Analysis of Counselling as a Therapeutic Intervention
Counselling is a very common word. Often times everyone hears that particular word when a person is in trouble emotionally, psychologically and socially. When one hears counselling the first thing that comes in to mind is the psychologist wherein a patient is soliciting for advice or in enrolled in a therapy. It is defined in dictionaries as the "act of exchanging opinions and ideas." (Answers, 2006) According to Corney and Jenkins (1993) counselling is a word that is constantly being used and misused. People all over the world use counselling without even knowing or understanding its true meaning.
This paper examines the real meaning of the word counselling, and differentiates counselling and counselling skills. A discussion on the application of counselling and counselling skills on a clinical situation and the effectiveness of counselling is given on this paper.
Counselling and Counselling Skills
Counselling according to the British Association for counselling (as cited by Corney and Jenkins, 1993) is the mastered and ethical use of association to enhance self-knowledge, emotional acceptance, growth and personal resources. The main purpose of counselling is to live life more fully and contently. The main concerns of counselling are to address and settle problems and issues, make decisions, cope with crisis, working via the person's feelings or inner conflicts and improving the relationship of an individual with the people around him or her. The main role of the counsellor is to make easier the patient's work in manners that respect the values, personal resources and the ability of determining the patient's self.
Moreover, counselling according to Arnason (2001) is an important aspect in the British society. The author describe that counselling works to suppress the necessities and wants of the patients and to established compulsory the counsellors own ideas and comprehension that is based on their experience.
In addition, Hall, Hall and Hornby (2003) pointed out that counselling is a useful and helpful tool in preventing common and normal problems from becoming a severe problem that could result in delinquency, failure in school and emotional disturbance. Counselling can be an approach in which it will aid in developing a healthy environment that assists children as well as adults in coping up with the stress and conflicts that accompanies growth and development. It could also be an important therapeutic force in helping children, teens and adults in trouble via evaluation, individual and group counselling, consultation with the parents and teachers and changes in the environment of the individual.
To sum up all the definitions and the aims given by different authors and researchers, counselling is a method in which the counsellor which is an expert in a particular field in counselling discusses the problems and issues of the client through different measures such as individual counselling and consultation with the people surrounding the patient. And in severe cases and problems of patients such as serious eating disorders, the counsellors impose rules to the patient in order to help him or her cope up with the disorder. And in some cases the patient is admitted in a facility wherein he or she is monitored closely not just by the counsellors but other health professionals as well.
Counselling is a significant aspect in an individual's life, from the development of the cognitive skills up to adult life. It plays an important role in improving the attitudes of a person towards oneself and life. An individual passes through different stages in life in which sometimes he or she is unable to cope up such as a divorce or sickness of a family member. That is where counselling enters a person's life.
However not everyone has the ability to conduct counselling, an individual must have the skills in order to address the issues of the client. It involves not just merely talking to the patient or client but a lot of processes in which can be very helpful in facilitating patients to overcome their problems. Often times a number of people lack the understanding between counselling and counselling skills.
Counselling is defined earlier as a method in which the counsellors help address the issues of the client and cope up with their problems, on the other hand Counselling Skills, according to Schapira (2000) are "techniques and strategies in communications that are useful in all human interactions." Individuals in different professions usually employ the skills without even knowing. In addition, Corney and Jenkins, discussed that in counselling skills the essential skills in listening, reflecting and sympathy are the core of counselling, the counselling skills also follows the values that are imposed in counselling. The counsellor uses different kinds of counselling skills in order to address the variety of the conditions of his or her clients.
Stages of Counselling
The most widely used model in the stages of counselling is the 3-Stage Skill model of Egan, according to Egan (1986) the stages of counselling are the exploration, new understanding and action. During the exploration, the counsellor cultivates a warm relationship with his or her patient in which it allows the counsellor to investigate systematically the issues from the client's perspective and then focuses on particular concerns. In this particular stage the counselling skills that are being utilised are giving attention, listening and active listening. And under the active listening, the important skills are emphatic understanding, non-critical acceptance and genuineness, reflecting feelings, focusing and assisting the patient to be particular. The second, stage is New Understanding in which the patient is assisted to look at her situation in a new perspective and to give emphasis on the procedures that must be done in order to cope up in an efficient manner. The counselling skills used in this stage are giving attention and active listening, and some challenging skills that include profound emphatic understanding through aiding the client to identify the themes, inconsistencies, patterns of behaviour and feelings; providing information through proper sharing of the feelings and experiences of the counsellor to the patient; and immediacy via discussion on what are the occurrences between the counsellor and the patient. And on the third and final stage, the patient is aided to view the possible ways to act, look at the consequences and the costs, plan action and then implement and evaluate those ways. The counselling skills that are needed in this particular stage are all the skills that were utilised in the first two stages.
Application of counselling in clinical situation
Health workers especially the nurses are in the forefront especially in taking care of the patients may it be in the hospital or the home care facility setting. The nurses are usually the persons that the patients talk to or turn into. Counselling is important for persons working in the sector of health; the nurses as well as the doctors must learn counselling in order to address some of the issues of their patients. In the case of the nurses working in the facilities for the elderly, they must know counselling and must have the skills because most of the elders in the home care facilities are depressed and misses their family members, by having skills in counselling the nurses will be able to help these elders to cope up with their depression that is caused by being away from their loved ones. As mentioned earlier, listening is an important skill in counselling, by listening to the elders, the nurses would be able understand what the elders are going through and then later would be able to assess them in coping with the situation.
Another case in which the nurses could apply counselling in the clinical situation is if the patient is suffering from a serious disease or illness. The nurse could use counselling following the 3-Stage model of Egan. First is to develop a good relationship with the patient in whom the nurse could examine the concerns and issues of the patient through listening to his or her problems without judging him or she, being sincere is important when listening to the patients. After listening to the concerns of the patient the nurse could give help by suggesting ways to overcome the difficulties such as having a hobby and engage in various activities in order to take away his or her thoughts from the illness. And after giving suggestions, the nurse could help the patients look into the activities in order to check whether it fits on his or her ability or capacity. The nurse should also listen if the patient does not seem to like the suggested idea or whether the patient approved of the idea. Counselling the patient is a continuous process wherein the nurse should always check the emotional stability of his or her patients.
Counselling a Patient who Self-Harms
Different types of patients are being encountered by health care professionals especially the nurses in hospitals and different health facilities. These patients are very vulnerable, a number of them have problems emotionally and psychologically therefore, extra care, and careful counselling must be given to them. According to Rethink (2006) there are a number of reasons why these people are harming their selves. Each people have a reason for doing self-harm which can be grouped as following:
· Ability to deal with personal emotions and feelings. When someone is stirred by feelings that are unmanageable and unsettling in which were not able to overcome, self-harm gives these people temporary relief from those feelings, and at the same time, positive brain chemicals is being released which improve the mood of the person.
· To express things that cannot be spoken about. Persons who self-harm because of this reason have tried other ways that are more acceptable in communication which often have been ignored or received an improper response.
· To deal with emotional, physical or sexual abuse they have experienced. Individuals who self-harm have experienced events that are traumatic in the past they often think that if they induced self-harm he or she can prevent the thing that happened in the past from happening again.
One of the best ways in dealing with these type of individuals is to approach and talk to these individuals and find out the reason behind harming themselves afterwards different methods could be used to really help these persons.
According to the Nice Guideline as cited by Rethink, the following are the key implementation priorities for managing patients that are self-harming:
- Patients that are self-harming must be treated with the same care, respect and privacy just like ordinary patients.
- The healthcare professionals must be fully responsible if these individuals became distress.
- Health professionals who have in contact with these type of patients must have the knowledge and understanding in order to take care for them.
- Individuals who self-harmed must be offered treatment even though they are unwilling to undergo treatment.
Moreover, in the study conducted by Shepperd et al (2003) the researchers determined that the CARE Framework is a significant, flexible, and practical tool which can be useful in mapping out a plan of care for helping the individual who intentionally self-harms. The CARE is comprised of the following:
Containment- promotes accurate, helpful diagnosis, provision of safety, relief of symptoms and inner calm.
Awareness- aiming for self-awareness and insight via learning, self-reflection, safe recall, expression, storing understanding and acceptance of memories.
Resilience- stressing on personal strengths and abilities that is a necessity for a full, meaningful, connected and peaceful future and recruiting self and others to build and maintain changes.
Engagement- creating a trusting partnership via listening, empathising and conveying hope and concern.
Effectiveness of Counselling
Counselling has been an effective tool in coping up with different problems of the clients. A number of studies have already pointed out the positive outcome of counselling among different types of patients. In the study of Bower and Rowland (2006), they found out that counselling for mental and psychosocial problems is more excellent than the common care given by the general practitioner. The patients that acquired counselling during the primary from a professional and well-trained counsellor are more likely to feel better as soon as after their treatment and feel more satisfactory than patients who acquired care from their general practitioner. In addition, the study of Elley et al (2003) revealed that patients that employ counselling in general practice regarding exercise is very efficient in increasing the patient's physical activity and at the same time enhancing the quality of life for over 12 months. Aside from the efficiency on younger patients, counselling has also been found effective among older populations in the study conducted by Andrew and Alison (2005) it revealed that counselling is effective especially in treating anxiety and depression among the older people. Aside from recovering through illnesses and coping up with depression counselling is also helpful in unhappy marriages, according to McKeown et al (2002) counselling is big help in almost half of their clients stating that from being stressed over unhappy marriage they become stress free through counselling, it also helped in improving the married relationship of about four in ten of their clients. The results have shown that about third of the men and fifth of women employed in counselling have shifted from having no satisfaction in their marriage to being satisfied with their marriage.
And based from the gathered studies, it revealed that Counselling is an effective tool in facilitating recovery of patients, combating anxiety and depression, saves marriages and relationships and even enhances the physical activity of an individual. However, according to the Counselling Resource (2006) determining the most effective form of counselling is comparatively complicated. All of the approaches have delivered effective results on particular psychological distress. Like in the case of depression wherein counselling alone is an effective tool in addressing the problem of the patient, on the other hand, some of the patients takes medications such as antidepressant together with the counselling sessions and in the case of counselling on marriages wherein older people do not usually resolve the issues with regards to marriage. It only shows that no specific therapy stands out as the best therapy for patients, employing the use of voluntary counselling, befriending or telephone counselling can be effective in some cases and ineffective in some other cases. The different approaches of counselling may have ambiguous results and cannot be directly be responsible in the therapeutic outcomes of the patient; however the person or the counsellor has a huge impact on the outcome of the counselling, the knowledge and capacity of the counsellors plays an important role in the positive outcome of the counselling sessions. A counsellor that does not have enough knowledge and counselling skills will have a hard time addressing the problems and concerns of the patient. That is why prior to becoming a counsellor, extensive studying and reviewing of the counselling skills is required.
Counselling is not a simple job that anyone can just undertake if he or she wants to. The counsellor needs the required skills in order to perform the task in the most efficient manner. Counselling is an effective tool, with different types and procedures already created and new methods being developed. There is no doubt that it's a helpful tool; however counselling needs an efficient person to perform those procedures. A good form or model of counselling will not be effective when the person in charge or the counsellor does not understand the true meaning of counselling and does not have the required counselling skills to perform the task.