KCD S1 Eng

Counseling Practice and Research
Week 10. Stages and Processes of Counseling

Contents
1 Progression of Counseling: Overview

1 Stages, Cycle, Process
2 General Stages of Counseling

1 The Beginning of Counseling
2 Understanding Client's Main Complaint and Setting Goals
3 Evaluating and Understanding the Client
4 Wrapping Up and Linking Sessions
Ⅰ. Progression of Counseling: Overview
1 Stages, Cycle, Process

1 Atheoretical Stages vs. Theoretical Stages
2
Big Cycle vs. Small Cycle
Atheoretical Stages vs. Theoretical Stages
Stages, Cycle, Process
Atheoretical Stages
General, transtheoretical stages; not concerned with one partic-
ular counseling approach
[Example]
• intake interview  early stage  working stage
Individual  termination stage
counseling • relationship building  goal setting  interven-
tion  termination
• Formation of group  initial stage  transition
Group stage  working stage  final stage
counseling
(Corey, 2014)
Atheoretical Stages
[Example] Prochaska’s ‘Stages of Change’
Pre-Contem-
Contemplation Preparation Action Maintenance
plation
• A new be-
• Is aware of
havior re-
• Has no in- the prob- • Is motivated
• Changes places the
tention to lem but to deal with
behavior old; is able
change not willing the problem
to maintain
to change
the change
Theoretical Stages
Stages that reflect the change mechanism of a particular theory
[Example] Rogers’ 12 stages of counseling
Details of the coun- Counselor facilitates Negative emotions
A client visits seling setting are es- the client to freely are acknowledged
tablished express emotions and accepted
Possible choices and Insights and under- Positive impulses are

Positive impulses are
directions are pre- standing of self are acknowledged and
expressed
sented facilitated accepted
Deeper insights and

Active and positive Integration of active Counseling is termi-
complete self under-
actions are engaged behaviors in life nated
standing
Theoretical Stages
[Example] Lee & Lee (2014): Counseling Process
Presenting problems and recognizing
the need for counseling
Forming facilitative relationship Promoting awareness and

rational thinking
Setting goals and structure

Planning practical action
Attempting to solve problems Evaluating action results

and terminating
Theoretical Stages
[Example] Earley (1999): 4 Stages of Group Counseling
Therapeutic Inner heal-

Approach Responses
Experiment
ing
Theoretical Stages
[Example] Kim (2009): Process-based Intervention Model (PBIM)
Accepting Learning
Experiencing Affirming Improving
existential knowledge
emotions self patterns
propositions and skills
• Exploring client’s • Confront the

messages discrepancy
• Choose be- • Practice and
• Desensitizing • Identify client’s between
tween old and maintain new
overly activated desires client’s pursuits
new behaviors behaviors
emotional re- /goals and cur-
sponses rent behaviors
Big Cycle vs. Small Cycle Stages, Cycle, Process
Big Cycle
Starts with the client's awareness of the need for counseling
and ends with termination of counseling.
Visit Relationship Goal setting Work Termination

formation
Small Cycle
Applying the change mechanism repeatedly, focusing on one
topic or situation per cycle.
(In an extreme case) there could be one cycle per session.
Visit Relationship Goal setting Work Termination

formation
Small Cycle
[Example] Rogers’ 12 stages of counseling
Details of the coun- Counselor facilitates Negative emotions

A client visits seling setting are es- the client to freely ex- are acknowledged
tablished press emotions and accepted
Possible choices and Insights and under- Positive impulses are

Positive impulses are
directions are pre- standing of self are acknowledged and
expressed
sented facilitated accepted
Deeper insights and

Active and positive Integration of active Counseling is termi-
complete self under-
actions are engaged behaviors in life nated
standing
Small Cycle
[Example] Changdai Kim: Process-based Intervention Model (PBIM)
Accepting Learning
Experiencing Affirming Improving
existential knowledge
emotions self patterns
propositions and skills
Small Cycle
[Example] Earley (1999): 4 Stages of Group Counseling
Therapeutic Inner heal-

Approach Responses
Experiment
ing
Ⅱ. General Stages of Counseling
1 The Beginning of Counseling

1 Structuring
2
Forming Facilitative Counseling
Relationship
Structuring The Beginning of Counseling
Meaning
Agreement on the circumstances, environment, and procedures
in which the counseling occurs.
• Time and spatial structure

• Role of the counselor and the client
• Counseling goals, intervention method and procedures
• Principle of confidentiality and procedures in case of a crisis
situation
Length of 1 counseling session

Duration of counseling period
Unlimited vs. limited
- Whether the fee is paid by a third party (e.g., employer, gov-
ernment, etc.)
- University counseling centers : during the semester and breaks
Challenges!!
- “How long do I have to receive counseling?”

- “Wasn't counseling supposed to end today in one hour?”
Clarifying expectations about the role of the client

Decides on the topic dealt in counseling
Initial stage • Questions of the counselor

Subsequent
• Client chooses the topic
sessions
• “Counseling is more effective when you decide on
the topic. I will help you to talk about the topic of
Method your choice.”
• Or ask “What should we talk about today?” at every
session
Adjusting the pace of counseling

Adjusting the time progression during sessions
Starting • 5 minutes
Wrapping
• 5-10 minutes
up
• when a client continues to talk non-stop.
• a client who brings up something important
Chal-
near the end of the session
lenges!!
• What should we do to wrap up without making
the client feel rejected?
Adjusting the order of topics during sessions

When clients present several topics at once (the Ms. Kang case)
Anger with Clinging be-

Self-criticism
her child havior
Adjusting the order of topics during sessions

Painful experience vs. response behaviors to a problem
• Evaluate the level of damage in the daily life functioning
• When serious : deal with response behaviors first before the
painful experience
• Challenges!!
 In case of a rape victim client, which topic should we tackle first?
- her painful experiences and emotions about rape
- the problem of how she becomes overwhelmed with her emotions and
cut her wrist, and that it is difficult for her to go to work every morning
Maintaining focus
When maintaining • Distracted client, jumping from one story to another
focus becomes dif-
ficult • Avoidance or defenses
• “Several issues came up already. Which topic should we talk about

first?”
• “I am getting a bit confused about what you are saying.”
• “I feel like we are getting sidetracked.”
Response • “Should we go back to the original (important) topic?”
• “It seems to me that you feel uncomfortable talking about this issue.
Am I right?”
• “Is there an important reason for you to feel uncomfortable about
this issue?”
Clarification of the private aspects of the relationship

Addressing: name, professor, Dr., counselor
Decide whether we will allow private questions
- whether you are married or not, or whether they can call you at home,
whether you can be friends
Decide how much of physical contact is allowed

Challenges!!
- “(A client who came with marriage/childrearing issues) Are you married?
Can a counselor who is still single help solve marriage/childrearing issues?”
- “Can you give me a hug?”
Forming Facilitative Counseling Relationship
The Beginning of Counseling
Meaning
A relationship that is essential for providing counseling and
promoting growth in clients.
Similar terms
Working
Rapport Alliance
Characteristics
Feeling of being respected, understood, and accepted
Feeling safe even in confrontations
Natural and smooth
Successful formation of facilitative relationship happens within
the first three sessions
Conditions for establishing facilitative counseling rela-

tionship
Generally similar to those of Rogers' conditions for promoting
client growth
• Unconditional positive respect

• Empathic understanding
• Consistency
• Active listening
Conditions for establishing facilitative counseling re-

lationship
Recognize client's efforts and success experiences until now

Explore previous counseling experiences
- Good aspects
- Bad aspects
- How the client ended or maintained the counseling relationship
Video Clip
General overview of the client and the video clip

Background : Mid-20s, female, graduate student, healthy and
adaptive person
- In the beginning: Felt nervous when presenting
- Later: Became aware of the discrepancy between her inner
state and outer expression, recognized and opened up about
her experiences with her parents as they are
Duration: 4 sessions (two sessions at a time)
Focus: Counselor’s responses; thoughts / emotions / decision-
making processes that happened inside the counselor
Video Clip
Beginning of counseling
Building facilitative relationship
Establishing structure
- setting counseling time and explaining about confidentiality,
etc.
Building facilitative relationship and establishing structure

View video clips A, A’
2 Understanding Client's Main Complaint
and Setting Goals

1 Understanding Client's Main Complaint
2 Setting Goals
Understanding Client's Main Complaint
Understanding Client's Main Complaint and Setting Goals
Meaning
The pain and problem that the client wants to work on
The unfortunate situation of the client
Examples
- "I'm anxious."
- "It's hard for me to make friends.“
- “I can’t concentrate on my studies.”
- "I can't control my anger."
Characteristics
‘Something that causes discomfort in the client’
The easiest way to define client's problem
Easily explores the client’s task at hand
May be modified as counseling proceeds
- Because the first main complaint has been resolved

- Because the understanding of the client's ‘real issue’ has changed
Why now?
‘Why did you decide to receive counseling now?”
Characteristics
• A core question in short-term counseling
- This can help us to access client's current most important problem.
• Sometimes the client's reason for receiving counseling isn't her

main complaint.
- “Mom said she won't give me my allowance if I don't receive counseling.”

- “I'm not a very emotional person but my husband wants me to change.”
Video Clip
Exploring the client’s main complaint

Clarifying the main complaint
- The starting point of this difficulty
- The issue of presentation anxiety
- The issue of feeling uncomfortable in front of many people
Exploring & understanding the main complaint

View video clip B
Need to state client's issues in a solvable form

Clients don't state their main complaint in a solvable form
Challenges!!
When the problem
• “I'm so stressed out because of my husband.
is pointed at oth- Please change my husband.”
ers (external fac-
• “Life is unfair. Such a rotten world~~”
tor)
• “I feel depressed.”
When the reality of
a problem is di- • It could be from loss, from helplessness due
to repeated failures, from self-criticism, or
verse
from temperament, etc.
Setting Goals Understanding Client's Main Complaint and Setting Goals
Meaning
Using client's main complaint to make a statement about the
state the client should (wants to) reach
Points to note
We need to distinguish between the objective standards as well
as client's subjective standards
Goals may include moving beyond the “normal” state
Set goals as specifically as possible
Method
Focusing on symptoms
To a state where depres-

sion is alleviated
From a depressed state

Method
Making goals more specific / behaviorism
• “If you become less depressed than now,

‘I don't want to
what are some things you would be able
be depressed.’
to do?”
• “In the recent 1-2 weeks, what were some
“I want to im- things you wanted to do but could not, or
prove my per- things that you shouldn't have done but
sonality.” kept on doing because of your bad per-
sonality?”
3 Evaluating and Understanding the Client

1 Client Evaluation
2 Case Conceptualization
Client Evaluation Evaluating and Understanding the Client
Mental state evaluation

Overall appearance
• Self-managing skills
• Out of season clothing
Appearance
• Unusual accessories (e.g., a shiny
cane)
• Suspicious and cautious about coun-
Attitude selor
• Hostile or overly compliant Client
Motor skills, ac-
• Excessively high or low activity level
tivity level
Consciousness
• Substance use or abuse
level

Awareness about the current situation
- Awareness about self, place, time, and current happenings


Emotions and feelings
• Consistency between the contents of the story and expressed emotions
Adequacy
• Ex : ‘consistent’ vs. ‘inadequate’
• Compared to how strongly an average person would feel

Strength
• Ex : ‘Dull’, ‘flat’ vs. ‘Excessive’, ‘dramatic’
• The speed and direction of client’s move from one emotion to another
Fluidity
• Ex : ‘Restricted’ vs. ‘Fast’, ‘unpredictable’
• The complexity and diversity of emotion expression

Range
• Ex : ‘Varied’ vs. ‘Restricted’

Thought content and process
• How close is the thought content to reality?
- ‘God gave me a mission to reconcile the good and the evil.’

- ‘The politician told me to choose him to give birth to superior
species, so it is my duty to seduce the politician.’

• How much does the client think he can control his own thinking?
- Whether he believes that his thoughts are controlled by the exter-
nal forces
- Whether he believes others know about his unexpressed thoughts
- Whether he believes that a thought has invaded him and that his
thought does not feel like his own

• How organized are the thoughts?
- Question: Do you know where you are now?
- Answer: "I don't care where I am. The police cares. Thieves are
stealing things so the police is in charge.

• Do the thoughts have jumps in the logic?
- Doesn't care whether the listener understands or not, and just
goes on linking his own chain of thoughts

Perception
• Hearing or visual hallucinations
• When you are suspicious of such hallucinations, ask:
- Have you heard (unknown; unidentified) voices?
- Have you ever felt the shape, sound, or smell of a certain item to
be particularly strange?
- Do you see or hear things that others do not?

Intellectual functioning
• There are many clients with low intellectual functioning and
are in poor social conditions
• They might be able to get more help from social workers or
other types of interventions
• When you are in doubt about whether your client's intellectual
functioning is low, you can ask:
- Count numbers backwards.
- Say a word backwards.
- Who is the current president?

Self-awareness
• One does not feel like oneself
• One knows one’s name and past but is not entirely sure about
oneself
• One feels like one is observing oneself
• When you are suspicious about client’s level of self-awareness:
- Do you sometimes feel like you don't know who you are?
- Does it seem like your thoughts and feelings don't belong to you?
- Do you think your feelings are realistic?
Risk of self-harm
Risk factors
• Past suicide attempts • Panic disorder
• Pain or illness • History of depression, addiction, personality
• Hopelessness disorder
• Senescence or adoles-• Humiliating stress event
cence • Severance or conflict in important interper-
• Male sonal relationship
• Unemployed • Recently improved state after a period of se-
rious depression
• Not married
• Recent or accumulated loss
Risk of self-harm
Suicide risk evaluation
• Suicide ideation
- ‘I want to die.’ ‘I wish everything to be over.’ ‘I want to revenge.’ ‘I
can’t take it anymore.’
- Question : “People who feel like that sometimes think about self-
harm. Is this the case with you?”
Risk of self-harm
• Suicide intention
- Deciding to kill oneself and actually planning it.

- The more fatal, concrete, and imminent it is, the higher the risk.
- The counselor needs to know of the details of the plan and the
characteristics of the plan.
- Especially note the answers to what, when, where, and how.
- See if the client has the means to carry out the plan.
Questions for evaluation

1 “Have you ever tried to harm yourself?”
2 “How? When was it?”
3 “Did you ever think that you should do something to harm yourself?”
4 “Did you ever make a plan to do it?”
5 “Do you think you will actually implement your plan?”
6 “When do you think you will do it?”
7 “Do you have a method to do it?”
“What do you think the outcome would be like?”

Risk of self-harm
• Impulsiveness
1 “Do you have a strong impulse to harm yourself?”
2 “What kind of impulse do you feel?”
3 “How difficult is it for you to control that impulse?”
4 “How do you usually cope with such event or emotion?”
5 “Do you know what you tend to do when you feel this impulse?”
6 “Do you feel that you can control yourself in such situation?”
Risk of harming others

Risk factors
• Previous incidences of violent behavior • Male
• Physical attack or fear-provoking actions • Separation from parents before age 16
in the recent 2 weeks • Not married
• Experience of being harmed as a victim
• Maladjustment in elementary school
• Lack of suicidal behavior in the recent 2
• Previous incidences of damaging properties or hurt-
weeks
ing animals
• Diagnosis of schizophrenia, mania, or
• Experience of substance abuse
personality disorder
• Lack of empathy
• Accumulated sense of revenge and anger
Risk of harming others

Evaluation of violence

“What method do you plan to use when you get the urge to
1
harm her?”
2 “What stops you from doing that?”
3 “How often do you think about harming xxx?”
4 “When do you think about violent behaviors?”
5 “Does this thought bother you?”
6 “Have you had this feeling before? How did you react then?”
Case Conceptualization Evaluating and Understanding the Client
Meaning
Case Conceptualization / Case Formulation
A way to define client's problem
A hypothesis about the causes and facilitating, maintaining factors
of client's psychological, relationship, or behavioral problems
(Eells, 1997)
A comprehensive description system that defines the client's ①
problem behavior and ② the factors behind it, and describes ③
the process by which those factors trigger or maintain the problem
behavior (Changdai Kim)
Function (Eells, 1997)

Helps us to organize various complex and conflicting informa-
tion about the client
Acts as a milestone that helps to promote change in the client
and provides structure for the counselor to better understand
the client
Informs us of the anticipated barriers to counseling and helps

the counselor to deeply understand and empathize with the
client
Counseling theories and case conceptualization

Counseling case conceptualization depends on the theoretical
theory and approach of the counselor
Psychodynamics
• focus on unconscious processes and conflict
Theory
• focus on environmental events, individual learning experiences, and stimulus-

Behaviorism
response association, instead of psychological, internal events
Cognitive Counsel-
• focus the dysfunctional thinking and beliefs about self, others, and the world
ing Theory
Person-centered • focus on the desire for self-realization and client's relationship with external
Theory conditions that interferes with self-realization
Process-Based Inter-
• focus on experiencing emotions, affirming self, and behavioral/thought/rela-
vention Model (P-
tionship patterns among the 5 PBIM factors
BIM)
4 Wrapping Up and Linking Sessions

1 Wrapping Up a Session
2 Starting a Subsequent Session
Wrapping Up a Session Wrapping Up and Linking Sessions
Session evaluation
“What did you learn today?”
“Was there anything about today's session that you weren't
quite satisfied with?”
“What would you like to do in the next session?”
Video Clip
Wrapping up a session
Wrapping up Session 1
Things the client has learned today
Things the client wants to discuss in the next session
Things the client wants to do differently at home
Making adjustments regarding the client's expectation level
Video demonstration
View video clip C
Video Clip
Next video clip

Wrapping up Session 2
Her difficulties in high school
Finding out what she really wanted to hear from her parents
Her tendency to talk about positive side of everything
What she had learned in the session; points to think about
Video demonstration
View video clip E
Starting a Subsequent Session Wrapping Up and Linking Sessions
Evaluating what happened after the previous counseling

session
Client’s life after the previous session
What the client had felt or learned after counseling
Anything the client has tried after the last session and its out-
come
Choosing the topic for this week

May utilize the ORS
Outcome Rating Scale (Scott Miller)

Individual (individual well-be-
ing)
Interpersonal (family, inti-

mate relationship)
Social (work, school, friends)
General evaluation
Video Clip
Next video clip

The beginning of the Session 3
In Session 2,
- The client talked about her difficulties of attending a special
high school
- The client practiced expressing herself to his parents which
was something she could not readily do before.
A new session began by utilizing the ORS.
Video Demonstration
View video clip F
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Counseling Practice and Research

Week 10. Stages and Processes of Counseling

1 Progression of Counseling: Overview

2 General Stages of Counseling

1 Stages, Cycle, Process

Possible choices and Insights and under- Positive impulses are

Deeper insights and

Forming facilitative relationship Promoting awareness and

Setting goals and structure

Attempting to solve problems Evaluating action results

Therapeutic Inner heal-

• Exploring client’s • Confront the

Visit Relationship Goal setting Work Termination

Visit Relationship Goal setting Work Termination

Details of the coun- Counselor facilitates Negative emotions

Possible choices and Insights and under- Positive impulses are

Deeper insights and

Therapeutic Inner heal-

1 The Beginning of Counseling

• Time and spatial structure

Length of 1 counseling session

- “How long do I have to receive counseling?”

Clarifying expectations about the role of the client

Initial stage • Questions of the counselor

Adjusting the pace of counseling

Adjusting the order of topics during sessions

Anger with Clinging be-

Adjusting the order of topics during sessions

• “Several issues came up already. Which topic should we talk about

Clarification of the private aspects of the relationship

Decide how much of physical contact is allowed

Conditions for establishing facilitative counseling rela-

• Unconditional positive respect

Conditions for establishing facilitative counseling re-

Recognize client's efforts and success experiences until now

General overview of the client and the video clip

Building facilitative relationship and establishing structure

2 Understanding Client's Main Complaint

and Setting Goals

- Because the first main complaint has been resolved

• Sometimes the client's reason for receiving counseling isn't her

- “Mom said she won't give me my allowance if I don't receive counseling.”

Exploring the client’s main complaint

Exploring & understanding the main complaint

Need to state client's issues in a solvable form

To a state where depres-

From a depressed state

• “If you become less depressed than now,

3 Evaluating and Understanding the Client

Mental state evaluation

Mental state evaluation

- Awareness about self, place, time, and current happenings

Mental state evaluation

• Compared to how strongly an average person would feel

• The complexity and diversity of emotion expression

Mental state evaluation

- ‘God gave me a mission to reconcile the good and the evil.’

Mental state evaluation

Mental state evaluation

- Question: Do you know where you are now?

Mental state evaluation

Mental state evaluation