Counselling and psychotherapy

Published Date: 23 Mar 2015 Last Modified: 15 May 2017

The objective of the final assessment was to video a short counselling session, and then to write a reflective essay critiquing the session in light of the particular counselling method selected. The logistics of the interview were made difficult by a recent move to a country area, where I did not have access to recording equipment, a DVD burner, or classmates willing to volunteer to act as the client. After a few technical difficulties, I was able to record a session using a webcam. It was then that I found that I was unable to burn the file to a disc, and after looking through the entire town for a business that would burn it to disc, finally transferred the file to a memory stick to be posted.

Approach

The chosen approach was person-centred counselling, where the client is at the centre of the method, unlike some other forms of counselling where technique is more pronounced. The approach, founded by Carl Rogers in the 1940's, has also been called 'non-directive' which also emphasises that the counsellor is not giving advice and directions, but rather a format where the client can look at and consider their own feelings and options. Rogers also focused on the present rather than the past, as opposed to the Freudian approach, as well as a closer focus on feelings. In addition, Rogers used the term client rather that patient, to highlight the fact that the person being treated was taking responsibility for their own selves, rather than being reliant on the counsellor. In the person-centred approach, it is the client who ultimately makes all decisions, looks at alternatives, and takes responsibility and ownership of their own lives and choices.

Dryden & Mytton (1999) identify three important areas in person-centred counselling. The first is creating an environment in which the client can freely express their emotions. Approval and understanding from the counsellor towards the client is stressed. The outlook of the counsellor is also important, and the counsellor must trust the client to be able to cope with their problems, and undertake change and development. The counsellor is there to provide support and empathy, and unconditional positive regard. The counsellor's own feelings and world-view must also be taken into account - there must be congruence between the counsellor and client - there need to be a genuineness of emotion, with the counsellor being really there in the moment of the session.

The theory behind the person-centred approach puts forward that as long as there is unconditional positive regard, empathic understanding and congruence, all the core conditions for theraputic improvement or problem solving are met, and positive change will occur.

As I counsellor using a person-centred approach, I would be trying to establish the core conditions, and be non-directive. Using this approach I do not try to cause anything to happen, or prevent any thing from happening, it is the client who does the real work.

One of the better analogies I've heard to describe this approach is it is the counsellors' job to hold up a mirror for the client - we need to comb our hair, and can do an okay job without the mirror, but unusually there are spots we cannot see without the assistance of the mirror, and maybe can do a better job if we can view our hair from a different angle. It may take some extra time, and we may have to hold the mirror just so to catch that awkward angle, but we can see so much more, hopefully in a more sympathetic and kinder light.

Evaluation

Trini agreed to not only record the session on her webcam, but to be the client as well. This was appreciated, especially as the only from of counselling that Trini is familiar with is either around the kitchen table with family, or with an ordained minister. When asked as to what subject she would like to discuss, that would not to substantial or in-depth, Trini requested that we discuss baby names, as it is only a few weeks until the birth of her next child, and a decision was still to be made about names.

The setting was chosen to more due to the location of the webcam, as much as for privacy and fewer distractions from noise outside or children. There was not much choice in seating, but it was comfortable for Trini, who has reached quite an uncomfortable stage in her pregnancy is not able to sit for too long in any one position. In addition to the physical environment, I tried noticeably tune in to improve communication as described by Egan (2007; 71). The acronym SOLER is used by Egan to sum up these key skills:

I tried to establish and keep eye contact as much as possible, although I found this harder when taking notes of names for Trini. I think I will need a bit of practice to get to the point where taking notes is not a distraction for both myself and the client. Throughout the session I tried to always facing Trini, maintain eye contact as much as possible, stay calm and relaxed, lean forwards without being too overt; more of an incline of the head rather than the entire body.

Throughout the session I tried to encourage Trini to do most of the talking, ask as many open questions as possible, and pay attention to what the client way saying and how it was said, and listen without expressing criticism or judgment. The session was also very brief, partly due to it being an assessment rather than a normal session of fifty to ninety minutes, besides Trini being unable to sit comfortable for any length of time. After becoming used to longer practice sessions in class, if felt very strange to take such a short time.

Because of time constraints, information about privacy and confidentiality was provided prior to the session. No sensitive matters were discussed, but it was still important for Trini to know how the recorded information would be treated and stored.

I started the session with thanks and "what would you like to talk about", which I prefer due to its simplicity and directness.

Improvement for future

The physical location of the session could definitely been improved, but there was little that could be changed due to technical restraints. Counsellor Challenges

The line between talking too much and talking too little.

Fight the need to jump in, to talk, to fill in the gaps - sometimes silence is just fine.

Burnout - trying to do much, insufficient supervision and support

Taking breaks, and not doing too much.

Personal and professional development.

Develop more effective techniques - learn more about different problems. Learn more about specific problems effecting people living in remote or rural communities.

In such a small community, being extremely vigilant concerning privacy and confidentiality, offering alternatives where needed.

Personal and professional implications

I have to have sufficient and specific training to address different kinds of issues that present in rural communities - I don't want to try to treat problems outside my range of experience.

I need to be able to listen to the client, and hear the changes that they want to make and their goals for therapy - it is not about me. I need to be able to clearly communicate how I can help the client solve for themselves whatever problem or concern they have. I cannot make any promises or guarantees, but I can walk with the client as they go through the problem solving or decision making process.

I need to continue to be non-judgmental of any clients' life choices, behaviour, or the problems that they face. I need to be able to keep up-to-date with any changes in legislation and policy to be able to provide accurate information about client rights, confidentiality and informed consent, and appropriate duty of care towards my clients.

I need to find a balance in my own work life, incorporating adequate supervision and continued education. If I am not able to deal with my own emotional issues, feelings and what is happening in my life, I will not be able to efficiently help others to cope with their own problems and emotional issues.

References

• Bolton, R. (1986) People Skills: How to Assert Yourself, Listen to Others and Resolve Conflict. New York: Prentice-Hall.
• Brammer, L.M. and MacDonald, G. (1996) The Helping Relationship, Process and Skills 6th ed. Boston: Allyn and Bacon.
• Burnard, P. (1999) Counselling Skills for Health Professionals 3rd ed. Cheltenham: Stanley Thorne.
• Dryden, W. and Mytton, J. (1999) Four Approaches to Counselling and Psychotherapy. London: Routledge.
• Egan, E. (2007) The Skilled Helper: A Problem Management and Opportunity Development Approach to Helping 8th ed. Pacific Grove: Brooks/Cole Publishing Company.
• Heaton, J.A. (1988) Building Basic Therapeutic Skills. San Francisco: Jossey-Bass.