179. LIMITATIONS OF COUNSELLING •Counselee does not gain any liability of self analysis. •The counselee is over dependent on the counsellor . •Directive counselling does not guarantee that the counselee will not make mistakes in future.

180. THEORIES OF COUNSELING Psychotherapy theories provide a framework for therapists and counselors to interpret a client’s behavior, thoughts, and feelings and help them navigate a client’s journey from diagnosis to post-treatment. Theoretical approaches are an understandably integral part of the therapeutic process.

181. PSYCHOANALYSIS/ PSYCHODYNAMIC THEORY Psychoanalysis or psychodynamic theory, also known as the “historical perspective,” has its roots with Sigmund Freud, who believed there were unconscious forces that drive behavior. The techniques he developed, such as: Free association (freely talking to the therapist about whatever comes up without censoring) Dream analysis (examining dreams for important information about the unconscious), Transference (redirecting feelings about certain people in one’s life onto the therapist) are still used by psychoanalysts today.

182. BEHAVIORAL THEORY Behavioral theory is based on the belief that behavior is learned. Classic conditioning is one type of behavioral therapy that stems from early theorist Ivan Pavlov’s research. Pavlov executed a famous study using dogs, which focused on the effects of a learned response (e.g., a dog salivating when hearing a bell) through a stimulus (e.g., pairing the sound of a bell with food). B. F. Skinner developed another behavioral therapy approach, called operant conditioning. He believed in the power of rewards to increase the likelihood of a behavior and punishments to decrease the occurrence of a behavior. Behavioral therapists work on changing unwanted and destructive behaviors through behavior modification techniques such as positive or negative reinforcement.

183. COGNITIVE THEORY In the 1960s, psychotherapist Aaron Beck developed cognitive theory. This counseling theory focuses on how people’s thinking can change feelings and behaviors. Unlike psychodynamic theory, therapy based on cognitive theory is brief in nature and oriented toward problem solving. Cognitive therapists focus more on their client’s present situation and distorted thinking than on their past. Cognitive and behavioral therapy are often combined as one form of theory practiced by counselors and therapists.

184. HUMANISTIC APPROACH Humanistic therapists care most about the present and helping their clients achieve their highest potential. Instead of energy spent on the past or on negative behaviors, humanists believe in the goodness of all people and emphasize a person’s self-growth and self-actualization. Humanistic theories include client-centered, gestalt, and existential therapies. Carl Rogers developed client-centered therapy, which focuses on the belief that clients control their own destinies. He believed that all therapists need to do is show their genuine care and interest. Gestalt therapists’ work focuses more on what’s going on in the moment versus what is being said in therapy. Existential therapists help clients find meaning in their lives by focusing on free will, self-determination, and responsibility.

185. HOLISTIC/INTEGRATIVE THERAPY Holistic and integrative therapy involves integrating various elements of different theories to the practice. In addition to traditional talk therapy, holistic therapy may include nontraditional therapies such as hypnotherapy or guided imagery. The key is to use the techniques and psychotherapy tools best suited for a particular client and problem. There are various therapies that counselors can choose to study, but the type of theory matters less than the success of the relationship between client and therapist.

186. PRINCIPLES OF COUNSELING Listening skills Listen attentively to the client in an attempt to understand both the content of their problem, as they see it, and the emotions they are experiencing related to the problem. Do not make interpretations of the client's problems or offer any premature suggestions as to how to deal with, or solve the issues presented. Listen and try to understand the concerns being presented. Most people want and need to be heard and understood, not advised.

187. PRINCIPLES OF COUNSELING Resistance Changing human behavior is not usually a linear, direct, and logical process. It is very emotional and many habits of behavior and thought that are dysfunctional are difficult to break. People invest a sense of security in familiar behavior, even some behavior that causes them pain. Changing this is often a difficult and tangential process. Many threads of behavior are tied to others and when one thing is changed a new balance must be established, otherwise people couldn't function. This means people change at different rates depending on how well they can tolerate the imbalance that comes from change. So, when people resist certain changes that one hopes will occur in therapy it is important that the therapist not take this personally and recognize the stressful nature of the process for the client. Some resistance to therapeutic change is quite natural.

188. PRINCIPLES OF COUNSELING Respect No matter how peculiar, strange, disturbed, weird, or utterly different from you that the client is, they must be treated with respect! Without this basic element successful therapy is impossible. You do not have to like the client, or their values, or their behavior, but you must put your personal feelings aside and treat them with respect.

189. PRINCIPLES OF COUNSELING Empathy and Positive Regard Based in the writings of Carl Rogers, these two principles go along with respect and effective listening skills. Empathy requires you to listen and understand the feelings and perspective of the other person (in this case your client) and positive regard is an aspect of respect. While Rogers calls this "unconditional positive regard" it may be a bit too much to ask that it be "unconditional." Treating the client with respect should be sufficient.

190. PRINCIPLES OF COUNSELING Clarification, confrontation, interpretation These are techniques of therapeutic intervention that are more advanced, although clarification is useful even at a basic level. Clarification is an attempt by the therapist to restate what the client is either saying or feeling, so the client may learn something or understand the issue better. Confrontation and interpretation are more advanced principles and we won't go into them except to mention their existence.

191. PRINCIPLES OF COUNSELING Transference and Counter transference This is a process wherein the client feels things and has perceptions of the therapist that rightly belong to other people in the client's life, either past or present. It is a process somewhat related to projection. Understanding transference reactions can help the client gain understanding of important aspects of their emotional life. Counter transference refers to the emotional and perceptional reactions the therapist has towards the client that rightly belong to other significant people in the therapists life. It is important for the therapist to understand and manage their counter transference .

192. BASIC COUNSELING SKILLS & PROFESSIONAL ETHICS

193. DEFINITION OF TERMS COUNSELING: A helping process in which clients learn how to use their personal resources to make decisions/choices, and formulate new ways of behaving, feeling and thinking. It is a special kind of relationship aimed at helping clients respond to the challenges of their lives. It uses specific skills and techniques to help people become more competent, contended and creative .

194. Definitions contd … SKILL: Ability to do something with proficiency, competence and expertness. BEHAVIOUR: A generic term covering acts, activities, responses, reactions, movements, process, operations (overt)

195. GOALS OF COUNSELING To help a person become fully alive and fully functional To help clients better understand themselves and other people and situations/circumstances Help clients find possible ways of making good choices Help clients in making plans to achieve their life goals Facilitate behavior change Enhance coping skills

196. APPROACHES TO UNDERSTANDING DRUG ABUSE BEHAVIOUR Social, cultural variables: Mass media, interests, family variables Biological variables: Genetic transmission, alteration in some biological process serves as a predisposition for problem drinking Psychological approaches: Psychoanalytic perspective in ADA behaviour ADA behaviour is deterministic ADA behaviour is determined by sexual or aggressive drive ADA is determined by unconscious motives and drives ADA is caused by the conflict in the structure of personality ADA is a manifest of defense mechanisms

197. Approaches contd … ii. Behaviour perspective in ADA behaviour ADA behaviour is learned ADA behaviour is a product of an environment- assertiveness should be taught ADA is not the symptom of behaviour problem, but the behaviour problem iii. Humanistic Perspective in ADA behaviour ADA behaviour is a result of conflict between the real self and ideal self ADA behaviour is a result of in ability to be REAL self and hence resists societal values ADA behaviour arises when one relies on others and evaluating self from external locus of evaluation rather than internal

198. Approaches contd … iv. Cognitive perspective in ADA behaviour ADA behaviour is a result of irrational thinking ADA behaviour is as a result of self blame, absolustic language SHOULD, MUST. In ADA behaviour , attitudes, opinion, belief play a great ADA is as a result of development of negative triad i.e. negative view about the world, self and future hence magnification, overgeneralization, selective abstraction and minimization

199. Approaches contd … iv. The Gestalt approach in ADA behaviour ADA behaviour emenates from the unfinished business which are expressed feelings/emotions which linger in the background i.e. rage, anger, grief, guilt etc. ADA behaviour is a result of unmet needs ADA behaviour is as a result of one pre- occupation with the future- focus on the HERE $ NOW, not past or future.

200. THE COUNSELING PROCESS By Gerard Egan. Comprises three stages; Exploration Understanding Action The above are preceded by a stage for attending, where counselor demonstrates to client that he/she is willing to become involved with client. Aimed at welcoming and settling/relaxing client to make them be at ease.

201. Counseling process contd… Exploration stage: Aimed at gaining a full and accurate understanding of client’s issue. Client given much freedom to present their case without much interruption. Skills used here are questioning, reflecting of client’s statements, summarizing and active listening.

202. Questions to ask yourself at exploration stage What concerns has the client focused on? What important areas have been omitted? What are some of the implications of these concerns on the client? Who else is involved? When do these problems typically arise? What has the client tried to do about them? What support does this client have?

203. Counseling process contd … Understanding stage: Counselor seeks to gain a deeper understanding of client’s issue. Counselor sees world from client’s viewpoint Counselor aids client to gain a better and deeper understanding of their issues. i.e. client aided to gain insight, especially how they have contributed to the situation Client assisted to set goals Skills used are empathy, questioning. Challenging skills used here to pick discrepancies.

204. Counseling process contd … Action stage (Treatment stage): Client regarded as decision maker with counselor acting an empowerment agent and facilitator to action. Support and inspiration provided here Termination then follows.

205. BASIC COUNSELING SKILLS Acquisition of appropriate counseling skills is key for effective peer education. Structuring; Both physical and psychological. If special room used, should be well organized with similar seats, no barriers S-O-L-E-R should be used Room should be plain without distractions Peer educator mind should be focused on client issues only

206. Basic counseling skills contd … Contracting; Involves giving of vital information to client Role of client and peer educator Confidentiality Punctuality and commitment Termination Active listening; Very key since enables peer educator to get implication/underlying meaning Peer educator able to respond appropriately

207. Basic counseling skills contd… Observation skills; Helps peer educator to get non-verbal communications from client in order to infer meaning. Responding skills; Skills used by peer educator to explore the client’s issue. Encouragers/minimal prompts Restatement -(use of content in same way) Reflection of content Reflection of feelings Paraphrasing (use of content in own words)

208. Responding skills contd… Focusing (to avoid digression) Concreteness -(makes client be specific and stop blaming others) Questioning ( open ended) - helps in probing and understanding. Closed ended questions are interrogative and puts client on defense. Summarizing - (for clarification, focusing on most pressing issue and shows client you are still with them). Used throughout session. Silence- Can indicate information processing or resistance. Peer educator should be comfortable with it.

209. Responding skills contd… Advanced level empathy; Enables peer educator to pick underlying messages in client’s statement e.g. I feel like a doormat Challenging skills; Immediacy- Handling of anything that will interfere with counseling e.g. ‘you are too young to understand’ Confrontation- Confrontation of irrational thinking/belief, also used to clarify in congruencies in verbals and non verbals Self disclosure- Used only when used for good of client. Aimed at showing that peer educator also human

210. MOTIVATIONAL TECHNIQUES Empathy; Ability to accurately understand what another person is experiencing and communicate that understanding A respectful listening to client with a desire to understand client’s attitude. Unconditional positive regard (UPR). Entails accepting client without being critical, judgmental or blaming Client accorded respect and warmth despite their state or condition Genuineness; Refers to honesty, congruence and authenticity Is the willingness to be real and open/transparent with client-no facade

211. Motivational techniques contd.. Support self efficacy; Self efficacy refers to person’s belief in their capacity to perform certain tasks successfully. Aimed at helping client discover their potentialities and take the lead in their treatment. Helper increases person’s perception about their capability and competence to cope with obstacles and succeed. Assertive training; Very important for those that allow others to run their lives, and cannot say NO, yet hurting themselves Aimed at empowering individuals to voice their feelings and thoughts.

212. PROFESSIONAL ETHICS

213. IMPORTANCE Ethics are important for a number of reasons: 1) The client gets better treatment, and the assurance of their privacy and safety. 2) Other counselors can trust that their fellow counselors are held to such high standards. 3) The standards add a level of professionalism that is shown to those outside the field, which is always a challenge .

214. Elements of ethics Non-Discrimination Client Welfare Client Relationship Trustworthiness Compliance with Law Rights and Duties Dual Relationships Preventing Harm Duty of Care Confidentiality Misrepresentation

215. END THANK YOU