Counselling: Basics

1. By Dr.Soumitra Das ,JR2/Psychiatry
Chairperson: Prof.Varghese P Punnoose
HOD of Psychiatry
Govt.T.D.Medical College,Alappuzha,Kerala.

2. Introduction
 Traditionally family, friends, community members,
doctors, or priests
 Past few decades have led to increased social mobility
and reduced social cohesion
 Emerged since the Second World War in economically
advanced countries
 Major component of work.
 Continued growth > Indiscriminate practice > lack of
specificity and clarity > Misuse
 Important in Psychiatric treatment in different aspects

3. Definition
 Neither the British Association of Counselling nor the
American Counseling Association have either
proprietary rights of the terms or even official
definitions.
 Counselling is conceptualized as a way of helping or
assisting others to make their own adjustment and
decisions in the face of life problems.

4. Few other definitions
 The Oxford Modern English Dictionary offers the
following definitions:
 counsel: Advice, plan of action
 counselling:
1. The act or process of giving counsel
2. The process of assisting and guiding clients,
especially by a trained person on a professional basis, to
resolve especially personal, social, or psychological
problems and difficulties

5.  Burnard : The means by which one person helps
another to clarify his or her life situation and to decide
further lines of action.
 Nelson-Jones : A special kind of helping relationship
embodying counsellor qualities known as the ‘core
conditions', counselling as a set of activities
representing different theoretical viewpoints, and
counselling as special area for providing services.
 Counselling skills : The learned interpersonal
techniques of helping which are fundamental to good
clinical practice.

6.  Counselling psychology : Broad-based specialty of
applied psychology, aiming to foster the psychological
development of the individual and help people
develop more effective and fulfilled lives (UK).

7. Points to be very clear
 Not giving just advices and encouragements
 Different from Psychotherapy
 Not a treatment for psychiatric disorders may be
helpful along with definite treatment
 Its mostly applied to real life events
 Can be practiced by lay persons, but medical
professionals are best suited.

8. objectives Correction of
situational problem
rectification of
deviant behavior
Alteration of
interpersonal and
social adjustment
personality
growth
Interview
focus
Symptoms situational
problems conflicts
attitudes
Under lying roots
of complaints and
conflicts defenses
Psychic
arena
Conscious process Conscious pre&
unconscious
Temporal
focus
Immediate present Present and
historical past
Difference: Counselling Psychotherapy

9. Common Problems
 Loss – by bereavement, by separation, of self-esteem,
of health-organ, of job loss
 Change – role, demands, maturational crisis
 Interpersonal – communication
 Past
 Environmental

10. Coping
 Nature of the problem
 Personality
 Past experience

11. Good Coping
 Defensive behaviors,
 Information-seeking behaviors,
 Affiliative behaviors,
 All-round problem-solving behaviors

13. Maladaptive Strategies
 Denial
 Avoidance
 Giving up- admitting failure
 Blaming
 Fantasy
 Smoking, Alcohol use
 Self- Injury, DSH (suicide)

15. Common Features
 Four features that are common to all forms of
counselling:
Gelder et al.
 The relationship between client and counsellor,
 Information-giving,
 Emotional release, and
 Examination of the patient's situation and potential
solutions

16. Qualities
 Knowledgeable in the area- update
 Genuinely interested in client
 Good listener
 Capacity for empathy
 Non-judgmental attitude
 Good verbal and non-verbal communication skills
 Maintain high ethical standards
 Seek help from experts

17. Counselling methods and
techniques
 Core conditions ,
 Unconditional positive regard,
 Expressed through genuineness,
 Empathy ,
 Non-possessive warmth,
 Congruence in the therapeutic relationship.

18. Aims and Indications
 Wellness,
 Personal growth,
 Career development,
 Distress relief and
 Problem solving.

19. General principles
Enabling the client to cope more effectively with current
problems
 Adult- adult nature of interaction
 Individual responsibility for the client
 Dependency Regression not encouraged
 Common sense
 Humor

21. Client-centred counselling
 Carl Rogers
 Respect for the person, and adopts the optimistic
assumptions that each person has an inner potential
for healthy development and achievement, or ‘self-
actualization’
 ‘core conditions‘> empathy, warmth, unconditional
positive regard, and genuineness in human
relationships, including the counselling relationship

22. Problem-solving counselling
 Problem-solving is integral to cognitive–behavioural therapy or
counselling
 ‘Interpersonal cognitive problem-solving therapy'.
STAGES:
 Identification and formulation of the patient's problem(s)
 Setting clear and achievable goals
 Generation of alternatives for coping
 Selection and operationalization of a preferred solution
 Evaluation of progress, with further problem-solving as
necessary
 Problem-solving therapy or counselling is a feasible, acceptable,
and effective treatment in the primary care setting for depression
and other emotional disorders.

23. Cognitive–behavioural approaches
 Therapy is aimed at changing the thought, belief, and
behaviour elements of functioning
 Rational-emotive behaviour therapy: Our problems
stem not from events themselves but from our
irrational thinking about events.
 Disputing such ‘irrational' thoughts and conducting
experiments to discover new ways of behaving.
 Development of a collaborative relationship in which
client and counsellor work together to understand
and resolve problems

24. Interpersonal counselling
 Modified version of interpersonal therapy
 Human behaviour is influenced by the basic need for
fulfilling mutual relationships.
 Major focus : patient's current interpersonal relationships
 Effective treatment for depression , dysthymia, and bulimia
nervosa
 Interpersonal domains: grief; interpersonal disputes;
interpersonal role transitions; and interpersonal deficits
 Alternative interpersonal strategies are identified,
rehearsed between treatment sessions, and modified as
necessary.
 Brief , Feasible

25. Psychodynamic counselling
 Significant past experience > Adverse experiences in
relationships during early life
 Continuing influence of which may be mediated by
unconscious processes
 Influence attachment patterns, psychosocial development,
and later psychological functioning>generation and
maintenance of abnormal psychological states
 Counsellor encourages patients to talk about their
difficulties, but also to reflect on their spontaneous
associations and their attitudes towards the counsellor
 Helped to recognize how her submissive and placatory
traits originated in childhood in response to her mother's
hostile and rejecting behaviour

26. Crisis counselling
 Crisis is the response of an individual, family, or other
group to challenges (stressors) that threaten or overwhelm
usual coping resources.
 Developmental > Transitional phases of psychosocial
development characterizing the lifecycle, such as
adolescence, leaving home, childbirth, and retirement.
 Accidental > Unexpected or non-developmental life events
such as injury, bereavement, relationship breakdown, or
redundancy
 Represents challenge, but it also presents an opportunity
for resolving old maladaptive coping patterns and for
psychological growth in the individual, family, or social
network.

27.  Crisis counselling is an active, focused, and short-term
intervention, usually involving no more than a few
sessions in the days and weeks after the onset of crisis
 Help the patient redefine the challenge and to
mobilize resources for its resolution
 Psychodynamic exploration may be helpful >
maladaptive reactions to earlier crises obstruct
resolution of the current problem

28.  Techniques of cognitive appraisal and problem-solving are
more relevant.
 Assessment > Nature of the stressor, the nature and
severity of the patient's initial response, an assessment of
risk, and his or her available coping resources including
external supports, previous coping resources and specific
vulnerability factors.
 Shared formulation > forming the basis for a redefinition
of the problem.
 Appropriate emotional expression , new strategies are
encouraged, but maladaptive responses are gently
discouraged.

29. Application of counselling to
specific conditions
 Stress-induced disorders( Adjustment problems, Grief,
Recent or past trauma)
 Postnatal depression

30. Counselling settings
 Primary care
 Student health
 General hospital
 Workplace
 Voluntary organization
 Staff counselling
 Employee assistance

31. Conclusions
 A rapidly growing part of Psychiatry
 Process to help others to take life decisions in different
conditions
 No fixed models but depends on empathetic
relationship , information giving and emotional
expression
 Though not a definitive treatment for mental illness
but helps in growing inner potentials , coping with
adversities and crisis , also deals with problem solving ,
interpersonal and behavioral errors.

32. References
 New Oxford Textbook of Psychiatry (September
2003): by Michael G. Gelder (Editor), Juan J. Lopez-
Ibor (Editor), Nancy Andreasen (Editor), Jaun J.
Lopez-Idor
 Sadock, Benjamin J.; Sadock, Virginia A.; Ruiz,
Pedro,Kaplan & Sadock's Comprehensive Textbook of
Psychiatry, 9th Edition.