Sunday, June 20, 2010

INTRODUCTION TO COUNSELLING


1.1 INTRODUCTION
The importance of counselling in the area of HIV/AIDS can no longer be ignored. Unlike other diseases, HIV/AIDS requires special care and attention to the client. Although the concept ofcounselling in medical services is well known, the practice of this strategy in developing countries is almost absent. In India, efforts have been made to provide counselling services at least in some ofthe medical institutions. However, much needs to be done so that more and more people may take up counselling as their profession and may seek the required training in this field. In this unit we shall try to define the concept of counselling and other introductory characteristics pertaining to the areas of counselling. This will enable some ofyou, who are either involved or interested in getting involved in pre-test and post-test counselling of the HIV/ AIDS patients, to understand the basic aspects related to counselling.
1.2 WHAT IS COUNSELLING?
Let us try to understand the concept of counselling by defining the term counselling and by examining other related components of counselling.
Definition: Counselling is an interpersonal process through which guidance and support is provided to persons .with psychological problems. These problems may be personal or interpersonal in nature.
The persons involved in counselling: The individual who provides the support and guidance is known as the counsellor. The individual who receives the support and guidance is known as the client.
What counselling seeks to do: Counselling seeks to resolve personal and interpersonal problems through a variety of approaches, and in a way that is consistent with the values and goals of society in general, and that of the client in particular.
Goals: Specifically stated, counselling has four important goals, namely:
1) To reduce the emotional distress of the client,
2) To reduce the dysfunctional behaviours of the client, 3) To promote better adaptation of the client to his environment, and to develop his potential, and 4) To assist the client in making important personal decisions.
Counselling is a special relationship. From the preceding discussion, it should be clear that counselling is a unique, helping relationship that allows the client an opportunity to learn, feel, think, experience, and change in ways that are socially desirable.
Most clients enter the counselling relationship voluntarily. Although clients typically expect the counsellor to resolve their difficulties, the counselling relationship is actually collaborative: client and counsellor collaboratively work towards the goals of counselling, with the counsellor acting chiefly as a facilitator of behavioural change.
How the counsellor works: To facilitate the achievement of the goals of counselling, the counsellor uses his understanding of behaviour, learning and interpersonal relationships to establish conditions favourable to client change.
While much of the work in counselling may involve one-to-one interaction with the client, interaction with 'significant other' persons in the client's Efe can also contribute towards the attainment of the goals of counselling.
Counselling is a very variable process: The nature. ;';(lurse, and techniques of counselling vary widely across categories of counselling, such as crisis counselling, career counselling, marital counselling etc.

1.3 THE DIFFERENCE BETWEEN PSYCHOTHERAPY AND COUNSELLING
Having defined counselling, let us try to learn what is psychotherapy? Psychotherapy is the treatment of psychological disorders by psychological means within the framework of an existing psychological theory. Psychotherapy is conducted by psychologists, psychiatrists, or other mental health professional who are highly trained in the field. Psychotherapy is a formal and structured process.
Differences between counselling and psychotherapy: Counselling is not the same as psychotherapy. Both normal and psychologically disordered persons can benefit from counselling (consider processes such as career counselling, premarital counselling, etc.). Counselling does not depend on psychological means alone to provide benefits to the client. Counselling may utilize processes such as restructuring the client's environment or recommending leisure pursuits. Counselling is not based upon anyone specific psychological theory; rather, it is a commonsense approach to problems. Counselling also utilizes practical techniques derived from several different forms of psychotherapy, as appropriate to the situation.
Persons do not need extensive training to become counsellors. While a degree of training can prove extremely helpful, research has shown that, for persons with mild emotional disorders or interpersonal problems, teachers, elders and other experienced persons can produce as good results as do professional psychotherapists. Finally, counselling is far less formal and structured than psychotherapy. Counselling is also more flexible.
This discussion should not be interpreted to suggest that counselling is superior to psychotherapy because each process has its advantages and limitations. Perhaps, the best way to view counselling is to consider it as a first line of management for individuals with interpersonal problems.
The nature, course, and techniques of counselling vary widely also across client groupings, such as is seen in individual counselling, couple counselling, group counselling etc.
The nature, course and techniques of counselling also vary widely across categories of clients, such as children, adolescents, families, alcohol and drug addicts, etc.
Finally, the nature, course, and techniques of counselling vary widely across clients even ifthe clients belong to the same category and are receiving the same category ofcounselling. This is because each client is a unique person, different from everyone else.

1.4 NOT EVERYBODY NEEDS COUNSELLING
Nobody is in total physical health. This does not mean that we need to consult a doctor for every cough and cold, or for each ache and pain. Likewise, nobody is in total mental health. However, this does not mean that we need to consult a mental health professional each time we feel anxious or unhappy. Thus, while counselling may be helpful, it is not essential for everyone who has to deal with problems. So, for who is counselling necessary?
Indication Criteria for Counselling
After understanding the concepts of counselling and psychotherapy, let us now try to see the main criteria indicating the need for counselling.
Counselling should be considered for everybody with stress-related mood disturbances and adjustment problems that additionally fulfil the following criteria:
1) The symptoms are related to stress, but are out of proportion to the stress in duration or severity. For example, even ifthere is a death in the family, after a few days or weeks we are able to pick up the pieces of our lives and carry on with our regular responsibilities. Ifsomebody is unable to adjust after several weeks, and/or ifthe degree of emotional disturbance is so great that the individual is unable to attend to his or her regular work, then individual would probably benefit from counselling.
2) The symptoms interfere with psychological, cognitive, biological, social, personal, and/or occupational functioning. Associated physical symptoms may be present. Interference with psychological functioning means that depression, anxiety, fear, anger or other dysfunctional emotional states are present more than is characteristics of the normal state.
Interference with cognitive functioning means that attention and concentration are poor, and forgetfulness develops. Mental slowness and mind blocks may become common. The individual begins to feel that his or her intellectual capacity is becoming affected. Interference with biological functioning means that there is impairment of sleep, appetite and sexual functioning. Disturbed sleep can be either sleeping too little or too much. Disturbed appetites can mean either eating too little or too much. This is often associated with weight loss or weight gain. Disturbed sexual functioning is most commonly characterized by decreased sexual drive and capacity.
Interference with social functioning means that there is impairment in the ability and desire to interact normally in social situations. Often, the individual may prefer to avoid company. Interference with occupational functioning means decreased work efficiency, making errors at work, avoidance of responsibilities, and/or absenteeism. Interference with personal functioning means decreased involvement in the usual recreational and leisure activities such as reading, watching television, and hobbies. Associated physical symptoms include fatigue, lethargy, aches and pains, headaches, psychosomatic problems etc.
Common Disorders that might benefit from counselling
There are several disorders that might benefit from counselling. These include:
                      Most forms of depression,
                      Most forms of anxiety,


                      Most disorders which are characterized by a failure to adjust to some recent or longstanding stress,
                      Most conduct and emotional disorders of childhood and adolescence,
                      Most kinds of interpersonal problems,
                      Alcoholism and drug abuse etc.

1.5 COMMON DISORDERS FOR WHICH COUNSELLING SHOULD NOT BE THE PRIMARY THERAPY
Many mental disorders are partly or wholly biological in origin. These include:
                      Dementia,
                      Schizophrenia, mania, and other psychotic states,
                      Obsessive-compulsive disorder,
                      Certain forms of depression, such as endogenous depression,
                      Certain forms of anxiety, etc.

Such disorders require primary medical management, such as the use of drugs or . electroconvulsive (electric shock) therapy. Counselling may, however, be useful as an adjunctive intervention.
It is impossible to develop proficiency in the diagnosis and management of psychiatric disorders through distance teaching since exposure and practical training components are not included in distance teaching. Ifyou are interested in gaining more information in psychotherapy, you may refer to standard textbooks of psychiatry or join a full-fledged regular course from a recognized institution.
Warning for Counsellors
The counsellor should ensure that the client who comes for counselling has first been screened for suitability for counselling by a medical professional, preferably a psychiatrist. This is because a counsellor will not have the skills to identify psychiatric states that have subtle medical origins, and which consequently require medical management.
Ifthe counsellor does not take this warning seriously, there is a definite possibility that, by attempting to counsel a client for whom medical therapy is more appropriate, harm will result to the client.
Warning symptoms that suggest that medical intervention is necessary for the following:
                      Grossly abnormal behaviour (e.g. being violent, not taking care of personal hygiene);
                      Abnormal talk (e.g. being irrelevant and incoherent);
                      Presence of delusions (these are false beliefs, such as that of being persecuted, followed, talked about, poisoned, etc.);


                      Presence of hallucinations (e.g. hearing voices, seeing visions);
                      Presence of obsessions or compulsions (these are repeated thoughts and actions that are beyond the subject's control);
                      Severe abnormality of mood (that markedly interferes with normal life );
                      Loss of judgment; and
               Loss of insight (that is, the failure to acknowledge that one is ill).

1.6 GENERAL CHARACTERISTICS OF A GOOD COUNSELLOR
Everybody can offer counsel, but not everybody has the skills to be a good counsellor. This section discusses the characteristics of a good counsellor. In the process, some of you who are already involved in counselling can introspect and see to what extent you possess the characteristics of a good counsellor.
1) A good counsellor must be fluent in the language of his client in order to guess what is unsaid, and to correctly interpret nuances in communication.
2) A good counsellor must understand the culture to which the client belongs. Without such an understanding, the counsellor may misinterpret various behaviours that the client shows.
3) A good counsellor should have charisma and personality. He should inspire confidence and respect in his client.
4) A good counsellor must have much experience of life. Without such an experience, it is difficult to put the client's problems and behaviour in the correct perspective, or to provide the most appropriate guidance.
5) A good counsellor must be reasonably mature and intelligent to understand the client's problems, formulate an appropriate plan ofmanagement, and carry it through. A counsellor without maturity and intelligence is one who may show poor judgment when counselling clients.
6) During therapy, the counsellor's values invariably percolate down to the client. Therefore, a good counsellor must have a healthy set of values.
7) A good counsellor should be psychologically minded; that is, he should understand the intricacies and the workings of the human mind.
8) A good counsellor should be knowledgeable about the range ofpsychological disorders that individuals experience, and the characteristics thereof. To use a parallel, a doctor who is not knowledgeable about malaria will not be able to diagnose and treat it competently.
9) A good counsellor should be knowledgeable about the client's problem field. For example, unless a counsellor knows much about children, he will find it hard to competently counsel a parent who is having difficulties with his offspring. It can help if the counsellor is also experienced, in addition to being knowledgeable, in the client's problem field. For example, a counsellor who is a parent (as compared to one who is not a parent) will be able to better understand and counsel a client with parenting problems.
10) A good counsellor should have few emotional problems. This is because a counsellor who is unhappy may not be able to give the client his undivided attention. Furthermore, his judgment may be clouded by his personal problems. A good counsellor must be particularly free ofproblems in his client's area of difficulties.
11) A good counsellor must be well trained. To use a parallel, a doctor who is poorly trained may be competent in treating straightforward coughs, colds and fevers, but will be out of his depth with conditions such as heart disease or kidney failure. .

12) A good counsellor should have good communication skills; he must know  what to say, how to say it, and when to say it.
13) A good counsellor should be genuinely motivated to help persons in distress. He should not counsel merely out of a feeling of duty.
While counsellors can be of any age or sex, most clients tend to prefer their counsellors to be older than they are. Some clients may find it easier to confide in a counsellor of a particular gender. In India, many clients (particularly females) prefer same-gender counsellors.
1.7 CHARACTERISTICS OF A GOOD COUNSELLOR DURING THERAPY
During therapy too a counsellor demonstrates some of the good characteristics of a counsellor. These may include:
1) A good counsellor easily establishes rapport with the client. He readily makes the client feel comfortable with him.
2) A good counsellor shows empathy; that is, he understands what the client is experiencing. He is able to make his client feel understood.
3) A good counsellor is intuitive. He is able to read between the lines; from what has been said, he is able to understand what has been left unsaid.
4) A good counsellor feels warmth towards his client, and is able to make his client perceive the warmth and the desire to see him well again.
5) A good counsellor is able to accept his client as a good and deserving human being irrespective of the problems under consideration. He does not feel contempt for or hostility towards the client. He is able to communicate this acceptance to the client. .
6) A good counsellor realizes that it is more important to listen than to talk.
7) A good counsellor is able to gain his client's confidence such that the client is willing to express the most personal details of his life to the counsellor. A good counsellor also respects these confidences. Nothing that the client reveals should be shared with anybody else without the client's permission.
8) A good counsellor does not criticize or sit in judgment upon the client. (It is important to remember that several persons would already have criticized and judged the client before he came in for counselling.) A non-critical atmosphere is one in which the client becomes willing to share his innermost thoughts and feelings without fear of negative reactions.
9) A good counsellor does not offer advice; rather, he understands and guides. In order to do so, he discusses the subject with the client, leading up to the suggestion in such a way that, sometimes, the client may himself propose it. Tact and timing are important in this context. Remember, several of persons (who did not take the trouble to understand the client) would already have offered advice to the client before he came in for counselling.

 10) A good counsellor does not impose his opinions, beliefs, and values upon his client, particularly if the client already has a valid opinion, belief, or value system.
11) A good counsellor is sensitive to the client's emotional state. For example, he does not probe sensitive areas until he is certain that the client is ready to disclose the desired information. Or, he does not advise until he is certain that the client is ready to receive that piece of advice. Or, he does not convey to the client an interpretation of behaviour until he is certain that the client is ready for the understanding.
12) A good counsellor is not a voyeur. He does not ask for information that will . embarrass the client without contributing materially to the counselling process.
13) A good counsellor is patient. He does not expect the client to reveal everything at once. He does not expect the client to show dramatic improvements with counselling. He understands and is accepting when the client experiences 'slips' after improvement.
14) A good counsellor is optimistic, and is able to convey this optimism to the client.
15) A good counsellor has a sense of humOUT. This can produce transient lightening of the client's mood, and help him feel more positively about the counselling sessions.
16) A good counsellor focuses the session around the patient alone, and does not allow any aspect of his personal life to contaminate the session. Ifevents in the counsellor's life have provoked irritation, impatience, sadness or any other emotion, he avoids allowing these to become visible to the client. Although this is a controversial subject, most believe that counsellors should avoid self­disclosure. Most clients wish to believe that their counsellor is infallible, and do not want to know about problems that their counsellor is facing, or has faced.
1.8 COMMUNICATION SKILLS OF A GOOD COUNSELLOR
Counselling is an interpersonal process, and good communication skills are therefore essential if a counsellor is to be effective. Let us now examine some of the characteristics of a good counsellor:
1) A good counsellor is conscious of his body language and the impact that it has on the client. He makes eye contact with the client, nods to convey his interest to the client, and avoids signs of boredom (e.g. yawning) or restlessness
(e.g. fidgeting).
2) A good counsellor listens far more than he talks. He practices reflective listening; that is, saying a few words every now and then that reflect the gist of what the client just said. He does not interrupt unless absoll~~dy necessary.
3) A good counsellor is polite, courteous, and tactful. He IS aware of the client's sensitivities. He does not make his client feel Juilty for past mistakes. He practices good timing in conveying his insights tJ the client.

1.9 CHARACTERISTICS OF A GOOD CLIENT
Counselling can benefit everybody, irrespective of age, sex, culture, creed and other characteristics. Intelligence is also not a prejudicial issue, provided that the client is sufficiently intelligent to understand what is happening during counselling. In most cases, the client approaches the counsellor of one's own choice or through referral services. However, in most cases of alcohol and drug addiction, a client is motivated and sometimes forced to seek counselling.
There are certain client characteristics, however, which can increase the extent to which a client may benefit from counselling. These characteristics describe a 'good' client, and are considered in this section.
1) A good client is self-motivated for therapy. A friend or family members do not bring him unwillingly.
2) A good client is flexible, and is willing to accept that his point of view may be incorrect. He is willing to consider alternate options that may facilitate his adjustment.
3) A good client is psychologically minded. He accepts that his behaviour may be influenced by unconscious impulses. He is able to introspect and analyze his moods and behaviour with the help of the counsellor.
Client characteristics that suggest a favourable outcome: In addition to the good client characteristics, discussed in the previous section, certain client characteristics suggest an increased likelihood that the client will respond favourably to therapy. These client characteristics are:
4) Fewer past problems,
5) Better previous adjustment in social and other walks of life,
6) Healthy family life,
7) Healthy social life,
8) Good physical health,

9) Ability to relax and enjoy leisure pursuits, 
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