Summary PYC3705 STUDY NOTES

PYC3705 - Transformative Counselling Encounters Study notes Transformative counselling encounters (University of South Africa) Potential phases and aspects of transformative counselling encounters Step 1: Relationship Building The first step involves building a relationship and focuses on engaging clients to explore issue that directly affect them. The first interview is important because the client is reading the verbal and nonverbal messages and make inferences about the counsellor and the counseling situation. Is the counsellor able to empathise with the client? Does the client view the counsellor as genuine? Some steps for Relationship Building for the Counsellor  Introduce yourself  Invite client to sit down  Ensure client is comfortable  Address the client by name  Invite social conversation to reduce anxiety  Watch for nonverbal behaviour as signs of client’s emotional state  Invite client to describe his or her reason for coming to talk  Allow client time to respond  Indicate that you are interested in the person Step 2: Problem Assessment While the counsellor and the client are in the process of establishing a relationship, a second process is taking place, i.e. problem assessment. This step involves the collection and classification of information about the client’s life situation and reasons for seeking counselling lOMoARcPSD| Step 3: Goal Setting  Like any other activity, counselling must have a focus.  Goals are the results or outcomes that client wants to achieve at the end of counselling.  Sometimes, you hear both counsellor and client complain that the counselling session is going nowhere. This is where goals play an important role in giving direction.  Goals should be selected and defined with care. Step 4: Intervention  There are different points of view concerning what a good counsellor should do with clients depending on the theoretical positions that the counsellor subscribes to.  For example, the person-centred approach suggests that the counsellor gets involved rather than intervenes by placing emphasis on the relationship.  The behavioural approach attempts to initiate activities that help clients alter their behaviour. Step 5: Evaluation, follow-up, termination or referral  For the beginning counsellor, it is difficult to think of terminating the counselling process, as they are more concerned with beginning the counselling process. However, all counselling successful termination aims towards terminating the counselling process will have to be conducted with sensitivity with the client knowing that it will have to end.  Counsellor always mindful of avoiding fostering dependency and is aware of own needs.  Preparation for termination begins long before open door / plan for possibility of future need.  Termination considered not just at end of successful relationship, but also is considered when it seems counselling is not being helpful.  Think of this as a means of empowering client.  Role to review progress, create closure in client counsellor. lOMoARcPSD| STUDY NOTE 1 for PYC3705 Theme: Principles of checking-in, building rapport (relationship) confidentiality and informed consent within counselling Counselling is a professional activity and as such it is important that at the beginning both parties are clear about what is on offer. Rapport can be understood as a harmonious or empathic relationship. The development of rapport starts with the initial contact and continues throughout the counselling process. Effective rapport is crucial for individuals seeking counselling, as this may be the first encounter with a professional counsellor and this interaction may either encourage or discourage the client from seeking counselling in the future or following up for subsequent counselling sessions. So after meeting your counsellor and chatting through what your difficulties are, the counsellor will invite you to make a 8contract9 this is basically an agreement which can be verbal or written, it sets out clearly what the counsellor is offering so you the client can make an informed decision on whether to proceed or not. o Engaged with the client during initial contact o Opening up the counselling space o Making an assessment on the client o Negotiated of the counselling contract together with the client o Preparation for the session both internally and externally Contracting issues to be considered in order to set the terms of engagement between the counsellor and client: A contract will usually cover the following areas;  Time and day/s of session/s.  Duration of the session  How many sessions are available  What approach the counsellor uses  Fee (if a paid service)  Cancellation policies  How long you notes will be kept for, who can see them, and how they will be disposed of.  Complaints procedure  Confidentiality Checking and verifying client expectations: As a client you would expect a counsellor to offer confidentiality; however there are some exceptions to confidentiality. Exceptions are disclosures such as: Harm to self, harm to others, (this is usually the policy of organisations who employ counsellors). Money laundering, Acts of terrorism, Drug Trafficking9 Child protection issues9 which the counsellor has a legal obligation to disclose. Open Rubric Downloaded by Thomas Mboya () lOMoARcPSD| The counsellor may also ask you would like them to respond if for instance you bumped in to them in the street and they were with their family, it might be that your client wants you to ignore them so that they don9t have to answer awkward questions such as 8 who was that ? 8 Finally when you agree the contact which in my experience takes about 10 minutes, then the work begins as you explain you issues to the counsellor and together you try to make sense of them and may be come to a resolution. Confidentiality Confidentiality is the process of protecting an individual9s privacy. It pertains to treatment of information that an individual has disclosed in a relationship of trust, with the expectation that this information will not be divulged to others without permission. Principles of confidentiality within counselling Confidentiality within counselling refers to the premise that what you say to your counsellor stays with your counsellor. You do not expect a counsellor to discuss your case sat in a restaurant with friends. Indeed it may be this confidential relationship that attracts people to counselling. Counsellors should make efforts to protect and respect their client9s privacy. This will include looking after personal details as well as records of counselling sessions. The Health Professions Council of South Africa HPCSA contains a privacy rule that creates national standards to protect individuals' medical records and personal health information, including information about psychotherapy and mental health. The clauses state that: • No information is exchanged with a third party, unless with prior client consent. • The content of the meeting remains private and confidential. • In extreme circumstances, where the counsellor becomes concerned for the personal safety of the client, the client is informed that confidentiality may be broken Limitations that prevent total confidentiality: Confidentiality is taken seriously by counsellors. However, there is no such thing as absolute confidentiality and it is misleading for a counselling service to imply this. There are a number of limitations that prevent total confidentiality which clients and potential clients should be aware of. Counsellors have legal and ethical obligations which could cause a break in confidentiality. Legally, records can be subpoenaed if it is required by law. Also, there are some laws which demand reporting of child abuse or suspected child abuse. Ethical decisions may have to be made when a counsellor feels other agencies need to be involved. For example, if a client is at a high risk of suicide. Such occurrences are rare and would be discussed with the client first, as long as this is feasible. There are other possible situations where a client9s case may be discussed with others. What if the client is under 18? Will their case be talked about with the parent? In such cases, counsellor should have a clear guideline of how confidentiality will work and both parent and child should be aware of the situation. If the counsellor works for an organisation or a health centre, client information may be shared with relevant parties. Such discussions would be for professional purposes only, with the client9s wellbeing in mind. Informed Consent Informed consent in the field of psychology is extremely important and is most relevant in psychotherapy, counselling, assessment (testing) and research settings. The standard of care in psychotherapy, psychological assessment and mental health research requires that clients be informed so that they fully understand the nature of the proposed interventions or procedures. Informed consent is also relevant in Downloaded by Thomas Mboya () lOMoARcPSD| situations where counsellors and clients communicate via email, and when a client authorizes a counsellor to release confidential information or to record a session. There are many other situations where informed consent is applied. Informed consent not only protects the client but also protects the clinician. By obtaining informed consent, the clinician possesses proof of the consent. By obtaining informed consent in writing, the clinician possesses even clearer proof of the consent. Unless a client can provide proof that s/he was misinformed or was not competent to provide consent, the signed document can minimize risk for the clinician should the matter end up in court. In such proceedings, a written consent will usually legally override later denial of informed consent by a client. However, written consent is neither always possible nor always clinically advised. Consent is most often used prior to beginning of therapy, counseling or psychological assessment. It is also used to authorize counsellors to release or reveal confidential information about the patients whom they are treating or have treated. The Process of Informed Consent: The process of securing informed consent has three phases, all of which involve the exchange of information between counsellor and client. Many scholars emphasize that informed consent is not just signed documents. It often involves a process, dialogue or discussion between a counsellor and a client. Generally, the process of informed consent involves three parts: Providing the client with information, evaluating the client's capacity to understand the information and, finally, obtaining consent from the client. Following are short discussions of these three parts: 1.The counsellor must communicate the nature, risks and benefits of the procedure, treatment, research or any other eventuality that the client is consenting to. This also includes authorizing the counsellor to release information, communicate by email, record a session, etc. At this phase the client gets to ask questions and be engaged in a dialogue or discussion with the counsellor. The counsellor should also outline feasible alternatives to the treatment (if there are any) and emphasize the element of choice (if there is any), so the client is clear on all options. The client should also be presented with information about the most likely outcomes of the treatment, release of information, etc. It is very important that information be presented so that the client can comprehend it clearly and rationally. 2.The counsellor must evaluate whether or not the person has the capacity to understand the information and is competent to make an informed decision regarding his/her healthcare and treatment or other occurrences. Once this has been determined, and the counsellor has provided the necessary information, the counsellor must determine whether or not the information provided was understood. The counsellor must be able to ensure that the client clearly understands and accepts the risks inherent in the procedure, release, or treatment. When appropriate and possible, the counsellor may verify that the individual is proceeding with the identified option with clear knowledge and forethought about its risks and benefits. 3.Finally, the client must acknowledge the s/he has been informed and expresses their consent in some way. There are several ways that a client may acknowledge that s/he has been informed and that consent is given. Written informed consent is only one form of consent, and there are situations where informed consent is either not required or impossible to obtain. Other situations may avail verbal or other consents but not written ones. For persons who are legally incapable of giving informed consent, psychologists nevertheless (1) provide an appropriate explanation, (2) seek the individual's assent, (3) consider such persons' preferences and best interests, and (4) obtain appropriate permission from a legally authorised person, if such substitute consent is permitted or required by law. When consent by a legally authorised person is not permitted or required by law, psychologists take reasonable steps to protect the individual's rights and welfare. When psychological services are court ordered or otherwise mandated, psychologists inform the individual of the nature of the anticipated services, including whether the services are court ordered or mandated and any limits of confidentiality, before proceeding. Downloaded by Thomas Mboya () lOMoARcPSD| Psychologists appropriately document written or oral consent, permission, and assent. There are, obviously, many exceptions to the process of securing informed consent in counselling. Emergencies are obvious examples. Many state laws and professional association codes of ethics have provisions that permit or even mandate to release information and provide treatment and assessment under certain circumstances, without an informed consent. These situations may include when a client is in danger to self or others, child or elder abuse or neglect. Downloaded by Thomas Mboya () lOMoARcPSD| STUDY NOTE 2 for PYC3705 Theme: Attending behaviours in counselling setting Non-verbal and verbal attending with regard to 8listening and sensing9 Reflecting and clarifying. As well as paying attention to and matching body language with the person we are communicating with, it helps if we can also match their words. Reflecting back and clarifying what has been said are useful tactics for repeating what has been communicated by the other person. Not only will it confirm that you are listening but also give you opportunity to use the words and phases of the other person, further emphasising similarity and common ground. Attending: In relationship listening, attending behaviours indicate that the listener is focusing on the speaker. Nonverbal cues are crucial in relationship listening; that is, your nonverbal behaviour indicates that you are attending to the speaker4 or that you aren9t! Eye contact is one of the most important attending behaviours. Looking appropriately and comfortably at the speaker sends a message that is different from that sent by a frequent shift of gaze, staring, or looking around the room. Body positioning communicates acceptance or lack of it. Leaning forward, toward the speaker, demonstrates interest; leaning away communicates lack of interest. Head nods, smiles, frowns, and vocalized cues such as <uh huh,= <I see,= or <yes=4all are positive attending behaviours. A pleasant tone of voice, gentle touching, and concern for the other person9s comfort are other attending behaviours. Downloaded by Thomas Mboya () lOMoARcPSD| STUDY NOTE 3 FOR PYC3705 Theme: Counselling Micro-skills:  Micro-skills are the basic foundational skills involved in effective helping relationships.  They are the foundational tools on which the success of interventions with clients may depend.  They help to create the necessary conditions from which positive change can take place.  They provide the client with such alliance building constructs as empathic understanding, genuineness and acceptance, and will greatly facilitate the development of a safe therapeutic environment.  They will aid in establishing rapport with clients: Rapport can be understood as a harmonious or empathic relationship. The development of rapport starts with the initial contact and continues throughout the counseling process. Effective rapport is crucial for individuals seeking counseling, as this may be the first encounter with a professional counselor and this interaction may either encourage or discourage the client from seeking counseling in the future or following up for subsequent counseling sessions. Essential Counselling Micro-skills: The micro-skills are a set of verbal and behavioural responses that facilitate the process of counselling and alliance formation regardless of the counsellors’ theoretical orientation. These skills are presented as a hierarchy that is organised within a systematic framework. At the bottom of the hierarchy are the basic attending skills such as patterns of eye contact, body language, and tone of voice. A bit farther up the skills hierarchy is the basic listening sequence, which includes questioning, paraphrasing, summarising, and reflection of feelings. List of Micro-skills: Attending  Good communication involves more than just verbal content4much communication takes place non-verbally. Following validation and education, clients ranked nonverbal gestures and presentation and body language as the most important alliance building factors.  Non-verbal attending behaviours communicate a counsellor’s interest, warmth and understanding to the client, and include such behaviours as eye contact, body position, and tone of voice. Focussing  Identification of a problem Open Rubric Downloaded by Thomas Mboya () lOMoARcPSD|  Zooming in on the clients’ particular thoughts, feelings or behaviours  Engages the client by reflecting on the observation(s) made  Focuses on the client’s experiences at the moment Empathic response  Entering the client’s frame of reference  Ability to see the client’s point of view and reflect it accurately  Accurate reflection of the client’s issue(s)/situation  Respond to client’s core message Clarifying/ Taking note of contradictions  Used when what the client says and his/her presentation are at odds  provides opportunity for deeper exploration  Gentle/indirect ways of challenging any contradictions Minimal encourager  Shows counsellor’s involvement with client and encourages them to talk more about the topic  Confirming and emotionally facilitating responses  Shows counsellor is listening Paraphrasing  Conveys the same meaning with different words/ conveys the essence of what the client said  Tentative, clear and concise, helps clarify things  Used to check perceptions  Conveys the message <I’m with you= Closed question  Used to narrow the area of discussion  Usually answered with yes or no  Can be used to direct the person’s thoughts back to the conversation Open ended question  Effective in gathering information and continuing a conversation  Provides client with maximum opportunity for self-exploration  Leads to further explanation of the topic(s) under discussion  In most cases cannot be answered with one word response  Can be used to aid clients in exploring their thoughts and feelings  (Any response which alludes to above suggestions) Summarising  Encapsulates the client’s or the client’s and the counsellor’s verbalisations, behaviours and feelings and presenting them back to the client  Integrating and ordering the discussion  Most important moments are captured  Links points and themes together  Helps client gain perspective of his/her situation Reflecting Feelings Downloaded by Thomas Mboya () lOMoARcPSD|  By reflecting feelings a counsellor can help the client become aware of the emotions experienced in relation to the issue at hand.  Reflecting feelings can promote the development of accurate empathy and help to create a safe environment for the client.  To reflect feelings one must be able to recognise and put words to those feeling states observed in the client. To aid in identifying a client’s feelings:  Pay attention to the affective component of the client’s communication� 삄 Pay attention to the client’s behaviour (e.g., posture, tone of voice, facial expression)  Use a broad range of words to correctly identify the client’s emotions.  Silently name the client’s feeling(s) to yourself. When reflecting feelings to your client:  Use an appropriate introductory phrase (e.g., sounds like...., you feel...., it seems...etc.)  Add a feeling word or emotional label to the stem.  Add a context or brief paraphrase to anchor or broaden the reflection.  Pay attention to the tense (present tense reflections can often be more powerful).  Do not repeat the client’s exact words.  Reflect mixed emotions.  Check out the accuracy of the reflection of feeling with the client. Downloaded by Thomas Mboya () lOMoARcPSD| STUDY NOTE 4 for PYC3705 Theme: Termination: the final stage of the counselling process When any relationship ends, including a counselling relationship, there are many emotions that those individuals involved in the relationship may experience. The Termination Stage is the final stage of counselling, but is just as important as the initial phase of counselling. How you close your counselling relationship can have a significant impact on your client's view of his or her experience in counselling and the likelihood of their practicing what has been learned in counselling after sessions have concluded. Termination is the final stage of the counselling process but is not something that should be broached during your last (or next to last) session with a client. Doing so does not allow for the proper amount of time for counsellor and client to process what termination means, how the client will handle the conclusion of the counselling relationship, and what follow-up contact or transitioning needs to happen for the client. Termination should be among the first topics that you and your client discuss. The therapist must be clear from the first contact, unless there are mitigating circumstances, which the intent of treatment is to help the (client) function without the therapist. As a counsellor, you are ethically bound to communicate to your client how long you will be available to counsel them, to discuss openly the timeline of your relationship, and to make appropriate referrals or recommendations at the conclusion of your relationship. It is a stage of counselling that clients need to be prepared for and counsellors need to address early on in the counselling process to avoid abandonment. Features of initiating termination: 1. Summarise the session  Ask client to summarise the main points that have emerged in the session  Refer back to overall goals of the counselling discussed in contract, if established 2. Review and remind about the action plan for after treatment  Discuss way forward  Establish need for more counselling sessions  Establish type of issues to be explored in counselling  Establish need for referral or whether help with the remaining problems can be provided within the same counselling process 3. Emphasise achievements  Acknowledge progress made and offer word of encouragement if client has made good progress  Stress specific outcomes which counsellor thinks has been helpful  Invite client to mention the highlights of the sessions 4. Normalise mixed feelings  Check feelings of sadness provoked by imminent ending of counselling relationship  Remind client that feelings are normal and appropriate 5. Conclude on a high note  Give client a meaningful quote or statement to think about  Utilise a metaphor where appropriate to describe the counselling process or counselling relationship  Thank client for involvement and wish them luck in the implementation of any steps or plans agreed upon  Remind client of ongoing availability of counsellor Open Rubric Downloaded by Thomas Mboya () lOMoARcPSD| STUDY NOTE 5 for PYC3705 Theme: Multicultural issue in a counselling relationship: The ethical and professional foundations for culture-centered counselling. Explanation of culture-centered counselling: Approach: The "culture-centered" approach to counseling and therapy assumes that cultural factors complicate counseling, but in a positive way, and that behaviours have no meaning until they are understood in the cultural context in which those behaviors have been learned and are displayed. Culture controls our lives and defines reality for each of us, with or without our permission and/or intentional awareness. A <culture-centered= approach to counselling recognises culture as central and not marginal, fundamental and not exotic, for all appropriate counselling interventions. The culture-centered approach to health communication explores the ways in which cultural meanings are co-constructed by participants in their interactions with the structures that surround their lives. By being culturally aware and recognising how culture will affect the counselling process, this cultural awareness will support the counsellor in developing an empathic understanding towards clients. Furthermore, it stressed the importance of empathic understanding. When counsellors exercise their multicultural counselling skills with their clients, it is imperative to provide them with guidelines which stressed self-experiences, self-awareness, and knowledge of culture. Cross–cultural awareness facilitates the counsellor’s knowledge, understanding, and respect for culturally diverse clientele. Culture-centered counseling theory provides an effective framework for addressing the needs of ethnically diverse lesbian, gay, bisexual, and transgender clients. The teaching material in this module described a cultural centered method to counselling:  have a clear sense of the diverse issues that affect well-being in society;  evaluate social contexts and identify potential counselling contexts;  be sensitive to issues of culture and diversity, including perceptual diversity;  see these within the broader socio-political contexts within which they present themselves;  have an awareness of culture, and how cultures and discourses shape identities, and  start seeing the relationship between health, wellness and community as well as the environment – where relationship is part of the promotion of well-being. Understanding personal biases: It is possible to unconsciously slip into your own biases when supporting a person from a different social background or culture, and in subtle ways communicate your disagreement with their religious beliefs or disapproval of their lifestyle. It is crucial that counsellors do not become culturally encapsulated. Cultural encapsulation puts counsellors at risk of using stereotypes, becoming judgmental, and imposing their values on their clients. Being able to show a positive and unconditional regard for people can help in forming a successfully progressive relationship between people. This unconditional way of being present is the basis from which people can explore thoughts, feelings and experiences, and develop a sensitivity and acceptance of diversity. The absence of conditional support inhibits interaction and the possibility for a meaningful encounter. We note in the study guide (story Mrs Bengu’s) that a positive acceptance of the other person is the key to encouraging interaction and even disclosure. Unconditional positive regard creates an opportunity to explore change, and provides a client with acceptance and genuine caring Counsellors are encouraged to respect and accept their clients and their life styles, receiving them as who they are, non-judgmentally. However, South African counsellors are faced with many challenges. They must first educate themselves about the new culture, and learn more about their beliefs and values of the people around them. Counsellors might need to ask clients to educate them about their cultures. It is especially important for counsellors to establish trust with clients and to demonstrate unconditional positive regard. Stereotypes, perceptions, and beliefs that counsellors hold concerning groups that are culturally Downloaded by Thomas Mboya () lOMoARcPSD| different could hinder their ability to form helpful and effective relationships. Collaborative relationships might be difficult to form in the presence of such hindrances. Aspects of awareness and differences between the client and counsellor: A culturally competent counsellor does not see her or his group‟s cultural heritage, history, values, language, traditions, arts/crafts, as superior to that of others. A culturally competent counsellor is open to the values, norms, and cultural heritage of clients and does not impose her or his values/beliefs on clients. Perceiving clients from other cultures in a negative way might lead clients to believe that the counsellor is superior to them, impairing the collaborative relationship between the counsellor and the client. Counsellors’ awareness of personal culture will benefit their clients and help them with the process of gaining awareness of cultures that are different from their own. The most important work for every counsellor is to become more culturally responsive and respectful. Cultural competence is first and foremost a commitment to take the next step, and the next and the next toward offering accessible and appropriate services for the diverse clients and communities being served. Counsellors need to learn to ask questions sensitively and to show respect for different cultural beliefs. A Multicultural issue in a counselling relationship It is very important especially in multicultural counselling to treat each client as an individual person first. Then being aware of possible differing values and beliefs according to culture, the counsellor must ask questions to find out exactly what the cultural differences are and how they impact on the client’s wellbeing. The main objective of counselling should always be respect for the client. The counsellor needs to be even more aware of not putting their own values and beliefs onto the client. Be careful not to assume how life is for them. What the counsellor may perceive to be difficult for their own culture may not necessarily be a problem in other cultures. We must be careful not to stereotype clients into cultures but rather to learn from them by asking questions and trying to truly understand and empathise with them and the problems they may be having, whether the problems are relationship or cultural. In summary, in multicultural counselling, counsellors need to be aware of their own values and belief system and understand that there are differences in all cultures. To realise that they do not need to know the values and beliefs of other cultures but they must be aware that they exist and to ask appropriate questions in order to understand the client’s cultural differences. If counsellors are honest and comfortable within themselves, clients will be more confident and willing to work in the counselling process, which leads to successful outcomes. Counsellors should endeavour to continue to gain self-awareness and experience in all aspects of counselling and to have regular professional education and supervision. Culturally competent counsellor Cultural sensitivity also allows a therapist to gain and maintain cultural competence, which is the ability to first recognise and understand one's own culture and how it influences one's relationship with a client, then understand and respond to the culture that is different from one's own. One key way to begin to establish your multicultural competency is to evaluate your own background and beliefs. By starting to understand your own underlying cultural assumptions, you will be training yourself to see your views as just a starting point for your work rather than a default setting shared by all of the people you encounter. Once you have a firm understanding of your own cultural grounding, you should begin to widen your focus on the ways that individuals from different backgrounds view the world. Reading up on the professional and clinical literature can help, as can looking in some unlikely places. Memoirs, for instance, are a great way to increase your understanding of how certain historical events impacted different social groups in ways that may affect their members’ psychology. The most important first step you can take to become a more culturally competent counsellor is to learn about the historical and social context behind inequities in the South African apartheids history. Understanding why certain groups have been historically disadvantaged, and understanding the impact this Downloaded by Thomas Mboya () lOMoARcPSD| has on development, is key to being able to communicate effectively with clients. Showing empathy and genuineness encourages the development of trust. Maintaining warmth and understanding, without