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Counselling Theory and Practice

Study Guide

Topic 9 The process of counselling

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Objectives

At the end of this topic you will be able to:

Introduction

In previous topics we have discussed the different skills that are required of a counsellor. These skills need to be used continuously; however, a counselling session or series of counselling appointments also follows a certain pattern or process. In this topic we explore some models for structuring the counselling process. Different authors use different models but we will show that the basic sequence of a counselling session runs along quite predictable lines, which basically consists of an introduction, storytelling and meaning making, followed by a conclusion.

The basic listening sequence

The basic listening sequence is a concept proposed by Ivey and Ivey (2007: 18–19). The basic listening sequence incorporates the microskills of ‘open and closed questions’, ‘client observation skills’, ‘encouraging, paraphrasing and summarising’, plus the microskill of ‘reflection of feeling’. In learning about these skills you have learned the basic foundation skill for the five stages of a counselling interview.

Ivey and Ivey (2007: 18) suggest that you can conduct a whole interview using these basic listening skills and that in this way you are pursuing the three-part goal of eliciting from the client the following:

  1. An overall summary of the issue

    This is done through questioning or simply attending, with perhaps a summarisation at the close of the session.

  2. The key facts of a situation

    Obtained through reflection of content and paraphrasing and ‘What …’ questions.

  3. The central emotions and feelings

    Reached through questioning, reflection of feeling, and encouragers that focus on emotional words.

A good example of a basic listening sequence can be found in Ivey, Ivey and Simek-Morgan (2007: 18):

'Could you tell me about your family and how they react to your fear of going out in public?’ (Open question – leads to drawing out how client organises the problem)

‘Protect you?’ (Encourager – leads to exploring client’s key words and underlying meanings)

‘So, when you find yourself not wanting to go outside, the family goes out for you?’ (Paraphrase – client knows she or he is heard)

‘Is that right?’ (Perception check – helps client know whether or not hearing has been accurate)

‘And you seem to be feeling very sad/frightened/inadequate right now?’ (Reflection of feeling – leads client to explore emotion)

‘So this is what I’m hearing you say …’ (Summarisation – counsellor emphasises main points of the client’s story to enhance understanding of the problem in a more organised fashion)

Thus the microskills you have learned about in the preceding topics form the internal detail of a counselling session. There needs to be a structure or process to move you through the session. It is to this that we now turn.

The process of counselling

Many counselling theorists have considered the process of counselling and there are similarities and differences in the various concepts. One point of agreement is that counselling has a beginning, a middle and an end, the same as some of the life events which bring our clients to the therapeutic process. As in life, these stages are not distinct. Similarly to the fluidity and contextual application of assessment, the counselling process does not define a definite time when you must do this, you must stop doing that, you must draw a line. In working with humans, we are subject to their needs – sometimes this means that the beginning will begin again, and the endings in particular can be quite indistinct. When the client and counsellor have agreed on an ending to a therapeutic process, this is a time when a client may want to address new issues or bring a different slant to those issues already covered. There are several reasons why endings can be enigmatic for therapist and client alike, and we will look at some of these a little later.

Three process models

With the knowledge that the process of counselling will differ according to the needs and goals of the client and the counsellor’s theoretical perspective to some degree, nevertheless there is a process or pattern which can be recognised in most of the models, and linked to the concepts of beginning, middle and end. Your textbook presents these stages as:

Textbook

Read Geldard, D, Geldard, K & Yin Foo, R., 2017), Chapter 16 ‘Combining skills to facilitate the change process’ in Basic personal counselling: training manual for counsellors.

Geldard, Geldard and Yin Foo’s suggested process also lists what is happening within the client and the counsellor’s skill application at each different stage, so this is quite useful – with the understanding that the various steps are intermingled, occur simultaneously, overlap and repeat themselves. Whatever process guides the counsellor and whatever concepts underlie his/her practice, it is very important to mentally stick to the process and develop skills to imperceptibly ‘bring the client’ back to the process – otherwise the session may not fulfill its therapeutic intent.

One theory of counselling presents it as substantially decision making or problem solving (Ivey & Ivey, 2007, p. 226). They suggest an easy problem solving model as having three stages:

  1. defining the problem
  2. defining goals
  3. generating alternative solutions and selecting a new, potentially, more effective approach (p. 227).

In applying these principles, Ivey & Ivey propose that a therapeutic interview has a sequence of stages from beginning to end. Each of these stages requires the application of counselling microskills to assist the client make their own decisions and set goals. The sequence is:

  1. Initiating the session

    Rapport and structuring

    ‘Hello’

  2. Gathering data

    Drawing out stories, concerns, problems or issues

    ‘What are your strengths and resources?’

  3. Mutual goal setting

    Defining goals and clarifying expected outcomes

    ‘What do you want to happen?’

  4. Working

    Exploring alternatives, confronting client incongruities and conflict, restorying

    ‘What are we going to do about it?’

  5. Terminating

    Generalising and acting on new stories

    ‘Will you do it?’

Although the authors present five steps of intentional interviewing, they make it clear that this is a circular process, underpinned by a concept of wellness and a positive asset search as the process is focused on rediscovering the client’s strengths and resources to find positive alternatives. There are particular microskills which apply to each of the above stages, and you will learn about these and how to apply them in the next three topics.

The model suggested by Peterson & Nisenholz (1999) suggests five stages to the helping process with specific actions occurring on the part of the client and the counsellor (similar to those expounded in the table in your textbook).

Stage One – Attending

Client presents problem, tests relationship, checks out procedures.

Counsellor provides working environment, clarifies process, attends, observes, listens and accepts client, gives space to client to express concerns, is non-judgmental.

Stage Two – Exploration

Client experiences counsellor as helper, starts to become aware of feelings and concerns, self-destructive behaviour and problems in the here and now, is more self-disclosing.

Counsellor establishes trust, is empathic, helps client explore deeper feelings, shows concern and caring, gives feedback, summarises.

Stage Three – Understanding

Client develops insight, takes responsibility for problems, confronts impasse, experiences release of energy, identifies discrepancies.

Counsellor uses advanced levels of empathy, helps client take responsibility for his/her part in problem, directs, interprets, probes, uses immediacy.

Stage Four – Action

Client further clarifies thoughts and feelings, puts insights into action, sets goals, implements plans and evaluates actions, if goals not met, revises plan, if goals met moves to new problem or toward termination.

Counsellor gives encouragement, gives feedback to client on results of activity, helps generate and evaluate alternatives.

Stage Five – Termination

Client evaluates gains, acknowledges changes, works with loss of relationship, plans beyond relationship.

Counsellor gives feedback, affirmation, assesses client readiness for ending counselling, arranges follow up (Paterson & Nisenholz, 1999, p. 79).

Whilst some of the stages are dependent on what has occurred in the previous stage, this is not a linear process. Clients cannot work on goals until they have disclosed problems, but as insight develops new doors for exploration of other goals and problems open and are explored. As counsellors it is not useful to ‘shut doors’ on clients because they are not sticking to our pre-conceived mental program of ‘what stage are we up to now?’ There may be only one moment in months or years of therapy when a client is able to disclose their deepest fear. So whatever process you use as your guide, ensure that it works for you and the client, and do not allow the process itself to become an impediment.

Beginnings

As we can see from the models above, the first stage of the counselling process starts with initiating contact, and attending to the client. Attending is an encompassing term, and requires specific microskills to commence building a therapeutic relationship. There is much to discover about attending behaviour, and you have addressed some of these theories and practical skills in Topic 8. It is important to understand that if we attend well to our client in the very beginning of the relationship, we have set good foundations for the therapeutic work which will be undertaken.

We are all aware of the need for good first impressions – in the corporate world it is said that we have only six seconds to impress our prospective employer with our power dressing and the flicker of the colour red which we have astutely included somewhere on our person. Counsellors and clients will have first impressions of each other, and similar to a jobseeker and a prospective employer, a power imbalance immediately exists. Our clients come to us in a state of vulnerability and distress, we are purported to be the ‘expert’ who will be able to assist them – there is little equality here, and our task as counsellors commences immediately with attempting to make our clients as comfortable as possible. Bugental (1978 cited in Paterson & Nisenholz, 1999, p. 78) describes this first contact as:

And so the two strangers meet … One silently thinks, “Is this someone I can believe in” Someone I can trust with my secrets, my guilts, my shames, my tender and deep hopes for my life, my vulnerability? The other wonders, “Is this someone I can invest in? Someone I can stand by in pain and crisis? Someone I can make myself vulnerable to? What surprise may this person bring forth, and what may that surprise trigger within me?”

As we work together as two human beings struggling to understand each other, miscommunication and uncomfortable moments will arise, particularly if both are fully able to commit to the stages of challenge and confrontation. We are also both subject to projections from our unconscious which may be difficult to handle. Counsellors who are able to convey to their clients an accepting and non-judgmental attitude at the beginning of therapy set the scene for depth of discovery in the middle stage of therapy.

The working alliance

Counselling is work! What occurs in the middle of the therapeutic process is geared towards addressing the presenting issue of the client. Cognitions, emotions and behaviours are explored and analysed, alternatives developed, goals defined and methods for achieving goals are decided upon. Then the circular process continues – evaluation occurs, client insight allows for the recognition of more goals, deeper feeling states are explored, clients develop understandings of the influence of the past and the family of origin, strategies and action plans are developed, destructive behaviours are identified and modified. Clients attending for specific reasons note an improvement in their understanding and response to the negative stimuli.

Some theoretical perspectives do not stipulate particular goals as such, but set goals through the use of language and focussed questioning to help clients heal through reconstructing the dominant stories of their lives. Goals exist in one form or another in most theoretical perspectives of counselling, but may be couched within the therapeutic process rather than developed collaboratively with the client as a motivational program.

Some perspectives identify process goals (therapeutic goals of therapy) and outcome goals (identified personal goals of the client) and the issue of goal setting and evaluation of achievement will vary accordingly. Where outcome goals are defined, usually in the middle stage of the counselling process, counsellors can assist considerably by working collaboratively with clients to:

Some goals of course will be both process and outcome goals. In counselling, as in other fields, if we set goals we must be able to evaluate the level of achievement. In doing this, we must not collude in allowing clients to set themselves up for failure – this can provide a perpetuation of some of the issues which may have brought them to counselling in the first place. Small, achievable goals are the answer. With some clients, a reasonable goal may be ‘turn up to the next session’. Gladding (2004, p. 140) explains that goals in counselling are:

As clients identify that they have achieved some of their goals in coming to counselling, they will start to think about how they will travel in life after the ending of the therapeutic relationship.

Endings

Ordinary human relationships do not have a built-in time limit, nevertheless they may come to a natural end when the connection or task is finished – life events such as moving away, having children, taking on different work responsibilities all impact on friendships. There are some unique friendships which are life-long, weathering the ups and downs of life on each side of the equation, and those involved in such friendships place great value upon them. Through the very deep sharing of emotion on the client within the therapeutic relationship, and the process of therapeutic work, it is understandable that a strong bond can develop. Some people, particularly therapists, may have been in psychotherapy for a considerable period of their lives – twenty years or more with the same therapist! Imagine the effects of coming to an end of this type of relationship. The ending of the therapeutic relationship does come with a feeling of loss.

There are some strategies to prepare for feelings of loss:

As the client has come to us in a state of vulnerability in the beginning and trusted us with their most intimate details of their lives during the working alliance, it is our professional responsibility to facilitate an ending. A therapeutic relationship is a professional tool, and cannot be the same as a personal relationship, even if at times our clients (and dare we say ourselves when we forget our ethical principles) would like to see it that way.

Textbook

Read Geldard, D, Geldard, K & Yin Foo, R., (2017) Chapter 12 ‘Creating comfortable closure’ in Basic personal counselling: a training manual for counsellors.

There are several ways therapy can end, such endings being initiated by the client, the agency, or the counsellor, or planned collaboratively at the outset. Even collaboratively planned endings do not always occur as expected, and not all endings are happy. Despite the existence of a planned ending, clients may end therapy unilaterally – they leave in anxiety, they leave aggressively and they leave in silence (Murdin, 2000, p. 61). Some of the problematic reasons clients may leave therapy include:

Some endings are unexpected, sudden and confronting. One of the most difficult endings is suicide. Some clients may threaten suicide throughout the counselling process, but when this actually occurs not only does it produce finality for the client, but counsellors are left with some questions for themselves:

As well as all the other emotions linked to death by suicide, counsellors may experience significant self-doubt, and this is a time to seek supervision.

Activity (write)

Although negative endings can occur, it is more likely that the counselling process ends on a positive note. There are many successful endings. Write a list of at least eight observations of how you would assess successful ending of the therapeutic process.

e.g. The client learned new ways to cope with old problems.

The client is not afraid of spiders any more.

One last thought about endings – many of the stages of counselling present a beginning, a middle and a termination. There is some debate about the use of the word termination – this word does have negative connotations – maybe ‘termination’ is not the best way to describe what happens at the end of therapy!

Summary

In this topic we have looked at the counselling process as a way of tying all the different skills, tools and qualities together in a comprehensive whole or sequence. Just like you wouldn’t start a meal with the desserts, counselling progresses along a well-defined path. And in simple terms this path has a clear beginning, a middle and an end, as demonstrated by Ivey and Ivey’s (2007) model. Different skills may be needed at different stages and as a counsellor it is your responsibility to guide this process to the client’s satisfaction.