Contains discussion about the different counseling techniques. The different techniques can be utilized by counselor during the process of counseling
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Discipline and ideas in applied social science
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COUNSELING Dr. Dr. Agnes Segunda Gerasmo
Counseling To To give advise or opinion opinion on what to do. Dr. Rakel – Family Practice emphasies knowledge in such areas as Family psychodynamics! interpersonal relationship! counseling and supportive psychotherapy. Dr. Dr. "ngel# $iosphychosocial %odel
CIA- Client Centee$ Counseling Catharsis# entilation Stage Insight Action $ased on (arl Rogers Also called (lient#centered counseling or patient#centered couseling.
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2 Types of Counseling 1. CIA- (Cathasis! Insight! A"tion# &ndividual counselling! with psychosocial issues 'ased on (arl Roger)s •
2. CEA- (Cathasis! E$u"ation! A"tion# &ndividual or group counseling usually done on clinical consult •
/2hen there is a discrepancy 'etween actual actual sel+ 3descri'ed 3descri'ed a'ove4! and the perceived perceived sel+# sel+# creates creates %isperc %isperceptio eption n 5Tensi ension on!! &nte &nterrnal nal (on+ (o n+us usio ion# n### ##il illl 0ealth.
The 6 main conditions can promote growth towards actual sel+ and improve communication.
1. Chaa"teisti" of a goo$ "ounselo% "mpathy *nconditional Positive Regard Genuineness Chaa"teisti" Chaa"teisti" of Goo$ Counselo% a# Genui Genuinen nenes essstransp transpar arenc ency! y! a'senc a'sence e o+ pretense. &# Un"on$i Un"on$itiona tionall 'ositie 'ositie ega$ega$we can care +or and accept the con+u con+usi sion on!! +ear +ear!! ange anger! r! lone loneli line ness ss!! resentments o+ our client. "# E)pathy a'ility to put onesel+ in the situation o+ another. 2. A"tie Listening S*ills Opening s*ill Attending Skills $racketing ,eading Re-ecting Focusing Pro'ing Summariing Closing s*ill
A"tie Listening S*ills Skills used 'y the doctor#counselor to understand how the patient sees the world and how he perceives the pro' pro'le lema mati tic c real realit ity y +or +or whic which h he is consulting.
paying ng atte attent ntio ion! n! 1. Atte Atten$ n$in ing g s*il s*ills ls# payi maintaining eye contact! nonver'als or the ver'als like saying yes or go on indicating that you are listening to the patient.
2. a"*eting #not so much a ver'al or non# ver'al skill as it is a mental skill. . +e/e"ting S*ill- /mirror re-ecting 'ack the image o+ the person gaing at it. A patient who is emotionally 'urdened is also una'le to see himsel+ clearly. "7ample Re-ecting skills8 39:;% walks in the o
3patient shi+ts in his seats and looks down at the -oor.4 The doctor gave me amo7icillin this time and & took it and the sore throat went away. $ut a +ew days ago> 3 patient takes his handkerchie+ and crumples it and pulls at it repeatedly4 >The sore throat came 'ack. 3oice 'ecomes so+ter? patient shakes his head4. & @ust cant understand what is happening.
A. +e/e"ting "ontent ver'al content is repackages or rephrased to 'ecome clearer.8 a. 'aaphasing # putting to clearer words and summariing what the patient is saying. '. 'e"eption Che"* # use same words with that o+ the patient 'ut putting /is that it / at the end to conrm the counselors perception. "7ample8 'aaphase8 This is the 6rd time you have had a sore throat within a month and you don)t understand why it keeps on coming 'ack. 'e"eption "he"* 8 This is the 6rd time you have had a sore throat within a month and you don)t understand why it keeps on coming 'ack. &s that itB . +e/e"ting 0eeling
articulate into words patients emotions. Giving name to +eelings makes pt. more aware o+ emotions. Feelings not articulated and acknowledge have a way o+ taking control o+ 'ehavior. 2hen +eelings accurately re-ected 'ack! patient +eels understood! rapport improves. "7ample8 +e/e"ting feeling 8 Cou seemed so an7ious a'out your sore throatB C. +e/e"ting Epeien"e pointing out the non#ver'als in order +or the patient to 'ecome aware o+ how he is 'ehaving. "7ample8 +e/e"ting Epeien"e 8 & noticed that a while ago you looked out at the door at your wi+e and you shut itB (ould you tell me 'ehind the actionB Lea$ing 2 in$s of Lea$ing% . In$ie"t Lea$# open invitation. (hoice o+ what to talk a'out depends on the patient. &ndirect leads take the +orm o+ words or phrases such as8 /Ces1! /Go on1! /And thenB1 E. 3ie"t Lea$# reuires that the doctor# counselor make a @udgment call to where the patient should go.
"7ample8 P8 Cou see! we have 'een married +or : yrs and we were okay most o+ the time 'ut several months ago! & noticed she had 'een less talkative and irrita'le and & got a hard time 'ecause she keeps on cutting me o. D8 Tell me more a'out how she cuts you oB 0o"using Asking the patient to prioritie his emotions or identi+y which one is heavier or trou'lesome +or him. "7ample8 D8 Cou have nancial di
Pro'es are uestions asked to elicit more in+ormation. They must 'e open#ended. Cou can pro'e 'y 'eginning the uestions with /2hat1! /2here1! and /when1 and /how1 Pro'e +or the +eeling rather than content. Pro'e where the emotional content is greatest! and watch out what the patient decides to mention last or when patient o+ten repeats it. •
1. Intepetation An active process o+ e7plaining the meaning o+ events that happened in the patients li+e +rom the Doctor# counselor Frame o+ Re+erence. &nterpretative Statements &nterpretative uestions %etaphor •
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A. Intepetatie state)ents. &t involves sharing your hunches with the patient in declarative +orm
"7ample8 P8 & hate the way & am 'eing treated in this hosp. Hust 'ecause & don)t have enough money everyone +eel they can 'other me anytime and insert all these needles. Sometimes & @ust +eel like yelling at them all to get lost. D8 Cou +eel very angry o+ the way you are 'eing treated with less respect simply 'ecause you cannot pay. . Intepetatie 4uestions The counselor who wants to conrm his hunch uses uestions.
"7ample8 D8 2hen are you going to 'e concerned a'out yoursel+ tooB P8 That)s selsh attitude. D8 So whats wrong with thatB
P8 & don)t like selsh people. D8$ecauseB P8 Selsh people arent so popular D8 3&.I.48 So popularity is important to you? and i+ you are sel+#centered! people wont like you. &s that getting close to where you are nowB Intepetation as 0antasy o )etapho Another +orm o+ interpretative statements using +antasy or metaphor. "7ample8 %etaphor8 & perceive you are like a puppet with strings who con+orms to what ever you are told to do. 2. Confontation This skill ena'les the doctor#counselor to challenge! discrepancies! distortions that the patient is using knowingly or unknowingly. a. (hallenging Discrepancies '. (hallenging Distortions. a. Challenging 3is"epan"ies (on+rontation can 'e J in on discrepancies 'etween what the patients thinks or +eels and what he says and 'etween what he says and what he does! 'etween his perception o+ himsel+ and the perception o+ others regarding who he is! 'etween what he is and what he dreams to 'e 'etween his e7pressed values and actual 'ehavior.
"7ample8 Henny says she +eels happy and is contented with her current @o' and yet e7presses that it would 'e a lot 'etter i+ she gets paid more and her 'oss would cut her some slack. She occasionally complains o+ the long hours. 3She has this tired and +araway look and a +orced smile.4 (hallenge8 Hen you say you are happy and content with your work yet & have listened a lot o+ your complaints a'out it. Also when you say your happy your eyes still have this tired and sad look. &m not truly certain i+ you are contented and happy. &. Challenging 3istotions Some patients nd reality as harsh and very hard to +ace so they distort it in various ways. . Info)ation Giing A. A$i"e Giing
Giving suggestions and Kpinions 'ased on e7perience. *se+ul in crisis situations when several people must cooperate to prepare patient +or ma@or read@ustment.
Active listening skills used in clinical practice. (orrecting o+ emotionally critical misperception! and medical misperceptions.
. Info)ing Giving valid in+ormation 'ased on e7pertise. Advise must 'e clear and relevant.
2 easons fo "onsult 1. 'hysi"al illness $iomedical aspect E. &mpact o+ illness or conseuence o+ impact o+ illness or psychosocial aspect o+ illness.
5. Su))ai6ing Tying together into several statements ideas and +eelings to close the discussion. Summaries are good way to close a session. &t is use+ul to the doctor to check i+ he has grasped the +ull spectrum o+ the patients message. "7ample8 D8 Cou)ve 'een discussing a'out your ideal @o's and what things you have liked and disliked a'out your work? Cou)ve also talked a'out your plans o+ getting more training. Are you ready to take a look at some options in planning +or a new careerB D8 Try to put it together 'rie-y. ,ets take a look at what we have accomplished so +ar. 0ow does that appear to youB
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7. Goal Setting As a result o+ earlier processes 'oth doctor and patient has a clearer view o+ what is happening and possi'le solutions to the pro'lem. This is a vital part o+ the counseling process since it ena'les the patient to e7plore new 'ehaviors to cope and deal with the circumstances. • • • •
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Specic and measura'le Realistic 0ierarchical Desired 'y the person and tailored to him. Freuently evaluated.
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL CEA Dr. Agnes Segunda Gerasmo Catharsis Education Action
+easons 8hy 8e hae to $eal 8ith I)pa"t of illness% 1. iopsy"hoso"ial Appoa"h #gives importance to the unity o+ 'ody! mind and social conte7t. /9olisti" Appoa"h:- addressing 'oth the illness and impact o+ illness. (onventional method# pathophysiology and pharmacology. E. 2e cannot 'e cere'ral when we are emotional. 2hen our patients are an7ious they nd it hard to listen to us. 6. "motions have their roots in the patients perception. •
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Perceptions o+ patient incongruent with the reality as the physician perceives it is a misperception.
EC;- E)otionally Citi"al ;ispe"eption # are misperceptions that are most# an7iety provoking.
CEA Cathasis- purgation ventilation o+ and emotions. E$u"ation A"tion CEA 'in"iples% Engel iopsy"hoso"ial Geoge )o$el %otivation +or consult may 'e due to physical illness or the impact o+ that illness. So we must address 'oth the physical and emotional impact o+ that illness. /The good
. The doctor plays as a doctor counselor. E. The doctor detects or identies misperception on the diagnosis! disease process! treatment or prognosis. 6. The doctor gives name or re-ects 'ack to the patient! what the patient +eels +or him;her to 'e aware. Goal of CEA /Mot to make patient +ear the disease process! 'ut rather +or them to understand and make clear the disease process.1
E. 2hat +eelings came out when did thoughts came to your mindB 6. 2hat conseuences o+ your illness makes you +eel this way mostB 2hat is the worst thing that your illness can do to youB 2hat is the result or outcome your illness that you dread mostB 3 "motionally (ritical %isperception4 9. Summarie the "(% and the emotions associated with it.
E$u"ation 0e will have articulated and ventilated his emotions 0e has now enough space in his mind to 'e a'le to listen. Address the "(% or medical misperceptions. "7plain and discuss to allay emotions. %ake comparison to make things clearer +or the patient. •
2hen to use it8 &+ you perceive the patient to 'e an7ious or with medical misperceptions. Chaa"teisti" of Goo$ Counselo% 1. Genuinenesstransparency! a'sence o+ pretense. 2. Un"on$itional 'ositie ega$we can care +or and accept the con+usion! +ear! anger! loneliness! resentments o+ our client. . E)pathy a'ility to put onesel+ in the situation o+ another. A"tie Listening S*ills Skills used 'y the doctor#counselor to understand how the patient sees the world and how he perceives the pro'lematic reality +or which he is consulting. . Attending skills# paying attention! maintaining eye contact! nonver'als Cathasis 1. ;e$i"al no8le$ge- as a $o"to a. "7plore the patient)s health understanding. '. &denti+y medical misperception i+ present 3on diagnosis!treatment or disease process.4 c. &denti+y 0ealth Framework.
2. E)otional='sy"hologi"al aspe"t >entilation- as a "ounselo a. Pro'ing the patients +eelings. '. &denti+y the "motionally (ritical %isperception Steps in Cathasis . 2hat came into your mind when you started +eeling your symptomsB
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Tips in E$u"ating% . Speak the language o+ the patient. E. *se the power o+ analogy. 6. *se o+ anecdotes and personal testimonies. 9. %isperceptions hidden under emotions should 'e e7plored and corrected. :. Allaying o+ an7iety.
A"tion Therapeutic Plans Pharmacologic and non#pharmacologic Schedule date and other plans. 0ee$&a"* Ask how the patient +eels.
