INTRODUCTION TO

COUNSELLING
BY GAFISEKI
Learning objectives
By the end of the session you should be able to:
• Define terms used in counselling
• Identify types of counselling
• Identify guiding principles used in counselling
• Explain characteristics of a good counsellor
• State general approach to counselling
• Explain barriers to counselling
• Explain stages of counselling
• Explain the two types of communication
• Recognize and interpret non-verbal communication
Introduction
• Counselling is a professional helping relationship of trust that aims at
helping the patient/client to make informed choices.
• It is the helping interaction which occurs between
counsellor/healthcare provider and a client/patient, families, and/or
couples, which is initiated and maintained as a means of facilitating
change in the behavior of the client/patient or in order to access
treatment, care and support services.
Types of counselling
• Individual counseling, and
• Group counseling
Individual counselling
• Individual counseling is a one-to-one helping relationship in which the
counselor helps the client to accept, own, solve or cope with the
problem.
• Features of individual counseling includes client comes on his/her
own or he/she is referred from another counselor/source
• Client coming for counseling may be an adult, youth.
Individual counselling cont…
Duration of individual counselling
• The nature and duration of individual counseling cannot be
determined until the nature of the problem is clarified.
• But in most initial sessions begin in a similar way of staying with a
client for 45 minutes to 60 minutes per session.
• Counseling relationship may terminate when a counselor and client
conclude a successful counseling relationship or client referral is
made.
Group counseling

• Group counseling is a one-to-group helping relationship in which the

counselor works with the group in seeking a solution to their common
problem.
• Example couples is considered as group
• Group Counseling is designed to help clients in a group to achieve
increased mutuality, integration, and acceptance of reality,
socialization, realistic goals, adaptability and responsibility for self.
• The general aim is to help members appraise themselves so that they
may gain understanding, and broad perceptive of themselves in
relation to others.
Group counseling cont..
Features of group counselling:
• A group of clients must have the following features:
 Clients in the group must have a common problem.
 There must be dynamic integration among members.
 Members must be reasonably mature and mentally sound to be able
to talk about and tackle their common problem.
 Members must have capacity for self-direction.
 Members should be as compatible as possible.
Group counseling cont..
Couple counselling
• Couple refers to two people, of opposite sex, who may be:
 Married
 Cohabiting (not married but a man and woman are staying together)
 Friends
• Couple counseling occurs when two individuals who have had or who
intend to have sexual relations wish to discuss issues concerning HIV
together and look for ways to cope with the situation.
Group counseling cont..
• Couple counseling occurs when two individuals who have had or who
intend to have sexual relations wish to discuss issues concerning HIV
together and look for ways to cope with the situation.
Group counseling cont..
Usually two people come in for couple counseling if:
• They intend to get married
• One or both member/s is/are sick
• They intend to have children
• They are having conflicts in the home around being honest about
sexual practices and safer sex
• The couple has a sick child; or the child dies of AIDS related complex
• They have been referred to the clinic by a doctor
Group counseling cont..
Guidelines for Couple Counseling
• In order for couple counseling to be effective, the counselor's own
knowledge and skills need to be strengthened.
• Counsellor should know:
 Tanzanian policy and services regarding disclosure
 Ethical partner notification and conditions under which confidentiality
can be breached
Group counseling cont…
 Build a working relationship with the couple
 Strengthen couple’s good relationship
 Facilitate dialogue and mutual decision making
 Encourage involvement of each partner and balance participation in
order to share their respective and enhancing the ability of listening and
respecting each others point of view.
 Help couple focus on the present
 Prevent or draw focus away from questions that aim at identifying the
source of infection
 Results are shared as agreed on during pre-test counseling
Goals of counselling
• Help patient discover their own thoughts and feelings
• Help clients/patient manage their situations by:
 Providing emotional support and safety in times of crisis
 Helping people to explore their emotions
 Helping people make informed choices and change their behaviors
based on accurate information
Effective counselling
• The counselling process is said to be effective if it meets the following
standards/qualities:
 Is private, confidential and respective
 View the patient as the expert on his/ her own life
 Understands that the patients come to counselling with great
strengths and knowledge upon which to build
Effective counselling cont…
 Doesn't tell the patient what to do, and never forces the patient to do
something
 Understands that the patient lives in a social setting that influences
choices
 Views social relationship as a resource for improving health
 Is developed through training and practices
Outcomes of Effective counselling
• The results or resolutions of a counselling process aim to enable the
client to:
 Develop a greater awareness of his/her problems
 Create new responses to old issues
 Make some of the changes that he/she wants in life
Outcomes of Effective counselling
 Develop positive relationships and explore his/her potential
 Cope with painful situations, like death, terminal illness and disability
 Develop a relationship with the counsellor
 Client is more likely to return to the clinic for additional care and
treatment
Characteristics of a good counsellor
• Competence
• Maintain confidentiality
• Trustworthiness
• Demonstrate self awareness and understanding
• Good psychological health
• Can build good rapport
Characteristics of a good counsellor cont..
• Show warmth and sensitivity
• Show empathy
• Remain objective and open minded
• Active listener
• Be able to reflect and clarify their needs
• Patience
• Be non-judgmental
Barriers to counselling
• It is important to note that the counselling process is not always
smooth.
• Sometimes the process is blocked or hindered by various factors.
• Counsellors should recognize those factors and handle them
effectively.
Barriers to counselling cont…
• Resistance
 Resistance is the conscious or unconscious defence that prevents
material in the unconscious from coming into awareness.
 Resistance is a defence mechanism where information is suppressed
knowingly or unknowingly.
For example, a girl who has difficulty remembering the details of
being raped.
 Resistance can occur at any time in the helping relationship.
Barriers to counselling cont…
 Resistance is often a response by the client who is feeling threatened
by the counselling relationship.
 It protects against fear, anxiety, hostility, depression and
embarrassment.
 Resistance can also result from inappropriate counsellor behaviour.
 Counsellors may also bring resistance and prejudices to their work.
 Visible fatigue or burnout on counsellor’s side can also encourage
client to be resistant.
Barriers to counselling cont…
Two Levels of Resistance
• Client’s resistance in allowing thoughts and memories to be known to
the counsellor.
• Client’s refusal in disclosing painful, frightening and embarrassing
issues, feelings, behaviour and materials to a counsellor.
Barriers to counselling cont…
Signs of Resistance
• Resistance becomes visible when the client:
 Begins to come late to appointments or forgets them altogether
 Questions counsellor’s ability/competence
 Is not assured of confidentiality
Barriers to counselling cont…
 Does not know how to begin
For example, teenagers failing to start telling their stories
 Talks non-stop on the same issue while avoiding others
 Is unable to speak
Barriers to counselling cont…
Dealing with Resistance
• Resistance should be dealt with from a client’s point of view.
• Resistance is usually a defence mechanism, and when the client recognizes
that the resistance is not needed, it will be dropped.
 Defence mechanisms are usually unconscious and people do not even know that
they are using them.
• A well-timed interpretation of the client’s feelings, situation, etc. that helps
the client see what is happening.
Barriers to counselling cont…
• The client should never be accused of being purposely closed.
• It takes time to work on resistance.
• Resistance is unconsciously dropped when the client feels more
comfortable with the counsellor.
Barriers to counselling cont…
Note:
• Sometimes, once a good environment has been created by the
counsellor, if the client still seems resistant, it might be because the
client does not even recognize that they are being so.
• If the counsellor at this time gently helps the client recognize that
they are being resistant by pointing out behaviours that suggest so
and explains that these behaviours will be a barrier in the counselling
process, the client might be able to overcome resistance and start
being more open and free with the counsellor.
Transference
• Transference is the process by which emotions associated with one
person, such as a parent, unconsciously shift to another, especially to
the counsellor.
• Effective counselling is a very intimate process in which a client is
exposed to the counsellor’s behaviour, communication style, gestures,
sense of humour, expression of interests, caring, support and
confrontational style.
• Transference occurs when a client identifies the counsellor as being
similar to an important person in their past such as a parent, lover or
any significant other.
Transference cont..
• Positive transference includes feelings of love, admiration, affection
and dependence toward the counsellor.
• Negative transference expresses hostile, mistrusting, fearful and
envious feelings towards the counsellor.
• When transference is diagnosed it must be dealt with adequately in
order to facilitate healthy growth during counselling.
• Positive transference is often helpful in lowering client’s resistance.
Counter -transference
• Counter-transference is the surfacing of a counsellor's own repressed
feelings through identification with the emotions, experiences, or
problems of a person undergoing treatment.
• Counter-transference occurs when the counsellor starts identifying
too closely with the problems of the client.
Counter -transference
• Counter-transference:
 Includes positive and negative feelings of a counsellor towards
their client
 Is at personal level
 Is due to perceived similarities between the client and the
counsellor
Counter -transference
• Counter-transference changes the counsellor’s perception and
feelings, towards the client.
• Positive counter-transference includes strong liking, affectionate and
protective feelings.
• Negative counter-transference involves strong disliking, critical and
judgmental feelings.
• Counter-transference is sometimes noticed when the counsellor tries
to develop an inappropriate relationship with the client to gratify
their own personal needs.
Dealing with Transference and Counter-
transference
• The counsellor must constantly reflect on the relationship with the
client, and be able to know when transference/counter-transference
is developing.
• Counsellors should not encourage the development of transference.
• While positive transference may be helpful in lowering client’s
resistance, the counsellor should be able to recognize positive
transference from a negative one.
• A counsellor should know that counter-transference is often
formulated partially in response to client’s transference.
• When there is positive transference by a client, the client exhibits
feelings of admiration and dependence towards the counsellor, and
generally trusts the counsellor more.
• The counsellor can then take advantage of these feelings, and prompt
the client to disclose information that might be embarrassing or
painful, thus lowering resistance and increasing the speed of the
counselling process.
Overcoming Barriers to Counselling

• It is important for a counsellor to step back and be attentive to the

process of counselling while encouraging progress in sessions.
• Counsellors should seek help from supervisors when required.
• Supervisors are essential in protecting a counsellor from the
potentially harmful results of resistance, transference and counter-
transference.
• For supportive supervision, the counsellor should seek assistance
from the immediate counsellor supervisor at the site, and there
should also be regular supervision from the Council Health
Management Team (CHMT) and the Regional Health Management
Team (RHMT) to adequately support counsellors.
• Regular meetings with supervisors are important to share experiences
and avoid burnout.
• Simple techniques such as good listening skills and body language
demonstrating the counsellor’s attention can be helpful while
overcoming barriers in counselling.
Stages of counselling
• Relationship building
• Exploration
• Understanding
• Action plan
Assignment test 1
1.(a)Define communication
(b).Explain the two types of communications

2.Explain the four stages of counselling