Nelson-Jones, R. (2014). Start the counselling and helping process. In Practical counselling and helping skills: Texts and activities for the lifeskills counselling model (6th ed.), pp. 124-135. SAGE Publications.
Prior to reviewing specific skills, five goals of the first two stages of the lifeskills counselling model are outlined. Where clients' problems have a limited focus, these goals can be attained in the initial session. More than one session may be required where clients' problems are complex or there are other factors, for example ventilating strong feelings or verbosity, that slow the process down. These goals apply to clients as well as to counsellors and counselling trainees.
Develop a Relationship
From the beginning of counselling, trainees convey support and understanding as a base for developing clients' skills. In lifeskills counselling the relationship is a vehicle for assisting clients to work on problems and problematic skills. Thus, relationships in lifeskills counselling usually have both communicating and working goals.
Develop a Working Model
Clients tend to be stuck at their present levels of understanding problems. Trainees and clients can collaborate to develop working models. A working model consists of a set of hypotheses about how clients function in problem areas and is a statement of how they feel, think and act.
Many advantages stem from this detective work of developing working models. First, clients can provide valuable insights if allowed to do much of the work themselves; their contributions are greater when they are treated as active partners. Second, both clients and you are hypothesis makers and testers. Collaboration improves both parties' skills as practitioner-researchers. Third, clients are more likely to own responsibility for possessing and altering insufficiently strong skills when they have played some part in discovering them. Fourth, collaborating can develop the counselling relationship more than active listening alone. Clients may perceive you as more empathic when you are active.
Develop a Shared Definition of Problems in Skills Terms
Counselling trainees assist clients to identify not only problems, but also the component parts of problems. However, it is insufficient to leave clients stranded at the identification stage. You need to help clients to restate their problems in skills terms so that they then have 'handles' for working on them. Here the distinction between descriptive summaries and skills definitions of problems becomes important. Descriptive summaries can certainly clarify problems, but do not move much beyond clients' existing concepts and internal frames of reference. Skills definitions identify the specific insufficiently strong mind skills and communication/action skills which perpetuate problems. Where possible, reach agreement with clients on how to restate their problems in skills terms.
Develop Working Goals and Interventions
By the end of the initial session, or if necessary initial sessions, trainees and clients should agree on preliminary statements of working goals in skills terms to guide future work. All the better if you can indicate how the goals might be attained. As part of this process, you may discuss the appropriateness of different interventions. Sometimes you can start implementing interventions during as well as at the end of initial sessions.
Develop Working Goals and Interventions
By the end of the initial session, or if necessary initial sessions, trainees and clients should agree on preliminary statements of working goals in skills terms to guide future work. All the better if you can indicate how the goals might be attained. As part of this process, you may discuss the appropriateness of different interventions. Sometimes you can start implementing interventions during as well as at the end of initial sessions.
Develop a Framework for Future Work
Counselling trainee and client need to decide on practical considerations: for example, when and where to meet and, possibly, the matter of fees.
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 strong and insufficiently strong skills.
| Box 8.1 Meeting, Greeting and Seating Skills |
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Imagine two counselling trainees, each of whom is using an office near the waiting area, meeting, greeting and seating a client for the first time. Insufficiently Strong Skills Counselling trainee A, who has just had an emotionally draining session with a client, decides to see the next client without any break. Still feeling distracted by unfinished business from the last client, the trainee opens her/his office door, peers out, takes a few steps in the direction of the waiting area and calls the next client's surname correctly but without any warmth. When the client looks up, the trainee offers no further introduction and in a neutral voice says, 'Come this way please'. Trainee A then goes into the office first and, when the client enters, shuts the door, points a finger in the direction of a chair and says, 'That's for you'. Strong Skills Counselling trainee B takes a moment to calm down after an emotionally draining session with the previous client. Then she/he calmly comes out of the office, goes over to the waiting area, smiles and calls out either the client's first name and surname or the client's first name alone, depending on the nature of the setting. The client gets up and the trainee introduces herself/himself along the lines of 'Hello, I'm ______. Please come this way' and then escorts the client to the office, smiles again as the client enters and then, with an open palm gesture, indicates where the client should sit and says, 'Please sit down'. |
Many trainees require practice at becoming comfortable people for clients to meet from the moment of first contact. An issue 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. You 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 you are not all-knowing. Opening statements, openers or permissions to talk are brief remarks indicating that you are prepared to listen and be informed. Start initial sessions with statements that build rapport and encourage clients to say why they have come. You can leave explanations of how you work until later. 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 unfortunate starts by implying that clients are dependent on you rather than on their capacity to help themselves.
Remember that when making opening statements, your vocal and bodily communication is very important in indicating that you are a comfortable and trustworthy person with whom to talk. Speak clearly and relatively slowly, be comfortably seated and look at the client. You should avoid crossing your knees or arms. However, you can still sit with an open posture if you are crossing your ankles.
Good vocal and bodily communication can also make it easier to record sessions. If asking for clients' permission in a nervous or hesitant way, you are more likely to trigger doubts and resistance than when asking calmly and confidently. Box 8.2 provides examples of opening remarks that might be used for initial lifeskills counselling sessions.
| Box 8.2 Examples of Opening Statements |
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When Meeting the Client Outside the Office Acknowledging Time Boundaries Permissions To Talk Permission To Talk Acknowledging a Referral Permission To Talk Responding to A Clients Bodily Communication Permission To Record a Session |
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. You can sometimes give permission to talk by body messages alone: for instance, a look, possibly accompanied by an arm gesture. On occasion you may sense that clients want to talk but have difficulty doing so. In such instances, if you follow up your 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 you may use permissions to talk when you 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, you 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, those of you who take notes may offer brief initial explanations for so doing and even ask clients' permission.
| Activity 8.1 Starting counselling sessions |
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If appropriate, those of you who work in informal settings can adapt this activity to suit your circumstances. In addition, those training to use counselling skills for roles other than that of counsellor can adapt the activity for maximum relevance. Meeting, Greeting and Seating Making an Opening Statement Combining Meeting, Greeting and Seating and Making An Opening Statement |
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 et al. (2013) 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 my focus is on structuring skills in the early part of counsel-ling, which may occupy only as much as the first 10 or 15 minutes of counselling 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, you are, in fact, beginning the pro-cess of assisting clients to assume responsibility for developing their skills. You 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 too little structure. If you provide too much structuring, clients may feel stifled by your agendas and reluctant or unable to reveal their own. You may establish a 'teacher knows best' emotional climate that is conducive to dependency and resistance. Clients may perceive you as too set on fitting them into your way of working whether it suits them or not. Furthermore, if you talk too much at the beginning of sessions, not only do you make it difficult for clients to talk, but you may structure the counselling process in too intellectual a way. Too little structuring also has dangers. Clients may feel anxious and confused. You too may be anxious and confused. In addition, clients may perceive that you have nothing of value to offer.
Counselling trainees' voice and body messages may enhance or impede structuring. Again, negative outcomes may arise if you come on either too strong or too weak. For instance, clients may feel over-whelmed 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 you offer the whole explanation at once, you 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 you can establish time boundaries and give clients permission to talk. After using your active listening skills to enable clients to say why they have come, you may summarize the main points for clients and check the accuracy of your summaries. Then you 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 applies where the client has presented with more than one problem. If a specific situation has not already emerged, then your follow-up statement may request the client to identify a situation within a main problem area for your work together.
| Box 8.3 Examples of Structuring Statements |
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Opening or First Structuring Statement Possible Second Structuring Statements 'You've given me some idea why you've come. Now what I'd like to do is to ask some more questions to help us understand more fully your problem [specify]. Then depending on what we find, I will review with you some skills to help you cope better. Once we agree on what skills might be useful, then we can look at ways to develop them. Does this way of proceeding sound all right? More than one problem After summarizing the different problem areas, the counselling trainee says: 'Which of these would you like to focus on7 [The client states her/his choice.] Good. Now I wonder if we can identify a particular situation within this problem that It Is important for you to manage better. Then we can explore this situation more fully and perhaps come up with some useful skills for dealing with it. Is that all right with you? |
Structuring can strengthen collaborative working relationships by establishing agendas or goals for the counselling process as well as obtaining agreement on how to proceed. You may need to help clients choose a particular situation to work on that is important for them. You may also need to respond to questions. However, do not allow yourself to be lured into an intellectual discussion of the counselling process. If you 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. Your voice messages should indicate your commitment to what you do. Good voice message skills include: easy audibility, comfortable speech rate, firm voice, clear articulation, and appropriate variations in emphasis. Your body messages should support your 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.
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, you can summarize to establish your presence and make the interaction more two-way. If clients are telling their stories very rapidly, it can hell) them to calm down if you deliver summaries in a measured and unhurried way.
When clients explain why they have come for counselling, you 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' under-standing. 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.
| Box 8.4 Example of Basic Reflection Summary |
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Marital counsellor to wife: ‘Just to summarize so far. You've known Alex for ten years and been married for five. You now have two children, Julia aged three and Russ aged two. Your relationship with Alex has always had some problems, but in the last year they have become greater. One of the problems has to do with money. At the moment, you do not go out to work and you feel that Alex could be making a fairer division of his salary to look after you and the kids better. Another issue has to do with Alex's spending a lot of time with his mates rather than with you and the kids. At the moment you do not feel Alex is really committed to the marriage and wonder what you can do about this. Is that about right?’ |
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. Please 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 of you learning to use your skills as part of other roles or in informal helping settings are asked to modify the way the relating stage is presented to suit your future work.
| Box 8.5 Example of The Relating Stage |
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Counsellor: We have about 45 minutes. Would you please tell me why you've come? Counsellor. Uhm. When? |
