UNIT 3

COUNSELLING PROCESS
ELEMENTS OF COUNSELLING
PROCESS
•Counseling is a relationship marked by confidentiality.
•It is a situation where the client comes with his/her problems and
difficulties and expects to learn how to deal with them.
•Hence the counselor should inspire trust and confidence in the client
and the counseling setting should make the client feel welcome and
relaxed to be able to share things.
•The physical setting of the counseling room should exude
warmth and comfort.
•It should be properly lighted with adequate ventilation.
•The room should be neatly arranged without any clutter.
•The place should also ensure confidentiality.
 The counselor should observe the following:

S •Sit squarely, i.e., face the client straight without any barrier in between.

O •Open posture.

L •Lean towards the clients lightly; it indicates interest in the client.

E •Eye contact should be proper

R •Relaxing manner
 THE SUCCESS OF ANY COUNSELING
RELATIONSHIP DEPENDS ON TWO MAIN
THINGS
1. Personal qualities of the counselor:
The counselor should have positive mental health, open-mindedness, genuine concern
for fellow human beings, caring and understanding attitude, sensitivity and critical
thinking. Ex: Autistic client upset with suggestions, sometimes therapist may be
unaware
Thus self awareness, awareness about others and understanding others are important
personal qualities that will help the counselor become an effective counselor.
The counselor should be clear about his/ her attitudes, motives, beliefs and values.
A helping attitude with sensitivity and empathy makes for the base of an effective
counselor.
The counselor should also have a sense of warmth and genuineness in helping others.
2. Professional qualities of the counselor:
Counseling is a profession and the counselor needs to acquire the professional qualities by
undergoing proper education and training, learning the skills and competencies, and
adhering to the counseling code of ethics.
Proper academic training in counseling theory and skills is essential to be called as a
counselor.
Ethical guidelines need also to be followed to ensure a professional conduct during the
process of counseling. Ex: Client upset that her boyfriend was spoken to
ASSESSMENT
•Assessment is a multifaceted process that involves a variety of functions, such as
testing and evaluation, that counselors go through in an effort to determine an
individual’s characteristics, aptitudes, achievements, and personal qualities.

•Assessment can be viewed as an integrative process that combines a variety of

information into a meaningful pattern reflecting relevant aspects of an individual.
•It never depends on a single measure, nor does it emphasize one dimension at the
expense of another.
•For an assessment profile to be meaningful and useful, it must provide a means for
understanding the individual from as broad and integrative a perspective as possible.
•Only with the most accurate information can an assessment be appropriately used in
counseling.
 ASSESSMENT TOOLS
INTERVIEW

STANDARDIZED MEASURES

NON-STANDARIZED TESTS
 INTERVIEW
•Interview is one of the most commonly used assessment tool.
•Counselors use interview method to help gather information about clients and clarify results of other
assessments.
•After establishing rapport, the counselor engages in what is called intake interview or history
taking in which detailed history of the client both in the past and the present is collected. Ex: In
counselling the presenting problem is delved into and then history is collected in bits and pieces
•In addition to the background data of the client, the appearance and behavior of the client are also
noted.
•History taking is the first important step to understand and analyse the problem.
•Data regarding different aspects of the client’s life is collected such as, information about the family,
client’s educational history, medical history, work experience, social relationships, client’s behaviour,
attitudes, values, coping strategies and strengths etc.
•Interview can be structured, i.e., carefully planned and systematic which follows pre-determined
steps and questions; whereas unstructured interview allows for flexibility, that is, the client can
have more freedom in the topic and direction of the interview.
•Here, open questions are used more.
STANDARDIZED TESTING MEASURES

Although it certainly is not the only way to collect useful information and assess client
functioning, testing is one of the most common methods that counselors employ.
The history of our profession is very much interwoven with the parallel evolution of
the testing movement.
However, sometimes there are conflicting results even in standardized tests
James Cattell, Beginning • Mental test to describe his attempts to measure the
intellectual ability of students
of 20th century
• Real impetus to psychological and educational testing.

WW1
• The U.S. Army Alpha and Beta were the first group intelligence
tests used to screen out those who might be unfit to serve.
• Army psychologists also worked to develop group personality tests
to screen recruits for potential problems.

1920-1940
• Many other tests were developed to measure a wide range of
characteristics, including intelligence, aptitude, ability,
attitude, personality, and interests

• Tests such as the Wechsler Adult Intelligence Scale (WAIS)

WW2 and the Minnesota Multiphasic Personality Inventory

(MMPI-2) were first developed and extensively used during
this time.
In spite of whatever advantages testing might offer, it has come under increased criticism,
primarily because of concerns that the instruments are culturally and ethnically biased,
reflecting the values of the majority culture to the disadvantage of others who are exposed to
a different set of educational experiences growing up.
These problems have led to a number of restrictions on the use of tests and to some
professionals’ disenchantment with them.
In spite of these concerns, recently there has been an increased use of testing for a variety of
purposes because of its economical way of helping decision makers predict future behavior.
 TECHNOLOGY IN ASSESSMENT
Computers have greatly simplified the general process of assessment, as well as
test development, scoring, and interpretation.
Counselors now routinely use the Internet, specialized diagnostic software
packages, videoconferencing, and Web-based sites to conduct their client
assessments and to consult with various sources during this procedure
(Hohenshil, 2000).
Computer generated reports will play a significantly more important role in the
future, not so much as a substitute for clinical judgment but rather as an aid to
help counselors make sense of client experiences and plan effective treatments
(Butcher, Perry, & Hahn, 2004; Lichtenberger, 2006).
These recent developments and innovations certainly enhance counselors ability
to select appropriate instruments, score and interpret them, and make sense of the
data—but also at some cost like compromised privacy and confidentiality
(Garb, 2000; Sampson, 2000).
 TYPES OF
STANDARDISED TESTS

Tests of Tests of Tests of Tests of

Achieveme Typical
Ability Aptitude nt Performance
1. TESTS OF ABILITY
Intelligence consists of several factors:
(1) abstract thinking
(2) problem solving
(3) capacity to acquire knowledge
(4) adjustment to new situations
(5) sustaining of abilities in order to achieve desired goals
Despite the difficulty in defining intelligence, a number of
instruments attempt to assess an individual’s general mental ability
or stable intellectual capacity for reasoning and applying
knowledge.
Tests that attempt to measure intelligence are most likely to
reflect a person’s scholastic/academic learning potential,
especially with conceptually difficult or abstract material.
Most of these tests also include a set of tasks that require a client to
demonstrate memory, pattern recognition, decision making, verbal
and analytic skills, general knowledge, and the ability to manipulate
the environment.
EXAMPLES
Stanford-Binet Test of Intelligence
Wechsler Adult Intelligence Scale
Wechsler Intelligence Scale for Children Individual tests
Wechsler Preschool and Primary Scale of Intelligence
Binet-Kamat Test of Intelligence

Cognitive Ability Test

Group tests
Otis-Lennon Scholastic Ability Test
2. TESTS OF APTITUDE
Aptitude tests are concerned primarily with prediction of a person’s performance in
the future.
Examples:
Scholastic Aptitude Test (SAT)
American College Test (ACT) for admission to college
Graduate Record Exam (GRE)
General Aptitude Test Battery (GATB)- for job placement
School systems rely on instruments such as the Differential Aptitude Test (DAT)
3. TESTS OF ACHIEVEMENT
Often called proficiency tests, achievement tests are used to measure learning,
acquired capabilities, or developed skills.
They are widely used and can be adapted to almost any type of task from measuring
course content (a typical exam) to administering the road test for a driver’s license.
Results can be used as diagnostic tools, as demonstrators of accountability, and,
because past performance is the best measure of future performance, as predictors.
4. TESTS OF TYPICAL PERFORMANCE
Tests designed to measure an individual’s day-to-day behavior or performance are
interested not in what a person can do (ability) but in what a person does.
Although motivation is important in this type of test, it is less so than in ability
testing.
Two common categories of typical performance testing are personality inventories
and interest inventories.
A) PERSONALITY
INVENTORIES
These tests are designed to gather information on an individual’s preferences,
attitudes, personality patterns, or problems.
Examples: Edwards Personal Preference Schedule (EPPS), the Personal Orientation
Inventory (POI), the Minnesota Multiphasic Personality Inventory, Beck Depression
Inventory-II (BDI-II).
1. Personality inventories, regardless of what they measure, are known as paper-and-
pencil tests (for self-evident reasons), and also as self-report instruments.
This latter characteristic is an important one for counselors to appreciate, because
what clients report about themselves may not be an accurate representation of what
they actually feel or believe.
2. Another type of personality measure is the projective type.
This type of test requires a client to respond to unstructured stimuli such as an inkblot
or an incomplete sentence.
A qualified examiner then interprets these responses as reflective of underlying
personality organization and structure.
Examples include the Rorschach and the Thematic Apperception Test (TAT).
Counselors who work with children sometimes use the House- Tree-Person drawing
test, which may reveal how a child feels more accurately than do the child’s spoken
words.
B) INTEREST INVENTORIES
Interest inventories attempt to develop a profile of an individual’s
career interest areas through a series of questions about preferences,
jobs, hobbies, and other activities.
The pattern of responses is then compared to the responses of persons
successfully engaged in a variety of occupational areas. Profiles are
constructed by matching high and low scores in occupational clusters.
A limitation of these inventories is that, because interest does not reflect
ability, it is possible for a person to dislike a career area in which he or she
has earned a high score.
Commonly used interest inventories are the Strong-Campbell Interest
Inventory and the Kuder Preference Record.
 WHY IS TESTING IMPORTANT?
An additional source of
useful information about
clients that can affect the
decision-making process.
Confirms that we are
using the right
techniques for the right
Offer a type of information
not readily available
through non-test methods
like verbal and non-verbal
interview techniques.
Test results can provide
clients with information about
themselves and illustrate how
they compare with others who
HOW TO SELECT A
TEST?
 Determine the goals of your client. •Before you even consider what tests to use, gather information from interviewing the client in order to define the client’s goals for counseling.

Choose instruments to reach client goals •Once you have become clear on what the client is seeking from counseling, you can begin considering the kinds of tests that might assist the counseling process.

Access information about possible •There are a number of sources you can turn to that will help you choose the best possible instruments
•Test manuals accompanying published tests compile relevant data on the theoretical base, development, standardization, validity, reliability, and other technical features.
instruments
 Examine validity, reliability, cross- •All of these factors need to be taken into account; if the publisher’s own data on a specific test does not
cultural fairness, and practicality of the provide information on cultural fairness, you can do a journal search to find articles that have assessed
whether an instrument is in compliance with multicultural assessment standards.
possible instruments.

•After you have narrowed down your selection to a few choices, consider such issues as convenience,
Choose an instrument wisely cost, ease of administration, ease of interpretation—and finally, your own comfort level.
NON STANDARDISED
MEASURES
Nonstandard assessment tools are widely used to gather information about clients.
They represent a ‘‘nontest’’ approach and are especially useful in gathering data that
do not lend themselves to numerical reduction.
Combining the results of standardized and non-standardized measures often creates an
optimal base for developing a truly multifaceted assessment process.
Some of the more common types of non-standardized measures are discussed here.
A) OBSERVATIONAL
ASSESSMENT
Observational measures are commonly used to gather information that is often
unavailable through other means.
Observational procedures can be classified in a number of different ways, according
to type (systematic, controlled, or informal), the setting in which they take place
(natural or contrived), or methods used (interview, direct observation).
The counselor must be a keen observer who can get important information from
observing the non-verbal behaviour of the client.
The non-verbal cues are significant indicators of the affective or feeling aspects of
the client.
Behavioural observations may be used clinically such as to add to interview
information or to assess results of treatment.
(first observation at PG level)
WHAT TO OBSERVE?
Appearance: is the client neatly dressed or clumsy; calm or composed?

Posture: How does the client sit or stand?

Eye contact: Does the client maintain eye contact?

Behaviour/ Manner: Is the client agitated, restless, anxious etc.?

Body language: Do the gestures of the client convey anything?

CRITICISM
Observational methods, however, lack the normative data available from well-defined
populations, a characteristic of standardized assessment tools, and are therefore more
susceptible to biases.
They have also been criticized because subjects can change their behavior if they
know they are being observed, and the relatively limited range of situations available
for observation may not produce an adequate sample of behavior.
B) RATING SCALES
Rating systems provide a common basis for collecting certain types of observational
data.
They differ from observation in that observation is only the recording of behavior,
whereas rating involves both recording behavior and simultaneously making an
evaluation of specified characteristics, which are usually tabulated on a scale.
The value of ratings depends primarily on the care taken in the development of the
rating form and the appropriateness with which it is employed.
When doing a simple observation you note that a client appears
anxious.
You make this assessment based on several nonverbal cues—a
repetitious tapping of the foot, averted glance, and wringing hands.
You check out your assumption by reflecting the feeling you observe:
‘‘You are feeling anxious because you aren’t sure where to go next.’’
If you attempted to actually measure the degree of anxiety that is
experienced, you could ask the person to rate on a 1 to 10 scale just
how nervous he really is.
Such rating scales, whether administered in verbal or written form,
are often useful in getting a more accurate assessment of not only
what someone is feeling or thinking, but to what degree.
C)SELF ASSESSMENT
Self-assessment is a valuable non-standardized assessment tool
that is often underused in appraisal programs.
Self-assessment reinforces self- determination and recognizes
that the individual is truly the expert on himself or herself.
It further enhances the participatory aspect of assessment.
Person-centered approaches to assessment particularly
emphasize the importance of the client’s self-authority in
identifying and using assessment information.
Portfolios are often used as supporting documentation in which
a number of items—including journal entries, videotapes,
photographs, and drawings—are included.
There is a parallel process involved in assessing the self.
While you are asking your clients to check out how they are doing, what they are
feeling and thinking, and then asking them to reflect on these self-observations, you
are doing the same thing.
This becomes the source of your intuition that develops from experience but also your
way of monitoring how you are doing at each stage of the process.
 SETTING GOALS
•In the third stage of the skilled helper model, Egan (1994) describes that clients are encouraged
to act, aided by the new understanding and knowledge which they have acquired in the previous
two stages.
•Along with the counsellor, the client explores a variety of ways of achieving goals.
•A plan of action is discussed and formulated, and throughout this process the counsellor
supports the client and helps him/her monitor and evaluate any changes proposed.
•Change is difficult for most people, and clients in counselling tend to find it especially difficult.
•This is because many of them have endured unsatisfactory work, relationship or other problem
situations, over long periods of time.
•No matter how unsatisfactory their lives have been, however, they are at least familiar
with the current situation, and any prospect of change is daunting since change always
represents a leap into the unknown.
•Ex: Client who is unable to break an unsatisfactory relationship, just because she is used to it.
Setting realistic goals in counselling is one way of helping clients to plan the changes they need
to make.
Sometimes clients know, as a result of the work they have done in initial stages of counselling
process, the action they need to take.
More often than not, however, they need support and encouragement in order to set and
achieve goals. (can even be through whatsapp msgs – Ad***)
Clients also tend to respond much more positively to goals and programmes they
themselves have chosen, so it is worth remembering that the counsellor’s role is a helping
one, which does not include offering solutions to problems. (Ar*** - didn’t ask for help, just
wanted to inform)
On the other hand, counsellors need to help clients consider a range of options and a number of
different ways of achieving goals.
Clients may also need to be encouraged to look at their own resources or those within their
environment.
Realistic goals are dependent on these internal and external resources, and when there is a
clear discrepancy between goals and resources, adjustments need to be made. Ex: Goal of
coming clean from drug addiction without getting into some sort of rehab is near
impossible
QUESTIONS IN RELATION TO ANY
GOALS WHICH ARE FORMULATED
Are they Are they
clear? specific?

How long will

How realistic
they take to
achieve? are they?
CLIENTS CAN BE ENCOURAGED TO
WRITE DOWN THEIR GOALS IN
CLEAR AND SPECIFIC TERMS
What is it I want?

How can I achieve this?

Why should I do this?

CONTRACTING
From the outset of the first encounter, the client clearly is in need of some assistance
and the counselor is identified as an expert with specialized talent and skills to provide
the desired help.
The relationship, therefore, involves a contract in which both parties agree to abide by
certain rules:
the client to show up on time, and to make an effort to be as open as possible.
the counselor to be trustworthy.
to protect the welfare of the client
to do everything possible to help the client reach identified goals in the most efficient period
of time.
The power between the client and the counselor is thus embodied in a unique structure
wherein the client is primarily responsible for the content of the relationship, and the
counselor has most of the responsibilities for directing its style and structure.
Counselling takes place in sessions which last for 50-60 minutes.
Clients need to know the basic details of counsellor/ client contracts well in advance
of sessions if possible, so that structure and stability are an integral part of the
relationship.
It is essential to establish clear boundaries with clients.
These limits exist not only to provide a predictable and reliable environment for
clients but also to protect the clients’ safety from those counselors who use the client-
counselor relationship to meet their own needs.
Ex: Client who offered help to get discount in booking
The therapeutic relationship is also different from other interactions in that there are
relatively specific objectives and stringent time limitations.
The relationship exists to seek solutions, and the discussion ends once the minute
hand of the clock reaches a previously agreed-on point.
Thus, in addition to many of the characteristics found in other successful human
relationships, the therapeutic relationship has several identifying features.
INFORMED CONSENT
Informed consent is based on the notion that clients have a right to freely enter
counseling, without any form of coercion or manipulation.
They have a right to be provided with clear, accurate, and comprehensible
information on such things as the limits of confidentiality, fee policies,
limitations and dangers of treatment approaches (confrontation/ mindfulness),
alternative treatment models, access to records, counselor qualifications and
training, and the right to refuse treatment.
By describing to clients, in writing, the relevant information they need to know
before commencing counseling, the clinician ensures clients are making a fully
informed choice when they consent to proceed (Welfel, 2006).
Informed consent also does not stop once the counseling begins; if counselors
make adjustments in a treatment plan, or change the theoretical model being
utilized, clients needs to know, and terminate if they so desire. Ex: A client
unhappy that her psychiatrist did not tell her the side effects of a medicine
prescribed
Like the issue of multiple relationships, the notion of informed consent is in a
state of flux, with an increasing emphasis on fully apprising clients of exactly
what they should anticipate from the counseling experience.
DISCUSS POCSO – PROTECTION OF CHILDREN FROM SEXUAL
OFFENCES ACT
FORMULATION
Sperry et. al (2000) define case formulation as “a process of linking a group of data
and information to define a coherent pattern and it helps to establish diagnosis,
provides for explanation and prepares the clinician for therapeutic work and
prediction.”
Wolpe and Turkat (1985) define it as “a hypothesis that relates all of the presenting
complaints to one another, explains why these difficulties have developed and
provides predictions about the patient’s condition.”
In short, it is a succinct description of the chief features of the case as well as an
encapsulation of the diagnosis, etiology, treatment options, and prognosis of
patients’ problem (De## varying diagnosis and treatment)
Denman (1994) went further by maintaining that the attributes of a good formulation
capture the essence of the case and include presence of a theoretical basis, sensitivity
about the patient, and specificity to the patient.
COMMON FEATURES OF CASE FORMULATION ACROSS
APPROACHES (JOHNSTONE AND DALLOS, 2014)

Summarise the Indicate how the

client’s difficulties
client’s core may relate to one
problems another

By drawing on Suggest, on the basis of

psychological theory, why
psychological the client has developed
theories and these difficulties, at this
principles time and in these situations
BENEFITS OF CASE
FORMULATION
1. Integrative level:
A case formulation summarizes the salient features of the
case in a nutshell and identifies important issues quickly,
particularly for complex cases with multiple problems.
Furthermore, the act of writing helps to organize and
integrate the clinical data around a linchpin and allows
the clinician to focus on the heart of the matter in each
individual case.
2.Explanatory level:
The case formulation provides insight into the intra as
well as inter-individual aspects of the case, thus
allowing a better grasp of the evolution of the illness
and its impact on the patient and caregivers.
It also gives a framework to examine the interactions
between underlying dynamic and nondynamic factors,
including psychological and neurobiological
vulnerability, in understanding the development,
maintenance, and resolution of a patient’s
difficulties.
3. Prescriptive level:
At the prescriptive level, an adequate formulation is a
precious blueprint guiding therapy, including the setting of
appropriate goals and choice of intervention point, modality,
and strategy.
This is of value, especially for the trainees, in being
grounded in the formulation and staying the course rather
than feeling the need to change tack with a patient’s intense
and shifting moods or behaviors in treatment.
4. Predictive level:
The initial formulation sheds light on the prognosis of
the case and points toward a need to redirect the focus
onto other areas such as exploring other underlying core
beliefs and challenging other automatic negative
thoughts when therapy is not progressing.
It also provides a useful baseline marker for later
comparison and reformulation as new information
unfolds and as therapy outcome is assessed over time.
5. Therapist Level:
Helps the therapist to understand the nature of the therapeutic
relationship, relationship difficulties and to experience greater
empathy for the patient beyond the presenting problems.
Patients’ explanatory model for their problems and their own
formulation and expectations for treatment should be explored
as well.
Allows for anticipation and management of therapy interfering
events such as noncompliance with homework, acting in and
out behaviors, or other forms of resistance to change in therapy,
including pharmacological treatment.
CASE CONCEPTUALIZATION
Understanding of clients, their issues, and the decisions
they want or need to make is fundamental in any
counselling process.
This involves cognitive and affective empathy, as well
as counsellor’s ability to mentalize and be with the
client holistically.
A case conceptualization is an individualized application
of one’s theoretical model that takes into consideration
the antecedents of the case and counsellor’s
observations and inferences.
CASE FORMULATION AND CASE
CONCEPTUALIZATION
Term is often used interchangeably.
Case Formulation is usually used in the context of client-counsellor relationship; to
explain the client your understanding of the case, the short term and long term plans.
Case conceptualization is your theoretical understanding on the case and a
discussion you are likely to have with your supervisor.
DYNAMIC FACTORS THAT COULD LEAD TO
RE-FORMULATION/ RE-CONCEPTUALIZATION
your what happens
changing emotional
nonverbals experience of during your
client issues experience
the client interactions

strengths and weaknesses supporting

test results diagnoses
assets and gaps materials

inferences
working goals of possible
and interventions
hypotheses treatment barriers
assumptions

effectiveness
evaluation of
of action
the impact
plans
REFERRAL
Feltham and Dryden (1993: 157) define ‘referral’ as
‘directing someone to a counsellor or alternative source
of treatment’.
Clients may be referred inwards to a counsellor (by, for
example, a GP or an OBG) or be referred onwards by a
counsellor (to another professional helper better suited
to helping the client)
ONWARD REFERRAL
No counselor has all the answers.
The Ethical Framework for the Counselling Professions,
published by the British Association for Counselling and
Psychotherapy (2018: 6), includes in its commitment to
clients that counsellors will ‘work to professional
standards by … working within our competence’.
Working within your own competence is key, and thus
there will be times when making a referral is the ethical
decision. Ex: Client with Adult ADHD
WHEN DO I MAKE A REFERRAL?
the client needs help with other issues (such as housing problems, law-related
matters or medical issues) instead of – or before being ready to engage in
counselling
the client has a mental-health issue that prevents the establishment of
psychological contact (e.g. they are delusional or are hearing voices)
the counselling issue that the client is bringing is not within your area of
competence (e.g. if they need specialist counselling for substance addiction).
your agency offers a limited number of sessions, and you know this
amount will be insufficient to work safely with the client
your modality is not a good match for the client’s issue (e.g. the client
needs help to overcome a fear of flying before an imminent holiday abroad,
and you are a person-centred counsellor rather than a cognitive behavioural
therapist)
the client is experiencing difficulties that mirror your own – i.e. there is
parallel process (e.g. if a client wishes to work on feelings related to their
divorce, and you are currently struggling with this in your own life)
It is important that clients are not taken by surprise by your suggestion that
referral maybe be needed.
This could feel like a rejection, and lead them to believe their problems are
particularly complex and therefore difficult to solve.
Preparation for referral should ideally begin during contracting, with the
counsellor introducing the idea that this is a process that sometimes
happens, simply because different professionals are trained and have
strengths in different types of helping and different client issues.
In this way, the client is aware from the very start that referral is not
threatening but is instead intended as a genuinely helpful action to
support them in getting the right help at the right time.
If you are considering referring a client, it is always important to explore the
possibility of referral with your supervisor, who can help you decide whether
this is the right course of action.
 STEPS IN MAKING A REFERRAL
Before telling the client about your specific plan to refer them, make sure:
1. you know where you will refer to
2. you are familiar with the referral pathways and processes (including any
documentation needed)
3. you have ascertained current waiting times for the new provider
CALDICOTT PRINCIPLES RELATING TO THE
USE OF PATIENT IDENTIFIABLE
INFORMATION (NHS, UK 2013)
• Justify the purpose(s) of using confidential
1 information.

• Only use it when absolutely necessary.

2

• Use the minimum that is required.

3

• Access should be on a strict need-to-know basis.

4
 • Everyone must understand his or her
responsibilities.
5

• Understand and comply with the law.

6
• The duty to share information can be as important
as the duty to protect patient confidentiality.
7
CONFIDENTIALITY
Confidentiality is the cornerstone of our tool kits- Robert Blum
Confidentiality is a means of providing the client with safety and privacy and thus
protects client autonomy.
For this reason any limitation on the degree of confidentiality is likely to diminish
the effectiveness of counselling.
Absolute confidentiality is legally not possible and hence, the counselling contract
must mention the degree/level of confidentiality.
Exceptional circumstances may arise which give the counsellor good grounds for
believing that serious harm may occur to the client or to other people.
In such circumstance the client’s consent to change in the agreement about
confidentiality should be sought whenever possible unless there are also good grounds
for believing the client is no longer willing or able to take responsibility for his/her
actions.
VERBATIM RECORDING AND ANALYSIS
Audio or video recording the session follows the same guidelines
of confidentiality and referral.
If the client wishes to not be recorded, the recording to be
interrupted or destroyed, it has to be acknowledged.
If you are relaxed and provide a rationale to your client, making
this type of record of the session generally goes smoothly.
If you do not take notes during a session, remember that records
typically need to be kept, however writing session summaries
shortly after the session finishes is recommended.
In these days of performance accountability for your actions, a
clear record can be helpful to you, the client, and the agency with
which you work.
Some expert counselors object to note taking, arguing that when the counselor is
closely in tune and has great listening skills, there is no need for notes.
Indeed, too much attention to note taking detracts from the central issues of rapport
building and active listening.
Carl Rogers, found that when one records an interview, one often finds that what
actually happened is different from what is found in notes.
Thus, a balance is clearly needed, particularly in a time of increased scrutiny and
possible legal issues.
INTERPRETATION
Interpretation skills are referred to a counsellor’s statements that are purposively
expressed in order to interpret an issue raised by clients.
The objective of the interpretation is to provide clients with a new perspective of an
issue so that the clients have other opinions on the same issues.
A therapist interpretation is a technique that introduces the client to a new,
theoretically based frame of reference.
An interpretation goes beyond the explicit and observable client content and
involves communicating an inferred component with the intention of adding new
knowledge, understanding, or meaning.
INTERPRETATION
A therapist interpretation is a proposition that
(a) goes beyond what the client overtly recognizes
(b) may take several forms, such as interpretation of defenses, transference, and
explanation of feelings and behavior (Client afraid of what I think of her (as I
was also her teacher earlier) – but this is also something she fears with
everyone, so the transference can be beneficial)
(c) adds something qualitatively different to clients’ verbalizations and often
presents clients with new meanings or perspectives (Friedlander, 1982).
TERMINATION AND
REPORTING
The main objective in counselling is to help clients become more independent, self-
reliant and capable of dealing with any present or future problems.
This means, in effect, that the counselling relationship, unlike many other
relationships, is meant to end.
Termination of therapy is, therefore, always implicitly present.
Endings can be difficult for all of us however, and clients in counselling are no
exception in this respect.
Many people experience a variety of conflicts about endings in general, and this is
especially true of those people who have been traumatised by separations in the past.
The ending of any relationship is obviously much more difficult for someone who has
lost a parent in early life, for example, or indeed for anyone who has been bereaved in
later life too.
Each new ending in an individual’s life tends to reactivate memories of previous
separations, endings or loss.
Clients need to be able to talk about these experiences and what they mean to them,
and counsellors can help by encouraging expression of all these feelings.
 REPORTING
Written records and reports of the counseling process can enhance the treatment process,
accelerate progress, expand availability of services, and provide protection to both
counselors and clients.
WRITTEN DOCUMENTATION, REPORTS, AND
RECORDS OF THE COUNSELING PROCESS CAN
ACCOMPLISH
1. THE
Help counselors organize andFOLLOWING GOALS:
remember information and develop sound treatment plans
and interventions based on that information.
2. Provide direction to the counseling process, thereby increasing client motivation.
3. Facilitate authorization for treatment and third-party payments.

4. Ease transfer of a client from one counselor to another.

5. Track progress, record homework tasks, and ease transition from one session to the next.
6. Facilitate revisions in treatment plans if progress is stalled or clients have achieved their
goals.

7. Protect the counselor in the event of a lawsuit or other challenge to competence by

demonstrating that appropriate treatment has been provided.

8. Facilitate supervision and case conferences.

9. Provide a written record at the termination of counseling that can be helpful if the client
returns for counseling at a later date.
A well-written psychological report can clarify personality dynamics and explain
overt behavior.
It is capable of providing answers to differential diagnostic issues and pointing a
finger at possible etiology.
Hypotheses and recommendations can be formulated from the information provided.
Often major treatment and placement decisions are based on the findings and
recommendations of the psychological report.
REPORTING CONTD…

Assessment reports usually are based on a combination of test data,

interviews, and observations.
Psychological or assessment reports usually are more analytical and
interpretive than reports based solely on intake interviews.
This is appropriate because the inventories most often used have
been studied extensively, and their interpretation has been validated
by empirical research.
Such reports should respond to the referral questions and enable
mental health professionals to better understand and help their client.