Reading A

Meeting, Greeting and Seating

The initial session starts at the moment of first contact with clients. Skilled counsellors and trainees possess good meeting, greeting and seating skills. Box 8.1 illustrates the difference between good and poor skills.

Many trainees require practice at becoming comfortable people for clients to meet from the moment of first contact. An issue that some trainees raise is whether or not to engage in small talk when first meeting clients. This is partly a matter of individual style. As long as the small talk is minimal and does not give the impression of a social relationship, it may humanize the meeting and greeting process. However, it is wise to be sensitive to clients who are nervous about their conversational ability, to those who want to get straight into counselling, and to clients in crisis. Trainees can convey many of the main messages of warmth, welcome and interest through good bodily communication without the need for inappropriate small talk.

Opening Statements

Opening statements can have various functions: greeting the client again, indicating the length of the counselling session, checking ‘where the client is at’, and, where necessary, obtaining permission to record the session. Counselling trainees need to convey that they are not all-knowing. Opening statements, openers or permissions to talk, are brief remarks indicating that they are prepared to listen and be informed. Trainees start initial sessions with statements that build rapport and encourage clients to say why they have come. Trainees can leave until later explanations of how they work. Opening statements are ‘door openers’ that give clients the message ‘I’m interested and prepared to listen. Please share with me your internal frame of reference.’

The common opening statement ‘Please tell me how I can be of help’ and similar remarks are probably best avoided. Such statements can get initial sessions off to an unfortunate start by implying that clients are dependent on counsellors or trainees rather than on their capacity to help themselves.

Trainees should remember that when making opening statements, their vocal and bodily communication is very important in indicating that they are comfortable and trustworthy persons with whom to talk. They should speak clearly and relatively slowly, be comfortably seated and look at the client. They should avoid crossing their knees or arms. However, they can still sit with an open posture if they are crossing their ankles.

Good vocal and bodily communication can also make it easier to record sessions. Trainees who ask permission in a nervous or hesitant way are more likely to trigger doubts and resistance in clients than students who ask calmly and confidently. Box 8.2 provides examples of opening remarks that might be used for initial lifeskills counselling sessions.

The opening remark ‘You seem very nervous’ gives clients the opportunity to talk either about a problem they bring to counselling or about how they feel here-and-now in the interview. Trainees can sometimes give permission to talk by body messages alone: for instance a look, possibly accompanied by an arm gesture. On occasion they may sense that clients want to talk but have difficulty doing so. In such instances, if they follow up their opening remark with another, this may make it easier for clients to talk. Examples of ‘lubricating’ comments include:

‘It’s pretty hard to get started.’
‘Take your time.’
‘When you’re ready.’

Some counselling trainees have contact with clients outside formal interviews: for instance: correctional officers in facilities for delinquents, residential staff in half-way houses for former drug addicts, or nurses in hospitals. Here they may use permissions to talk when they sense that someone has a personal agenda that bothers them, but requires that extra bit of encouragement to share it. Opening statements for use in informal counselling include:

‘Is there something on your mind?’
‘You seem tense today.’
‘I’m available if you want to talk.’

Sometimes trainees may need to complete organizational requirements for gathering basic information before giving clients permission to talk. However, they require flexibility: for instance, clients in crisis require psychological comfort before bureaucratic form filling, which can come later. On occasion, limitations of confidentiality surrounding a session may need to be explained: for example the need to report to a third party, or any legal limitations. Where necessary, trainees who take notes may offer brief initial explanations for so doing and even ask clients’ permission.

Objectives of Structuring

Clients come to counselling in various states of knowing what to expect. Even those who think they know, may be misinformed. ‘Structuring’ is a term used to describe how counsellors and trainees let clients know their respective roles at different stages of counselling. Cormier and Nurius (2002) observe that structuring refers to an interactional process between counsellors and clients in which they arrive at similar perceptions of the role of the counsellor, an understanding of what occurs in counselling, and an agreement on which outcome goals will be achieved. Structuring occurs throughout counselling and even prior to counselling: for example through the publicity, image and reputation of counsellors and counselling agencies. Here the focus is on structuring skills in the early part of counselling, which may occupy only the first 10 to 15 minutes of initial sessions.

Effective structuring leads to positive outcomes as well as preventing or minimizing the chances of negative outcomes. The functions of structuring in initial sessions include: reducing anxiety by clarifying roles, explaining the purpose of the initial session, establishing the expectancy that clients will work on rather than just talk about problems, providing an introductory rationale for working within the lifeskills counselling model, establishing the possibility of change, and, if necessary, communicating limitations concerning the counselling relationship such as any restrictions on confidentiality.

When structuring in initial sessions, counselling trainees are, in fact, beginning the process of assisting clients to assume responsibility for developing their skills. Trainees can establish cooperative alliances with clients as partners in developing their skills rather than doing things either to or for them. In the medical model of counselling, physicians might think: ‘What can I do to cure my patients?’ In the lifeskills counselling model, counsellors think: ‘How can I best cooperate with clients to develop their self-helping skills?’

Too Much and Too Little Structure

Counsellors and trainees can provide both too much and also too little structure. If they provide too much structuring, clients may feel stifled by their agendas and reluctant or unable to reveal their own. Trainees may establish a ‘teacher knows best’ emotional climate that is conducive to dependency and resistance. Clients may perceive trainees as too set on fitting them into their way of working whether it suits them or not. Furthermore, if trainees talk too much at the beginning of sessions, not only do they make it difficult for clients to talk, but they may structure the counselling process in too intellectual a way. Too little structuring also has dangers. Clients may feel anxious and confused. Trainees too may be anxious and confused. In addition, clients may perceive that trainees have nothing of value to offer.

Counselling trainees’ voice and body messages may enhance or impede structuring. Again, negative outcomes may arise if trainees come on either too strong or too weak. For instance, clients may feel overwhelmed and put off by trainees who structure in loud voices and gesticulate too much. On the other hand, trainees who structure in diffident voices, with minimal use of gesture and eye contact, may convey insufficient commitment.

Some Structuring Skills

A choice that counselling trainees face is how much to structure at the start of initial sessions. Lifeskills counselling always starts with checking out ‘where the client is at’. It is probably best to do initial structuring in two statements, an opening statement and a follow-up statement. If trainees offer the whole explanation at once, they may fail to respond to clients who want emotional release or are desperate to share information.

In two-part structuring, the opening statement provides the first occasion for structuring. Here trainees can establish time boundaries and give clients permission to talk. After trainees have used their active listening skills to enable clients to say why they have come, they may summarize the main points for clients and check the accuracy of their summaries. Then trainees can briefly and simply explain the remainder of the helping process to clients. Box 8.3 presents two possible second structuring statements providing a framework for the lifeskills counselling model presented in Chapter 4. The first statement applies where the client clearly has only one main problem, and the second statement where the client has presented with more than one problem. If a specific situation has not already emerged, then a trainee’s follow-up statement may request the client to identify a situation within a main problem area for their work together.

Structuring can strengthen collaborative working relationships by establishing agendas or goals for the counselling process as well as obtaining agreement on how to proceed. Trainees may need to help clients choose a particular situation to work on that is important for them. Trainees may also need to respond to questions. However, they should not allow themselves to be lured into an intellectual discussion of the counselling process. If they make structuring statements in a comfortable and confident way, most clients will be happy to work within the suggested framework.

How counselling trainees send voice and body messages matters. Their voice messages should indicate their commitment to what they do. Good voice message skills include easy audibility, comfortable speech rate, firm voice, clear articulation, and appropriate variations in emphasis. Trainees’ body messages should support their verbal and voice messages: for example by appropriate gaze, eye contact and use of gestures. A theme throughout this book is the need for counsellors and trainees to pay great attention to voice and body messages. Structuring is a clear instance where ineffective voice and body messages can countermand verbal messages.

Basic Summarizing Skills

Summaries are brief statements of longer excerpts from counselling sessions. Summaries can pull together, clarify and reflect back different parts of a series of client statements either during a discussion unit, at the end of a discussion unit or at the beginning and end of counselling sessions. Clients also use summaries: sometimes of their own accord and sometimes at the request of those counselling them.

Here the focus is on counselling trainees’ summaries in the facilitating client disclosure phase of initial sessions. Such summaries can clarify what clients have communicated and, if they have had a lengthy period of talking, trainees can summarize to establish their presence and make the interaction more two-way. If clients are telling their stories very rapidly, it can help them to calm down if trainees deliver summaries in a measured and unhurried way.

When clients explain why they have come for counselling, trainees may use summaries that reflect whole units of communication. Such summaries tie together the main feelings and content of what clients say. Basic reflection summaries serve a bridging function for clients, enabling them to continue with the same topic or move on to another. Other functions include ensuring accurate listening, rewarding clients and clarifying both parties’ understanding. A variation of the basic reflection summary is the reflecting feelings and reasons summary that links emotions with their perceived causes.

In this and previous chapters skills for beginning the initial session have been reviewed. Box 8.4 puts many of these skills together in an abbreviated example of the starting the initial session and the facilitating client disclosure phases of the relating stage of the lifeskills counselling process model. In actual fact, there is often no clear dividing line between the facilitating client disclosure phase of the relating stage and the reconnaissance phase of the understanding stage – it is more a matter of degree.

In the next example (Box 8.5) a male counsellor assists a male client to start telling his story, though the sexes could just as well be different. The setting is that of a college counselling centre. Readers should note that during the facilitating client disclosure phase, the counsellor is just ‘tracking’ the client by staying in his frame of reference. Remember, the most important thing for the counsellor to do at this stage is to start creating a relationship with the client that enables him to feel understood. Those trainees learning to use their skills as part of other roles or in informal helping settings are asked to modify the way the relating stage is presented to suit their future work.

Contracting refers to making agreements about the process of counselling and establishing the respective roles of counsellor and client. Contracts can be of varying degrees of formality. Each counselling approach has an implied or explicit contract built into it: for instance, a person-centred contract for person-centred counsellors and a cognitive therapy contract for cognitive counsellors. Likewise, lifeskills counselling has an assumed contract. The matter then becomes that of how formal and explicit to make the contract and when to do this. Related to this is the matter of whether contracts are more suitable for some kinds of counselling, for instance where there is a specific and limited goal to be attained, than where the goals are broader, for instance personal growth.

In reality, contracting is often assumed rather than explicit. For example, a client undergoing rational emotive behaviour therapy will have the approach explained up to a point as part of the process and by continuing in REBT might be perceived as participating in a contract, even though the word ‘contract’ may never be mentioned. Similarly in lifeskills counselling, the counsellor does not provide a full explanation of the approach, but describes enough of it to motivate clients, let them know how to participate, and answer any queries. This does not mean that both rational emotive behaviour counsellors and lifeskills counsellors might not draw up formal contracts if they considered that to be of most benefit to clients. However, most counsellors do not consider this necessary. Instead they choose to explain the process a little at or near the beginning and explain it further as it unfolds.

The lifeskills counselling process model may be viewed as having a contract built into it. The stages and phases are an outline of how counsellors intend to work with clients, though there is allowance for variation depending on specific client needs and wishes. For instance, phase 3 of the understanding stage, where counsellor and client agree on a shared analysis of the client’s problem, means that a contract defining what is wrong is part of lifeskills counselling. Similarly, the first or intervening phase of the changing stage follows on from the understanding stage to outline a plan of action and could be viewed as a contract between counsellor and client regarding remedying what is wrong. When counsellor and client agree on homework assignments, this might equally be viewed as making an informal contract.

An implicit feature of contracts is that of commitment to keeping them. Contracts that are signed and sealed can, of course, be broken and more informal contracts may be scrupulously kept. In lifeskills counselling, contracts tend to be verbal and their usefulness depends on the shared perception of counsellor and client that they have value.

Another aspect of contracting in counselling has less to do with the treatment approach and more to do with practical and business arrangements. An important issue is that of time-keeping. Here part of the lifeskills counselling’s informal and, if necessary, explicit contract is that both counsellor and client will turn up on time and, if not, provide notice if possible and have a good reason for lateness or absence. Confidentiality is another key issue and, where possible, any limitations on it should be shared in advance. However, both time-keeping and confidentiality can be matters of agreement between counsellors and clients rather than part of formal written contracts unless, of course, a counselling agency has its own strict rules which both counsellor and client are expected to observe.

In any session, counselling trainees may face decisions about referring clients elsewhere. Even experienced counsellors have types of client with whom they feel competent and comfortable and others where they feel less so. Lazarus states that an important counselling principle is to ‘Know your limitations and other clinicians’ strengths’ (Dryden, 1991: 30). He considers that referrals should be made where other counsellors have skills that the counsellor does not possess or more appropriate personal styles for particular clients. Important ethical issues surround referral, for instance ensuring the best treatment for clients where other counsellors are more expert with specific problems, for instance schizophrenia or traumatic stress disorders.

Referral may not be an either/or matter. Sometimes counsellors continue working with clients but also refer to other counsellors and helping professionals. Alternatively, counsellors may be the recipients of referrals from other helping professionals who continue to work with the clients concerned. I worked as a sessional counsellor in a leading career outplacement company where all my clients were referred by other professionals who continued seeing them for job search counselling. I acted as a ‘back-stop’ for clients whose problems were more severe or different from the normal clientele presenting for job search assistance.

Sometimes clients are referred to gain additional knowledge about their problems. For example, clients with thought-blocking problems or sexual dysfunctions might be referred for medical checks. Depending on the outcome of these checks, the counsellor may gain relevant information to help determine whether or not to continue seeing them.

On other occasions counsellors and trainees can refer the clients’ problem rather than the clients themselves to other counsellors and helping professionals. For example, they can discuss with colleagues or supervisors how best to assist certain clients. Occasions when one may refer the client’s problem rather than the client include being the only counsellor available in an area, or when clients state a clear preference for continuing working with their current counsellor, or when clients are unlikely to follow through on referrals in any case.

The following are some skills for making referrals.

• Know one’s strengths and limitations. Be realistic about the kinds of client with whom one works well and those with whom one is less skilled. Be realistic about one’s workload and set appropriate limits on it.
• Build a referral network. Get to know the resources available in the area so that good referrals are made. Where possible, avoid referring ‘blind’ to someone whose competence is unknown. Furthermore, check whether another counsellor or helping professional has the time available to see the client.
• Provide appropriate information. Provide the client with relevant information about an agency or individual to whom they are referred: for instance a contact person, their telephone number and professional address, their theoretical orientation, and the scale of fees charged, if any.
• If possible, refer early on. When counsellors and trainees defer referrals longer than necessary, they waste clients’ and their own time. In addition, it is preferable to refer clients before emotional bonding takes place.
• Avoid unnecessary referrals. Sometimes it is better for clients to continue working with the counsellors that they have. Tune into anxieties and fears about seeing certain clients. Counselling trainees build confidence and skills by expanding the range of clients with whom they can work. However, wherever possible, they should ensure that they have adequate supervision and support.
• Build a support network. A support network provides professional support for a counsellor or trainee when they want to refer clients’ problems rather than the clients themselves. Their support networks are likely to overlap with their referral networks