CHCCSL503B Facilitate the counselling relationship

# 4: Monitor the Counselling Process

Lesson Outline

• The review process in counselling• Minimising threats or disruptions to the counselling

process• Discrepancies between client & counsellor

expectations• Ethical dilemmas in counselling• Limitations to services

The review process

Monitoring is vital to the counselling process• The importance of monitoring issues such as client

readiness for change, ambivalences and possible counsellor-client tensions cannot be underestimated.

• Failure to readily recognise issues & respond appropriately could result in client mistrust of the counsellor, and break down the willingness of the client to disclose or move forward with their goals.

• Conduct ongoing observation of the client’s body language & reactions to gauge their progress & ongoing needs

•

The review process

The review process:Schedule a formal time to review the counselling

process with the clientThis is a mutual review to recognise progress and to

check the client is getting what they need

Be sure enough sessions remain in which to address the outcomes of this review

Feltham, C. & Dryden, W. (2004)

The review process

Reasons for counselling review:• Helps you keep to support plan and goals• Enables you to adapt services provided• Find out what is working and what isn’t• Helps setting new goals • Allows adaptation to new client circumstances• It allows counsellor to develop professionally as they

try new strategies

The review process

When a strategy or goal does not work• Stop and think: Why? What can you do better?• Ask yourself and the client: What is working? Can the client focus on this?Was the target too difficult? Would smaller steps help?Have you missed some client strengths?Is the client fully involved in the plan & in reviewing it?How are you and the client feeling about the process?Are enough resources or community agencies involved?

Minimise threats & disruptions

Minimising threats or disruptions to the counselling process

• Clients may cause disruptions to their own counselling process due to ambivalence, reluctance or hesitation on their part to engage fully in the process, e.g.:

• Missing appointments• Using mobile phone in session • Inappropriate behaviour: speaking louder than

necessary, disturbing others, conversing on irrelevant topics

– Can you think of some more?Feltham, C. & Dryden, W. (2004)

Minimise threats & disruptions

• If the counselling environment is disrupted, the session may be compromised and should be postponed

• It may be necessary to negotiate with the client to avoid further disruption

• Remind client of the terms of the counselling agreement, in accordance with your workplace policy and ethical considerations

• If they are unable to comply, it may be necessary to suspend or terminate the alliance

Minimise threats & disruptions

Other disturbances in the client’s life can disrupt the flow of sessions:

• Personal, relationship, health and work issues prevent a client from attending sessions.

• Relocating necessitates recommencing elsewhere, delaying progress

• Online counselling may be affected by unreliable technology or confidentiality issues

• Such disruptions can emotionally effect the client with stress, anxiety, depression, insomnia, irritability, temper, confusion and decreased confidence

Summers, N. (2012)

Discrepancies in treatment

Discrepancies may occur between client & counsellor expectations, or when client perception of the process differs to counsellor perception:

• Unrealistic expectations of counsellors – e.g.: to be on beck & call

• Unrealistic client expectations – e.g.: to get jobs not qualified in

• Requesting assistance when not helping oneself

• Contradictions – e.g.: attending AA while still drinking• Supporting or challenging the client can resolve the

discrepancy to improve awareness & resolve the issue

Summers, N. (2012)

• Summers, N. (2012)

Ethical dilemmas in counselling

Dealing with dilemmas which occur in the counselling process

Deciding which approach to take when confronted with a difficult moral dilemma regarding your client

Eg: in couple counselling, learning from the woman that her husband is not her childrens’ biological father. Should you tell the father?

Different professionals will implement different courses of action for the same situation. Rarely is there just one right answer to a complex ethical dilemma

Feltham, C. & Dryden, W. (2004)

Ethical dilemmas in counselling

To address such dilemmas use an Ethical decision- making model:

• Identify the problem• Apply Code of Ethics• Determine the dilemma• Generate courses of action• Consider all consequences of all options• Select & evaluate a course of action• Implement

http://www.counseling.org/counselors/practitionersguide.aspx

Limitations to services

Tension may also occur between client’s expectations & the resources actually available:

• Counselling aims to empower: as such the client should be shown how to access various resources, including formal agencies and informal supports:

• support groups and educational seminars• church and community groups• recreational and even entertainment facilities

Summers, N. (2012)

Limitations to services

However in regional settings or under cultural and financial constraints, or for other reasons, accessibility to external resources may be limited

This leaves the client to draw on their internal resources, which also may be limited

This can be stressful and conflict with the client’s hopes and expectations from counselling

Limitations to services

The counselling setting itself as a formal agency is a resource with its own set of limitations

For example, when couples’ counselling ascertains abuse within an intimate relationship is current and ongoing, the workplace policy may necessitate discontinuation of service to that couple

http://www.wocrc.ca/en/programs-and-services/counselling-information-referral/Limitations-of-Counselling.aspx

Limitations to services

This is due to research and clinical experience revealing couples counselling is ineffective and potentially dangerous in these situations

Yet the workplace can remain committed to working to help these families, assessing needs of individual members and offering recommendations and referrals as appropriate

http://www.wocrc.ca/en/programs-and-services/counselling-information-referral/Limitations-of-Counselling.aspx

Role play activity: The Skilled Helper, Exercise Book, Exercise 4.2, p 27 and page 3 - 4, Introduction on: Guidelines for giving effective feedback

References

Active Listening (Do’s & Don’ts), online video, accessed 5 June, 2012. http://www.youtube.com/watch?v=yIjnB9zp0sw

American Counseling Association (1996) A Practitioner's Guide to ethical Decision Making http://www.counseling.org/Counselors/PractitionersGuide.aspx Site last updated: 2012

An introduction to Person Centred Therapy, online video, accessed 5 June, 2012.http://www.youtube.com/watch?v=Qpfm5sY0OX0&feature=relatedAustralian Counselling Association (2012) Professional Supervision

http://www.theaca.net.au/documents/Supervision_Complete.pdf Site last updated: not disclosed

Biblos (2011) http://bible.cc/psalms/23-4.htm Online Parallel Bible Project, Site last updated: not disclosed

Centre for Global Health (2012) Encouraging Dialogue: Listening, Questions, Paraphrasing, and Reflecting Feelings http://www.globalhealthcommunication.org/the_center/contact_us Site last updated: not disclosed

Corey, G. (2009) Theory and Practice of Counselling and Psychotherapy 8th ed. Brooks/Cole Cengage Learning, California p.386

Corey, G., Corey, M.S. & Callanan, P. (2011) Issues and Ethics in the Helping Professions, 8th ed. Brooks/Cole Cengage Learning, California p.78, 117, 141, 269

Dictionary.Com (2012) Roget’s Thesaurus http://dictionary.reference.com/browse/ambivalence Site last updated: not disclosed

Egan, G. (2007) The Skilled Helper, 9th ed. Brooks/Cole Cengage Learning, California

Feltham, C. & Dryden, W. (2004) Dictionary of Counselling 2nd ed. Whurr Publishers Ltd, London p.9

Geldard, D. & Geldard, K. (2012) Basic Personal Counselling, A Training Manual For Counsellors 7th ed. Pearson NSW p.376

ReferencesCorey, M., & Corey, G. (2011) Becoming a Helper, 6th ed. Brooks/Cole Cengage Learning, California

p.151, 152, 153Counselling Skills Lecture 4: Paraphrasing & Reflecting Feelings, online video, accessed 4 June, 2012,http://www.youtube.com/watch?v=_M67ioQ1K2Y&feature=channel&list=UL

Dictionary.com, 2012, accessed 6 June, 2012, http://dictionary.reference.com/browse/ambivalence Site last updated: not disclosed

Ending counselling, online video, accessed 7 June, 2012, http://www.youtube.com/watch?v=7sv6emlOJeI&feature=related

Industry Skills Councils (2011) CHC51708 Diploma of Counselling Training Package Australian Government Department of Education, Employment and Workplace Relations

Interview Stories: Open versus Closed Questions, online video, accessed 4 June, 2012.http://www.youtube.com/watch?v=RoB--jhPIus

Ivey, A.E., Ivey, M.B. & Zalaquett, C.P. (2010) Intentional Interviewing and Counselling, Facilitating Client Development in a Multicultural Society 7th ed. Brooks Cole, California

Johari Window, online video, accessed 6 June, 2012,http://www.youtube.com/watch?v=c7rlCgy6i88&list=UUSnEXvOOpzPkB01mvlUl-2g&index=1&feature=plcp

“Listening skills – Paraphrasing” , online video, accessed 6 June,2012, http://www.youtube.com/watch?v=V_T4B9XANCw

National Institute on Alcohol Abuse and Alcoholism (NIAAA) (2003) http://pubs.niaaa.nih.gov/publications/niaaa-guide/index.htm Site last updated: not disclosed

Psychology Suite 101 (2012) http://linda-smallwood.suite101.com/counselling-and-endings---how-to-manage-them-a298878 Site last updated: not disclosed

References

Ruskin, John, 2009, How to.com, Brighton, U, acessed 6 June, 2012,. http://www.howto.co.uk/wellbeing/counselling-skills/helping_the_client_feel_safe/

Steven, J. C. (2010) http://www.basic-counseling-skills.com/strengths-based.html Site last updated: 2010

Stevens, T.G. (2010) Overcome Anger and Aggression http://www.csulb.edu/~tstevens/b-anger.htm Site last updated: not disclosed

Strengths-Based Counseling, online video, accessed 5 June, 2012, http://www.youtube.com/watch?v=RtADcIJYLzA

Summers, N. (2012) Fundamentals of Case Management Practice, Skills for the Human Services 4th ed. Brooks Cole, California p.335, 337, 409

The Red Couch Counselling & Psychology Clinic (2009) http://www.redcouchpsychologycounsellingtherapyclinicmelbourne.com.au/ Site last updated: not disclosed

Tom rath why we focus on weakness, online video, accessed June 5, 2012,http://www.youtube.com/watch?v=_A0ZE4_37As&feature=autoplay&list=PL974DFE9331A092A8&playnext=2

Victorian Government Department of Health (2009) Community Health Priority Tools http://www.health.vic.gov.au/pch/downloads/community_health_priority_tools.pdf Site last updated 2009

Western Ottawa Community Resource Centre (2012) http://www.wocrc.ca/en/programs-and-services/counselling-information-referral/Limitations-of-Counselling.aspx Site last updated: not disclosed