Counselling Skills

• What are the 5 P’s in the 5P Framework? 


  1. Presenting Issues: What the client is currently struggling with.
  2. Precipitating Factors: What triggered the problem or brought the client to therapy.
  3. Perpetuating Factors: What maintains the issue.
  4. Predisposing Factors: Historical vulnerabilities that made the client susceptible.
  5. Protective Factors: Strengths and resources that mitigate distress
• what does ethos of facilitation refer to? 


  No advice-giving or coercion
• What is evidence based practice (EBP) made up of? 


  1. research evidence (red)
  2. clinical expertise (green)
  3. client needs & preferences (purple)

  
• For effective outcomes, Carl Roger’s said there must be what 3 things? 


  1. congruence
  2. empathy
  3. unconditional positive regard
• What are the 6 desirable counsellor qualities?

  1. congruent
  2. empathic, warm and sensitive with good rapport
  3. non-judgemental with unconditional positive regard
  4. attentive, understanding and supportive
  5. collaborative and respectful of the person’s confidence
  6. proficient in using counselling skills purposefully
• You cannot ethically fulfil your clients needs if providing them confidential help would


  • Involve working in opposition to the policies of the organisation that employs you
  • Involve a breach of the law
  • Put other members of the community at risk
  • Be impossible for you personally
• Listening involves:

  1. Minimal encouragers (micro skill)
  2. Brief invitations to continue (micro skill)
  3. Non-verbal behaviour (micro skill)
  4. Silence (micro skill)
  5. Voice (a concept: polyphonic and complex channel of expression)
• Holding is done through:

  • Attending skills, minimal encouragers 
  • Being respectfully silent + match their speed of speech
  • Demonstrate empathy through verbal and non-verbal communication
  • Reflect/paraphrase/summarise what the client has said 
• Therapeutic presence involves a simultaneous awareness of: 


  • What the clients experiencing 
  • The therapists own resonant experience
  • The relationship between the two experiences
• benefits of therapeutic presence 


  makes the client feel safe enough to become present with their own experience, and in relationship with their therapist. It:

  • Is a necessary foundation for empathic responding
  • Facilitates feelings of safety and security
  • Contributes to the development of new neural pathways for the client
  • Contribute to repair of attachment injuries
  • Provides the positive social interactions essential for ongoing neural growth
• safety is based on the counsellors capacity to:

  • Be present
  • Be compassionately and genuinely interested (curious)
  • deeply/richly listen
  • “Hold” the person, and remain calm in the face of their pain, confusion and fear - but responsive!
  • Risk interpersonal honestly - say openly (yet kindly) things we do not normally say in social situations (phrases that reflect their experience) 
  • Consistent attempt to gain a broader/richer understanding of the person… not digging deep but expanding wide (not always discovery but collaborative construction) 
• Issues for beginning counsellors:

  • Be yourself and self-disclose appropriately 
  • Be comfortable with silence
  • Avoid perfectionism
  • Be honest about limitations 
• What are the 2 components of understanding?

  1. Perceptual or intellectual understanding: involves metacognition 
  2. Emotional understanding: being able to feel your clients feelings with them
• What is the theory of mind? 


  ability to recognise and attribute a particular ‘mental state’ to certain behaviour/s taking into consideration our own and others’ beliefs, thoughts, perceptions, intentions, feelings, and desires 
• What is the precursor for compassion? 


  empathy
• What does the counsellor’s reflexivity refer to? 


  practice and awareness of personal barriers
• Kohut (1977) describes two processes therapists participate in:

  1. a transitory, vicarious identification in the clients experience (experience-near)
  2. simultaneously taking a more objective, observing role in the interaction (experience-distant)
• Unhelpful responses:

  • sympathy - often about alleviating distress and moving past it (blurred boundaries, merging of experience)
  • identification - may be under or over, needs to be transitory, there is risk of being overly emotionally involved which diminishes capacity to take a broader observer perspective
  • projection - attribute qualities to others as a result of one’s own subjective experiences
  • countertransference - may involve excessively positive or negative feelings and responses towards the client, decreases through increased empathy
• What does ICE stand for? 


  Inclusive Cultural Empathy

  • ethnographic (ethnicity, religious orientation; nationality)
  • demographic (age, gender, lifestyle, location)
  • status (social, educational, economic) and affiliation (in/formal)
• the distinction between expressing empathy as a mode of communication and experiencing empathy as an attitudinal engagement
• Modes of empathy in a treatment context 


  1. experiential
  2. communication
  3. observation
• Stages of ICE development 


  1. awareness
  2. knowledge
  3. skill
• Why can “why” questions be unhelpful? 


  they generally prompt an intellectually thought-out response rather than centering on what is happening internally
• transitional questions 


  e.g., “I’ve noticed that you’ve moved away from…” or “I noticed you mentioned this earlier, would you like to spend some time taking about that now?”
• guru questions 


  invites the client to look at themselves from a distance and give themselves advice
• choice questions 


  enables them to explore choices and consequences to be better prepared for future situations
• circular questions 


  asking and wondering about how people in their life feel and what they’re experiencing
• Goal-oriented questions 


  in exploring how things could be different, this can help a person identify broad changes that they might like to make
• scaling questions 


  allow them to be specific when discussing goals
• building a collaborative relationship can be done through 


  • helping clients see their own expertise
  • actively involving them in the treatment decision-making process
  • recognising your own limitations
• wise mind =


  rational mind + emotion mind
• emotions vs feelings 


  emotions involve primary data whereas feelings play out in our heads
• advanced empathy involves 


  • hearing and reflecting deeper feelings than the client was aware of or able to verbalise
  • helping a client understand contrasting feelings or discrepancies in their experience
  • synthesise meaning across experiences, events, previously discussed topics
• approaches to advanced imagery 


  1. reflecting deeper feelings than
  2. eliciting and reflecting meaning
  3. visual imagery, analogies and metaphors
• internal frame of reference 


  experiencing the subjective perceptions and experiences of the client rather than an external viewpoint
• individuation / healthy differentiation =


  psychological separateness + a sense of intimacy
• cultural competence


  the ability to first recognise and understand one’s own cultural backgrounds and values, and then how it influences our relationship with a client
• systems theory


  1. individual
  2. microsystem - immediate family’s neighbourhood, school
  3. mesosystem - connections between family, neighbourhood and school
  4. exosystem - economic system, education system, government agencies
  5. macrosystem - social values, cultural values, customs, beliefs
  6. chronosystem - changes over time, historical events, biological changes, physiological changes
• the wounded healer model


  the power of the healer derives from their inner experience or pain, loss or suffering

  • existential touchstones - unique personal strengths that have their roots in specific childhood experiences
  • signature themes - a lifelong struggle that shapes the persons relationships with the self and others
• 4 possible trajectories from pain, loss or suffering

  1. the chronic dysfunction trajectory
  2. the relapse trajectory
  3. the recovery trajectory
  4. post-traumatic growth pattern (effective therapist)