COUNSELLING TRAINING MANUAL

TRAUMA, GUILT & SELF ESTEEM

INTERNATIONAL PLANNED PARENTHOOD FEDERATION

South Asia Regional Office
 T he International Planned Parenthood Federation (IPPF) is
a global service provider and a leading advocate of sexual
and reproductive health and rights for all. We are a worldwide
movement of national organizations working with and for
Counselling Training Manual
communities and individuals. Trauma, Guilt and Self Esteem
IPPF works towards a world where women, men and young
people everywhere have control over their own bodies, and
therefore their destinies. A world where they are free to choose
parenthood or not; free to decide how many children they will International Planned Parenthood Federation
have and when; free to pursue healthy sexual lives without fear
of unwanted pregnancies and sexually transmitted infections,
South Asia Regional Office
including HIV. A world where gender or sexuality are no longer
a source of inequality or stigma. We will not retreat from doing
everything we can to safeguard these important choices and
rights for current and future generations.

IPPF House, 66, Sunder Nagar,

New Delhi 110003, India
www.ippfsar.org
91-11-24359221-6

4 Training Module on Counselling for Trauma, Guilt and Self Esteem

 Contents
Foreword by the Regional Director 09

Sexual Rights: An IPPF declaration 10

Client’s Rights and Provider’s Needs 16

Introduction and Use of Manual 18

Module 1: Revisiting Counselling 22

1.1 Session plan for facilitator 23
The International Planned Parenthood Federation (IPPF) is a global network of 149 Member Associations 1.2 Activity sheet for the participants 32
in 183 countries, and the world’s foremost voluntary, non-governmental provider and advocate of sexual 1.3 Handout for the participants 37
and reproductive health and rights. The IPPF South Asia Regional Office (SARO) covers Afghanistan, 1.4 Power point slides 47
Bangladesh, Bhutan, India, Islamic Republic of Iran, Maldives, Nepal, Pakistan and Sri Lanka, through its
Member Associations in these countries. Module 2: Trauma 50
2.1 Session plan for facilitator 51
2.2 Activity sheet for the participants 57
Published in February 2009 by 2.3 Handout for the participants 62
International Planned Parenthood Federation 2.4 Power point slides 71
South Asia Regional Office 2.5 Relaxation techniques 76
IPPF House
66, Sunder Nagar Module 3: Guilt and Shame 78
New Delhi 110 003 3.1 Session plan for facilitator 79
3.2 Activity sheet for the participants 87
Telephone: +91 11 2435 9221-6 3.3 Handout for the participants 93
Fax: +91 11 2435 9220 3.4 Power point slides 102
E mail: info@ippfsar.org
Web: www.ippfsar.org Module 4: Self Esteem 106
4.1 Session plan for facilitator 107
Design: PealiDezine 4.2 Activity sheet for the participants 113
Cover Photo: IPPF/Jenny Matthews 4.3 Handout for the participants 118
4.4 Power point slides 124

Annexures 128
IPPF counselling training programme schedule 129

Glossary 131

Abbreviations 134

6 Training Module on Counselling for Trauma, Guilt and Self Esteem

Foreword

undreds of women and men—young and old—from poor and marginalized

H communities visit IPPF clinics for the sexual and reproductive health
(SRH) services that our clinics provide. Our counsellors help them explore
their thoughts, feelings and behaviour, reach an understanding of the
issues involved, and take appropriate decisions and healthy choices. As more and
more people accessed the services we provided, issues such as gender-based
violence including physical, emotional, and sexual abuse and early marriage, and
the resultant trauma, and feelings of low self esteem and guilt, began to emerge.
Our counsellors needed to build their capacity in dealing with these areas and to provide specialized
counselling that would equip their clients to deal with these situations.

With an aim to developing a pool of counselling trainers in the region, the IPPF South Asia Regional
Office (SARO) organized two ‘Training of Trainers’ (TOT) programmes for IPPF member associations in 2007.
The draft modules used in these TOT programmes were revised, based on the field tests conducted by the
newly trained professionals through ‘in-country trainings’ in their own country situation. Detailed feedback
received from field tests has been incorporated in this final training manual, in your hands now.

This manual is the result of long and well-thought out processes, conducted by a team led by Dr. Pratima
Mittra, Dr. Jameel Zamir and Dr. K.S. Sebastian of IPPF SARO, with support from Dr. Sushma Mehotra, the
technical expert and specialist in this area. I am certain that this manual will meet the long-felt need of
our counsellors in the region. I am also confident that this manual will be widely used by counsellors in all
SRH organizations in the South Asia region and beyond.

The IPPF Declaration on Sexual Rights will serve as guidance in the integration of our commitment to
respect, protect and advance sexual rights through our work, programme and counselling services.

Any feedback that will help improve this manual further is most welcome.

ANJALI SEN
Regional Director (Acting)
IPPF South Asia Regional Office, New Delhi, India

Message from Regional Director 9

 An IPPF Declaration
INTRODUCTION TO THE DECLARATION
Sexual Rights: An IPPF Declaration is grounded in core international human rights instruments,
authoritative interpretations of international standards and additional entitlements related to human
sexuality that IPPF believes are implicit in them.
The Declaration is in accordance with international agreements to which IPPF ascribes. The framework
of the Declaration is already broadly embodied in many existing IPPF and Member Associations
publications and reflects the mission, vision and values of IPPF. The Declaration is informed by the findings
and recommendations of several UN treaty bodies and UN Special Rapporteurs, particularly the 2004
report of the Special Rapporteur on the Right to the Highest Attainable Standard of Health. It was
developed by a panel of experts including internationally recognized leaders in the field of sexual and
reproductive health and human rights, such as Paul Hunt, UN Special Rapporteur on the Right to Health.

Sexual Rights: An IPPF Declaration contains three parts

■ A preamble which introduces the concept of the Declaration in the context of IPPF’s mission and

vision, the international agreements and documents relating to sexual and reproductive health and
rights and human rights, and also outlines the basic intention of the human rights framework.
■ Seven guiding principles which provide a framework for all the sexual rights included in the

Declaration and will inform and ensure respect, protection and advancement of sexual rights within
the Federation. Sexual rights fall within the canon of human rights which is both universal and
indivisible, and they are in accordance with the principles of non-discrimination.
■ The final part, ‘Sexual rights are human rights related to sexuality’, outlines the ten sexual rights.

Sexual rights are constituted by a set of entitlements related to sexuality that emanate from the
rights to freedom, equality, privacy, autonomy, integrity and dignity of all people.

While the significance of national and regional particularities and diverse historical, cultural and

Sexual Rights
religious backgrounds must be borne in mind, organizations and individuals working in all regions of the
world can incorporate the framework and underlying principles of the Declaration into their activities,
services and/or programmes. This will aid any efforts to promote, defend and advance sexual rights.
Convinced that these comprehensive and integrated human rights based approach to sexuality and
sexual health will promote the realization of sexual rights as an aspect of global justice, development and
AN IPPF DECLARATION health, we affirm the principles that follow:

Principle 1. Integral part of the personhood of every human being, for this reason a favorable environment
in which everyone may enjoy all sexual rights as part of the process of development must be created.
Sexuality is an integral part of the personhood of every human being in all societies. While individuals
experience their sexualities throughout their lives in ways that vary according to inner and external
factors, human rights related to sexuality, their protection and promotion should be part of the daily
existence of all individuals, everywhere. In addition, sexuality should be recognized as a positive aspect of
life. Sexual rights are universal human rights based on the inherent freedom, dignity and equality of all
human beings.
In accordance with the Charter on Sexual and Reproductive Rights, IPPF affirms that the person is the
central subject of development and recognizes the importance of creating a favorable environment in

Sexual Rights: An IPPF Declaration 11

 An IPPF Declaration
which every individual may enjoy all sexual rights in order to be able to take an active part in processes of Principle 5. Ensuring sexual rights for all include a commitment to freedom and protection from harm.
economic, social, cultural and political development. Sexuality is an aspect of human and social life which The right to be protected from and to have recourse against, all forms of violence and harm underpins
is engaged always with the body, the mind, politics, health and society. sexual rights. Sexuality-related harm includes both violence and abuse of a physical, verbal, psychological,
economic and sexual nature as well as violence against individuals because of their sex; age; gender;
Principle 2. The rights and protections guaranteed to people under age eighteen differ from those of gender identity; sexual orientation; marital status; sexual history or behaviour, real or imputed; sexual
adults, and must take into account the evolving capacities of the individual child to exercise rights practices or how they manifest their sexuality.
on his or her own behalf. All children and adolescents are entitled to enjoy the right to special protection from all forms of
IPPF understands that the rights and protections guaranteed to people under age eighteen (18), as a exploitation. This includes protection from sexual exploitation, child prostitution and all forms of sexual
matter of international and national law, sometimes differ from the rights of adults. These differences abuse, violence and harassment, including coercion of a child to engage in any sexual activity or sexual
relate to all aspects of human rights but require particular approaches in regard to sexual rights. IPPF practice and the use of children in pornographic performances and materials.
begins from the premise that persons under eighteen (18) are rights holders, and that at different points
within the spectrum of infancy, childhood, and adolescence, certain rights and protections will have Principle 6. Sexual rights m ay be subject only to those limitations determined by law for the
greater or lesser relevance. purpose of securing due recognition and respect for the rights and freedoms of others and the
In addition, the principle of evolving capacity combines respect for children, their dignity and general welfare in a democratic society.
entitlement to protection from all forms of harm, while also acknowledging the value of their own Sexual rights, as other human rights, may be subject only to those limitations determined by law for the
contribution towards their protection. Societies must create environments in which children can achieve purpose of securing due recognition and respect for the rights and freedoms of others and the general
their optimal capacities and where greater respect is given to their potential for participation in, and welfare in a democratic society, public health and public order, according to human rights law. Such
responsibility for, decision-making in their own lives. limitations must be non-discriminatory, necessary and proportionate to the achievement of a legitimate
aim. The exercise of sexual rights must be guided by awareness of the dynamic relationship between
Principle 3. Non-discrimination underlines all human rights protection and promotion. personal and social interests, the recognition of the existence of plurality of visions, and the need to
IPPF understands that a framework of non-discrimination underlines all human rights protection and guarantee equality, dignity and respect for difference.
promotion. This framework of non-discrimination prohibits any distinction, exclusion or restriction on the
basis of sex, age, gender, gender identity, sexual orientation, marital status, sexual history or behaviour, Principle 7. The obligations to respect, protect and fulfill apply to all sexual rights and freedoms.
real or imputed, race, colour, ethnicity, language, religion, political or other opinion, national or social Sexual rights and freedoms include core legal claims as well as access to the means to fulfill those
origin, property, birth, physical or mental disability, health status, including HIV/AIDS, and civil, political, claims. As with other human rights, states have obligations on three levels: to respect, protect and fulfill
social or other status which has the purpose or effect of impairing or nullifying the recognition, enjoyment the sexual rights of all. The obligation to ‘respect’ requires States to refrain from interfering directly or
or exercise on an equal basis with others, of all human rights and fundamental freedoms in the political, indirectly with the enjoyment of a particular right, in this case, with sexual rights. The obligation to
economic, social, cultural, civil or any other field. ‘protect’ requires States to take measures that prevent third parties from interfering with human rights
Individuals experience different barriers to the fulfillment of their sexual rights. Substantive equality guarantees. The obligation to ‘fulfill’ requires States to adopt appropriate legislative, administrative,
requires these barriers to be removed in order for diverse individuals to enjoy fundamental rights and budgetary, judicial, promotional and other measures towards the full realization of the right.
freedoms on an equal basis with others. This may require that particular attention be paid to marginalized
and under-served groups. Sexual Rights are Human Rights Related to Sexuality
IPPF affirms that sexual rights are human rights. Sexual rights are constituted by a set of entitlements
Principle 4. Sexuality, and pleasure deriving from it, is a central aspect of being human, whether or related to sexuality that emanate from the rights to freedom, equality, privacy, autonomy, integrity and
not a person chooses to reproduce. dignity of all people. The ten sexual rights are:
Sexual health spans a lifetime. Sexuality is an integral factor in almost all reproductive decisions;
however it is a central aspect of being human, whether or not one chooses to reproduce. Article 1. Right to equality, equal protection of the law and freedom from all forms of discrimination
Sexuality is not merely a vehicle for individuals to satisfy their reproductive interests. The entitlement based on sex, sexuality or gender
to experience and enjoy sexuality independent of reproduction, and reproduction independent of sexuality All human beings are born free and equal in dignity and rights and must enjoy the equal protection of
should be safeguarded, paying particular attention to those who, historically and in the present, are denied the law against discrimination based on their sexuality, sex or gender.
such an entitlement.

12 Training Module on Counselling for Trauma, Guilt and Self Esteem Sexual Rights: An IPPF Declaration 13
 An IPPF Declaration
Article 2. The right to participation for all persons, regardless of sex, sexuality or gender within an environment in which laws and policies recognize the diversity of family forms as including
All persons are entitled to an environment that enables active, free and meaningful participation in and those not defined by descent or marriage.
contribution to the civil, economic, social, cultural and political aspects of human life at local, national,
regional and international levels, through the development of which human rights and fundamental Article 10. Right to accountability and redress
freedoms can be realized. All persons have the right to effective, adequate, accessible and appropriate educative, legislative,
judicial and other measures to ensure and demand that those who are duty-bound to uphold sexual rights
Article 3. The rights to life, liberty, security of the person and bodily integrity are fully accountable to them. This includes the ability to monitor the implementation of sexual rights and
All persons have the right to life, liberty and to be free of torture and cruel, inhuman and degrading to access remedies for violations of sexual rights, including access to full redress through restitution,
treatment in all cases, and particularly on account of sex, age, gender, gender identity, sexual orientation, compensation, rehabilitation, satisfaction, guarantee of non-repetition and any other means.
marital status, sexual history or behaviour, real or imputed, and HIV/AIDS status and shall have the right
to exercise their sexuality free of violence or coercion. Sexual Rights: An IPPF Declaration provides a clear framework within which the Member Associations
can understand their responsibilities as service providers. They will be better equipped to begin or extend
Article 4. Right to privacy their work on improving access to all, and thereby enable their clients to fully realize their sexual and
All persons have the right not to be subjected to arbitrary interference with their privacy, family, home, reproductive rights. The Declaration will also act as a framework for advocacy to remind States of their
papers or correspondence and the right to privacy which is essential to the exercise of sexual autonomy. responsibilities. In particular, in the run up and planning for the next global initiative focusing on sexual
and reproductive health and rights, advocacy on the basis of the Declaration will help governmental
Article 5. Right to personal autonomy and recognition before the law organizations to understand and make lasting commitments based on the link between sexual rights,
All persons have the right to be recognized before the law and to sexual freedom, which encompasses public health and development.
the opportunity for individuals to have control and decide freely on matters related to sexuality, to choose
their sexual partners, to seek to experience their full sexual potential and pleasure, within a framework of The full Declaration Sexual Rights: An IPPF Declaration provides complete details of the sexual rights
non discrimination and with due regard to the rights of others and to the evolving capacity of children. and their background and is readily available at IPPF website http://www.ippf.org/NR/rdonlyres/9E4D697C-
1C7D-4EF6-AA2A-6D4D0A13A108/0/SexualRightsIPPFdeclaration.pdf. It can also be accessed through
Article 6. Right to freedom of thought, opinion and expression; right to association IPPF SARO homepage www.ippfsar.org
All persons have the right to exercise freedom of thought, opinion and expression regarding ideas on
sexuality, sexual orientation, gender identity and sexual rights, without arbitrary intrusions or limitations
based on dominant cultural beliefs or political ideology, or discriminatory notions of public order, public
morality, public health or public security.

Article 7. Right to health and to the benefits of scientific progress

All persons have a right to the enjoyment of the highest attainable standard of physical and mental
health, which includes the underlying determinants of health and access to sexual health care for
prevention, diagnosis and treatment of all sexual concerns, problems and disorders.

Article 8. Right to education and information

All persons, without discrimination, have the right to education and information generally and to
comprehensive sexuality education and information necessary and useful to exercise full citizenship and
equality in the private, public and political domains.

Article 9. Right to choose whether or not to marry and to found and plan a family, and to decide
whether or not, how and when, to have children
All persons have the right to choose whether or not to marry, whether or not to found and plan a family,
when to have children and to decide the number and spacing of their children freely and responsibly,

14 Training Module on Counselling for Trauma, Guilt and Self Esteem Sexual Rights: An IPPF Declaration 15
 CLIENTS’ RIGHTS & PROVIDERS’ NEEDS
INTRODUCTION
RIGHT to comfort: Clients have the right to feel comfortable when receiving services.
he aim of sexual and reproductive health programmes is to improve the quality of life of all women,

T men, and young people. To achieve this aim, all services that clients receive must be of consistently
high quality, and reflect this ideal.
Since the late 1980s, special focus on the concept of quality of care, and an increased attention to its
RIGHT of continuity: Clients have a right to receive sexual and reproductive heath services and supplies,
such as contraceptives, for as long as needed.

RIGHT of opinion: Clients have the right freely to express their views on the services that they receive.
importance, has enhanced client satisfaction and has led to increased demand for, and acceptability of, sexual
and reproductive health services, including counselling. A high quality of care ensures that clients are
empowered to make informed, confidential and timely decisions about their sexual and reproductive health.
The client should be at the centre of all sexual and reproductive health and family planning activities. A PROVIDERS’ NEEDS
client-centred approach means that providers of these services should be aware of the clients’ needs, and
must meet and respect their rights. Managers and supervisors should also be aware that if the rights of clients NEED for training: Service providers must have access to the knowledge and skills needed to perform all
are to be fulfilled, the needs of the service providers must also be met. Taken together, the clients’ rights and the tasks required to do their work.
the service providers’ needs form the two pillars of quality of care in the provision of such services.
NEED for information: All service providers need to be kept informed on issues related to their duties.

NEED for infrastructure: Service providers need to have the appropriate physical facilities and
organization to provide services at an acceptable level of quality.
CLIENTS’ RIGHTS
NEED for supplies: Service providers need continuous and reliable supplies of the methods of
RIGHT to information: All individuals in the community have a right to know about the benefits and contraception and materials which are required for provision of sexual and reproductive health services at
availability of sexual and reproductive health services for themselves and their families. They also have a appropriate standards of quality.
right to know where and how to obtain more information and services for planning their families and for
NEED for guidance: Service providers need clear, relevant and objective guidance: the type of guidance
sexual and reproductive health care.
which will reinforce their commitment and competence for delivery of high-quality services.
RIGHT to access: All individuals in the community have a right to obtain sexual and reproductive health
NEED for back-up: Service providers need to be reassured that whatever the level of care at which they
services, regardless of their race, gender or sexual orientation, marital status, age, religious or political
are working – from the community level to the most comprehensive clinical service delivery site – they are
beliefs, ethnicity or disability, or any other characteristics which could make individuals vulnerable to
members of a larger grouping in which individuals or units can provide support to each other.
discrimination.
NEED for respect: Service providers need recognition from the programme of their competence and
RIGHT of choice: Individuals and couples have the right to decide freely whether or not to control their
potential, and respect for their human needs.
fertility and which method to use. When seeking contraceptive services, clients should be given the
freedom to choose which method of contraception to use. NEED for encouragement: Service providers need stimulus in the development of their potential and
creativity.
RIGHT to safety: Clients have a right to be protected from unwanted pregnancy, disease and sexual
violence and, when receiving sexual and reproductive health services. NEED for feedback: Service providers need feedback concerning their competence and attitudes as judged
by others.
RIGHT to privacy: Clients have a right to discuss their needs or concerns in a private environment.
NEED for self-expression: All service providers, regardless of the level of care at which they are working,
RIGHT to confidentiality: Clients should be assured that any information they provide or any details of
need to express their views concerning the quality and efficiency of the programme.
the services received will not be communicated to third parties without their consent.
Policy makers and programme managers should assess and care for the needs of service providers in
RIGHT to dignity: Clients have a right to be treated with empathy, courtesy, consideration, attentiveness
order to ensure good quality of services. This is the best way to meet the rights of the clients and maintain
and with full respect of their dignity regardless of their level of education, social status or any other
the credibility and reputation of the programme.
characteristics which could single them out or make them vulnerable to abuse.

16 Training Module on Counselling for Trauma, Guilt and Self Esteem Clients’ Rights & Providers’ Needs 17
 Introduction
ounselling is a vital part of comprehensive sexual and reproductive health services for women,

C men and young people. Strong counselling skills have been identified as a major area of capacity
building to address key challenges in serving the needs of adolescents/youth, combating HIV and
AIDS, making abortion safe and increasing access particularly for the poor and the marginalized.
Therefore, it is important to build the capacity of the existing counsellors in dealing with trauma,
counselling to address guilt and loss of self esteem of the clients.
Trauma, guilt as well as self esteem are specialized areas of counselling. Dealing with self esteem
requires an ability to help a person reach her/his projected goal. Trauma counselling requires the ability to
help a client deal with an unexpected experience for which there was no psychological readiness and guilt
counselling needs to address the mismatch between feeling responsible for something that a person
cannot justify to the society. Young women may require guilt and trauma counselling after their first
sexual experience during adolescence. This kind of counselling is also needed by women with HIV living in
sero discordant relationship.

Objectives of the Training Manual

1. Develop a manual for counsellors of International Planned Parenthood Federation, South Asia Region
(IPPF SAR) Member Associations (MAs) on trauma, guilt and self esteem.
2. Build the capacities of counsellors and service providers of member associations as trainers in three
areas, namely self esteem development, dealing with trauma and addressing guilt.
3. To provide practical and hands on training by using participatory teaching methods.
4. Respond to the needs of counsellors so that they can apply knowledge and experience in their
respective setting.
5. Refine skills of counselling and maximize service quality.

The capacity building process should respond to the 5 A’s (Access, AIDS, Abortions, Adolescents,
Advocacy) framework of IPPF. The process will not only build capacities but will also create learning

Introduction
situations whereby the counsellor is empowered to deal with challenges faced in the course of providing
counselling. A menu of techniques of counselling e.g., cognitive and behaviour, family and couple
counselling and crisis intervention will be used while developing the skills of the counsellors.

Preparation of the Draft Manual for the Field Testing

& USE OF THE MANUAL IPPF SARO with the technical guidance and support of Sushma Mehrotra, a freelance consultant, has
started the preparatory work in 2007. Two meetings were held at Mumbai with the MA staff and the
counsellors to understand the nature of professional activities of the counsellors, the type of clients with
related problems approaching the clinics and the way counsellors handled the clients. Counsellors from
Mumbai also presented cases which paved the way, to the development of a need based curriculum for
the training.
Two training of trainers programmes have been successfully organized during the year 2007. This was
attended by 27 counsellors and health service providers from the Member Associations in Bangladesh,
India, Iran, Nepal, Maldives, Pakistan and Sri Lanka and participants from Bhutan. This programme has
facilitated the development of four training modules for counsellors, i.e., Revisiting Counselling,
Counselling for Trauma, Counselling for Guilt and Shame and Counselling for Developing Self Esteem.
These modules have been field tested through in-country training programmes organized by MAs. A team

Introduction and Use of the Manual 19

 Introduction
of in-country master trainers have been formed to improve the counselling skills of counsellors and service Equipment Required for Training Includes
providers in the South Asia Region. 1. Whiteboard or large sheets of paper (e.g. flip chart) and stand
This training package is prepared for counsellors and health care providers who offer sexual and 2. Photocopied trainee handouts and activity sheets arranged in a folder
reproductive health services to women, men and young people. The focal areas are trauma, guilt and self 3. LCD projector and a laptop
esteem. All three are interwoven and it is not uncommon to meet with clients who have gone through 4. Some pairs of scissors, scotch tape, roles of large brown papers, markers, scarves, rectangular cards,
experiences which have unnerved them and has impacted their lives. Sometimes the impact is deep and sheets of A4 paper, gum or adhesive and pins
paralyzes these people by impairing their day to day functioning. At times this emotional turmoil reduces 5. Usual stationary and note books for the participants
personal efficiencies. Similarly, some clients encounter life situations where their decisions for certain 6. Box for collecting written questions trainees feel unable to ask
actions make them ruminate and repent. They are embarrassed of their behaviour and its consequences 7. Box for collecting evaluation forms
that they do not know how to overcome this and move ahead. This situation makes them withdraw into
a shell and makes it difficult for them to unwrap and unburden themselves. Both trauma and guilt weaken Using the Training Manual
the self image and self worth of a person. The client blames oneself and she/he may also feel worthless, While no training manual can be exhaustive, this package attempts to outline the key activities and
useless and a burden to society. Counsellors sometimes find it difficult to deal with clients with trauma, information updates required for the counsellors and healthcare providers in sexual and reproductive
guilt and impaired self image. health centres. The manual contains four modules and is designed as a comprehensive kit divided into two
This five day training package is designed to train the healthcare professionals already counselling in components and includes step by step guide for conducting the session as a specified sequence, power
various settings. The focus is to enhance skills to deal with sensitivity and provide services to augment effective point presentations, activity sheet outlining the process to conduct simulations and exercises and
problem solving abilities to deal with life situations which have adversely impacted ones functioning. handouts for the participants. The facilitator’s section is intended as a resource for those conducting the
Clients come with a lot of expectations and hope to find solutions to their problems. The job of training and also serves as a reference book and provides information to help build the skills and expand
counsellors is not to be prescriptive and advise for overcoming the distress but to enhance the skills of the the scope of those who will be conducting the training.
clients to deal effectively with the disturbing state and augment problem solving. The handout intended for participants additionally includes material that serves as a reference guide
This package is being designed with techniques and methods which will be applicable and relevant for to be used back in their work settings. This section includes illustration and matrix which describe steps
the counsellors. The trainees will have practice sessions, case discussions, demonstrations and interactive and technique.
strategies besides lectures and power point presentations.
Although the counsellors attending this five day training were already trained for basic skills for Checklist of what is needed for the training (supplies and space)
counselling, however, some components are included for recapitulation and reinforcement of counselling ■ Timetable

processes. The inclusion of these contents will provide an opportunity for counsellors to reflect and refresh ■ Room

the skills and techniques of basic counselling. ■ Adequate seating

The training package is designed to have section for the facilitators with step by step session plans, ■ Personnel (trainers, resource persons, administrative support)

hand outs, activity sheets and power point presentations for bringing standardization and uniformity. ■ Participant notebooks and pens

Cases are selected from the real experiences of the clients and dealt by the counsellors which would help
to simulate and contrive actual conditions which counsellors come across. Key considerations for ensuring successful training
■ Ensure that the training materials are prepared in advance.

Interactive Training Methodology ■ All trainees must be present for the entire training.

This course employs interactive training methodology, allowing instruction, practice and feedback to take ■ Ensure training sessions commence on time. Request all trainees to arrive on time.

place, as it is crucial to address sensitive and confidential issues. ■ Encourage trainees to use a question box.

■ It is important to maintain confidentiality at all times.

The Methodology includes: ■ Encourage trainees to respect individual differences.

1. Role play exercises ■ Encourage trainees to listen carefully and with empathy, and respect each other’s contributions,

2. Brainstorming opinions, and experiences.

3. Focused discussions ■ Create an environment in which each participant feels comfortable asking questions.

4. Participatory activities and games

5. Case based small group learning exercises
6. Demonstrations

20 Training Module on Counselling for Trauma, Guilt and Self Esteem Introduction and Use of the Manual 21
 Module 1
1.1. SESSION PLAN FOR THE FACILITATORS
Session Objectives:

The participants will be able to:

■ Recap the basic skills of counselling
■ Review the requirements of counsellors for their settings

■ Analyze the counselling qualities and skills they have used so far

■ Identify the skills and techniques of counselling that they want to develop
■ Demonstrate practicing stages and process of counselling by using skills of counselling in a given

case study through role play

Time allotted: 6-7 hours

Training materials
■ LCD projector and screen

■ CD with slides
■ 4-5 flip charts to discuss brainstorming and activity
■ Stationary for participants to write down points for case study

■ Handouts and activity sheet

Session Instructions for Facilitators:

Start the session with the power point presentation, Slide 2 and then continue as specified below. The
matter in the power points is elaborated in the handouts and the activities are elaborated in the session plan
below. A separate activity sheet is available to the participants. The activities are interwoven with the theory.

1. Present objectives of the session, Slide 2

Module 1
Revisiting Counselling
2. Conduct activity 1, Slide 3

Activity 1. Trust Walk

Material: Scarf or a long length of material for a blindfold.

Time allotted: 30-45 minutes

The purpose is to take a blindfold walk as a pair with one participant as a guide and the other as a
companion. It is essential to provide some outdoor or open place where there are some obstacles present
such as chairs, a staircase, a garden with plants, an open veranda and other such hindrances in the path.
The pair is allowed to communicate as much as they want to, but it is preferred that the guide spends more
time listening to the blind folded partner. Explain to the guide that he/she has to make the partner reach
the finishing line without touching the obstacles in the path. The guide can touch and hold the hand of
the partner. The guide should ensure the safety of his partner.

Revisiting Counselling 23
 Module 1
Please note: 3. Continue with Slide 4 and emphasize the need for revisiting counselling
■ Do not specify that the activity is called a trust walk. 4. Conduct activity 2, Slide 5
■ The activity can be conducted outdoors or even indoors, depending on the facility available.

Instructions (Preparation for the Facilitators): Activity 2. My Existing and Future Counselling Expertise/Skills
■ Divide the trainees in to two equal groups, one as the guide and other as the blindfolded walker.
■ The guides could be further divided into two groups. Time allotted: 30-45 minutes
■ Guide group 1. Guide with instructions to help the blindfolded person.
■ Guide group 2. Guide with the instruction to provide minimum help to the blindfolded person. This activity will help the trainees to understand what skills of counselling are being used by them in
■ Pair the trainees, with one being blindfolded and the other acting as the guide. their routine practice and which skills need to be developed during this training. For example the
counsellors can say that they are good listeners, maintain eye contact, use appropriate words and
INSTRUCTIONS TO THE GUIDES: language, they are warm and they respect their client etc. However, they may say that they want to learn
how to reflect feelings, paraphrase the sentences etc.
Instructions to the Guide - Group 1 In the left column, list personal skills that you believe are your strength as a counsellor. In the right
‘You will walk together with one blindfolded partner towards the designated spot. Kindly provide verbal column, list skills and qualities you look forward to develop in the future.
instruction to the blindfolded partner, however, you can touch, hold and nudge when the walker encounter
some obstacles. You must try to encourage the blindfolded partner to speak and you should pay attention List personal skills that you believe List skills you look forward to
to what she/he is experiencing and expressing, verbally and non-verbally. Your task is of being a good are your strength as a counsellor. develop in the future.
listener and an observer. You are free to take the partner to the assigned area for 10-15 minutes. Kindly
return back to the classroom and remove the blindfold.’

Instructions to the Guide - Group 2

‘You will walk together with one blindfolded partner towards the designated spot. Kindly provide only
verbal instruction to the blindfolded partner. You cannot touch, hold and nudge when the walker encounter
some obstacle. However, you must protect your partner, if she/he is in danger of any physical injury. Try to
encourage the blindfolded partner to speak and pay attention to what she/he is experiencing and expressing
verbally and non-verbally. Your task is of being a good listener and an observer. You are free to take the
partner to the assigned area for 10-15 minutes. Kindly return back to the classroom and remove the blindfold.’

General instructions to the blind folded trainees: Note: Make sure you list some of the skills that you wish to develop as it will guide the facilitator to clarify
‘Simply experience the process and observe your thoughts and feelings during this experience.’ and demonstrate those expertises you are looking forward to be learning.
In complete silence, the guide will lead the blindfolded person towards the designated area. The idea is
to create some level of concern on the part of the blindfolded trainee while avoiding real danger, and is The participants will be divided into small groups and initially they should be encouraged to work
not of pushing the blindfolded partner into a feeling of terror. individually and then share their responses with the small group. They should choose a representative who
can put together the group response to the existing skills mentioned by the member and also the expertise
Debrief: they want to develop in future.
The facilitator asks the trainees to arrange their chairs in a circle and asks the blindfolded partners what The responses will be collated and presented by respective group representatives followed by a
they thought or felt during the exercise. If you need to break the ice, ask whether it was easier for them discussion on skills counsellors have in common and the skills they need to develop further.
to move on their own during the blindfolded state or to be led by verbal interaction along with physical
support. Many people will conclude that initially there was uncertainty to start with and that they could 5. Following Slides 6-7, invite group participation on what is counselling?
not trust the guide. Others will observe that they become anxious when they were not in control. 6. Conduct activity 3, Slide 8

24 Training Module on Counselling for Trauma, Guilt and Self Esteem Revisiting Counselling 25
 Module 1
Activity 3. Large Group Brainstorming for Counsellors’ Qualities and Attitudes ■ should be used as a counselling techniques
Invite participants by rotation to place their responses in the mutually agreed categories and complete
Time allotted: 30 minutes the activity by going through the entire group. There will be some common responses which could be
eliminated as the group processes are in progress.
Rules of brainstorming:
■ Each person shares one view/opinion/point at a time. Every person gets the chance and the rounds 9. Continue with Slides 12, 13, 14, 15, 16, 17 to summarize what is not counselling, types of
will start with the first person until every person ‘passes’. counselling, challenges in counselling and the counselling process.
■ The participants could be given a card to jot down their responses which could assist them during The stages and process are given in detail in the handouts with practical examples. The presenter
the brainstorming exercise. should read them prior to the session and elaborate on the each bullet point during the presentation.
■ The viewpoints expressed during the brainstorming session should be noted down on the flip chart. 10.Conduct activity 5, Slide 18

7. Continue with Slides 9, 10 and summarize on qualities of a good counsellor and elements of
good counselling Activity 5. Practicing Counselling Skills and Stages
8. Conduct activity 4, Slide 11
Time allotted: 60-90 minutes
Activity 4. Challenges and Contradictions in Counselling
The participants will be practicing the six stages of counselling with role plays. Some practical examples
Time allotted: 60- 90 minutes are given below followed by the procedure to conduct the activity by role plays

The most important component of counselling is to achieve counselling goals by sustaining motivation Some practical examples
of the client for a change in behaviour. Despite mastering counselling skill, counsellors face several
Procedure Content
difficulties in achieving counselling goals. This activity will help the counsellor to identify the challenges
they come across in their settings. Initial contact and first meeting ■ Communicating warmth and acceptance:
Remember to use your body language to show acceptance and warmth
The participants initially will be working independently and will be provided with 8-10 flash cards and say: “I welcome you to this centre for seeking our services, kindly be
seated.” “I am a counsellor in this centre; we help people to overcome
for this activity and following instructions to be given:
problems of various types.” “Whatever discussion we have here will be
A. ‘On the cards provided write challenges you came across as a counsellor. Write only one challenge on kept confidential.” (Ask personal details at this point e.g. name, age,
one card and you can use as many flash cards as you wish’. marital status, place of residence, occupation etc.) “Could you please
B. ‘On another set of cards, write the methods and techniques which should not be used while counselling. tell me what brought you here today?”
Write only one statement on a card’. “It seems you have some concerns that we will talk about today.”

■ Reflecting the feelings:

After participants have given their responses, gather the large group in a circle and divide the responses
The client may say, “I am worried that I may be pregnant for the second
on mutually agreed following the 3 categories for both A & B sets of reactions. (This can be done by time in one year, and won’t be able to take care of the young child.” The
displaying three categories on the large flash card on the floor for both responses A & B by keeping counsellor can say ‘you seem to be worried about taking care of your
sufficient space for putting the responses around the large flashcard prepared by the facilitator) young child in case you are pregnant.”

For responses A: Assessment and analysis of Ask open ended questions like:
the problem “I would like to understand the issue that concerns you.”
■ Most difficult to handle
“I want to know what you know about contraception.”
■ Sometimes can be handled
“Tell me why you feel that you are at a risk of getting pregnant.”
■ Mostly handled “What do you know about abortion?”
For responses B: “Tell me more about yourself so that I can understand the risk you have
■ Mostly should be avoided about HIV/STI infection.”
■ Sometimes to be avoided

26 Training Module on Counselling for Trauma, Guilt and Self Esteem Revisiting Counselling 27
 Module 1
Procedure Content ■ ‘Observers’ should follow the observer’s guide given below. ‘Observers’ are to observe the process of
the role-play and provide feedback to the ‘counsellor’ at the conclusion of the role-play.
Provision of ongoing supportive “I wish to know how you handle stress. What did you do in the past
■ Facilitators should remind ‘observers’ that they are not to interrupt the role-play.
counselling that helped you?”
■ Each ‘client’ is issued a case and is asked not to share the details of the case with the ‘counsellor’ or
“I understand what you are feeling right now.”
“In the situation you are at the moment, any one will feel miserable. ‘observer’. They are permitted only to disclose whether they are role playing a ‘client’ of a different
However, one has to find ways to come out of the crisis.” gender. Emphasize that it is up to the ‘counsellor’ to ask questions in such a way that they get the
“It is ok if you cry as it will help you to ventilate your feelings and information from the ‘client’.
I am here to understand your sentiments and difficulty.” ■ Allow a maximum of twenty minutes for the role play.
“We cannot change the situation and circumstances but we can look for
■ At the conclusion of each round of the role play, ask the triad to provide a brief feedback to each
other options to deal with the complications you are facing at the
moment.” other on what they experienced in the role play. Allow only five minutes for this activity.

Planning and initiation of steps “Since the methods you used so far to adjust and deal with the situation This is to be followed by requesting the class to regroup and ask the participants to discuss the
have not worked, we should look for other options”; “I would suggest we following:
make a list of things which are under our control and those which
1. What made the ‘client’ feel comfortable?
aren’t. We can then work on things which are under our control”.
The counsellor can also mention statements like “We can only make 2. What skills employed by the ‘counsellor’ were particularly important?
this work if you are willing to change. It is difficult to change the world 3. How did the trainees manage to balance the provision of information with being responsive to the
around us, so what would you like to work on today?” need of the ‘client’s’ emotions?

Implementation of the plan After selecting a course of action, the counsellor can encourage the ■ The small group debriefing should last no longer than 10 minutes each round.
client by saying “I am confident in your ability to handle the situation”
or use metaphors about how one should keep trying to succeed. Observer’s Guide
(The observer should make a note in the table provided, which will help during the feedback session either
Role Play in the triads or when the class regroups after the 3 cases)
The large group will be divided into the triads. For each triad 3 case studies will be needed.
Case study1 Observers detailed comments on skills
Case study 2
Key Counsellor Tasks Task Addressed? Comments and Recommendations
Case study 3
These case studies could be from real experience of the participants while working at their setting or
those given below.
The facilitator should ensure that these three case studies are kept ready prior to the beginning of the
session in three different sets, so that a participant gets to see only one of the case studies.
Observers Detailed Comments on Process and Stages
Preparation and Procedure:
■ Organize the class into triads (groups of threes). Each triad will comprise a ‘counsellor’, a ‘client’ and an
‘observer’. Explain that all trainees will rotate between the roles of the ‘counsellor’, ‘client’ and ‘observer’.
■ There will be three rounds of cases. One case is to be conducted per round.
■ At the conclusion of all rounds, every participant will have participated as a counsellor, a client and Observers Detailed Comments on Qualities of Counsellor
an observer.
■ The 3 case vignettes given below, are real case studies from IPPF MA settings.

The following instructions should be issued per round:

■ Instruct ‘counsellors’ to use the counselling stages, process, qualities and skills discussed in the role-
play for the different case studies.

28 Training Module on Counselling for Trauma, Guilt and Self Esteem Revisiting Counselling 29
 Module 1
Case Studies Provided by the IPPF MA Counsellors:

CASE STUDY 1 CASE STUDY 3

T he client Anita was referred to Family Planning Association of India clinic by an NGO where she had
gone for the treatment of infertility. She lost her parents in early childhood and was sold by her
relatives to a brothel owner in a small town in the south of India when she was 16 years old. She later
A bida, 24 years old, a graduate and unmarried girl approached the centre through telephone
counselling. She was profusely crying and was unable to express herself. On giving emotional support
through paraphrasing and assuring confidentiality she revealed her story and also came to the centre for
fled from the brothel and came to Mumbai and became a bar girl. She fell in love with a customer and personal counselling.
got married to him. She reported having a good relationship with her husband, however, the family Abida lost her parents when she was 6-7 years old and was brought up by her aunt and uncle. They
members of her husband did not accept her because of her earlier profession of being a bar girl. Anita brought her up with tender love and care and provided support for all her needs. Her aunt and uncle
thought of having a child in order to please her in laws and fulfill her married life. An NGO clinic got her engaged to a 46 years old man whom she did not know at all. Abida thinks that she is a burden
suggested to Anita to undergo HIV test prior to conceiving. During the post HIV test counselling, the on her foster parents and in order to get rid of her, they have got her engaged to a much older man.
counsellor informed her about her HIV positive status. Anita is now aware of her HIV status and is She does not like the idea of getting married to a much older man and also does not find him
shocked. She is worried about her husband and feels guilty that he too will be found HIV positive. She attractive as he is not very educated. She is attracted towards a cousin who had once proposed to her.
does not know how to inform her husband about her HIV status. She is unable to express her true feelings to her foster parents as she does not want to hurt them.
Abida is undergoing tremendous stress and conflict as she is unable to make any decision.

11. Continue with Slides 19-22 discussing what benefits will FPAs get with better counselling services?
CASE STUDY 2 Elaborate on the importance of self awareness and explain the techniques to understand ones own

A woman client, aged 28 yrs visited the MA clinic for ANC check up during the third month of her
pregnancy. During ANC check up the PSK counsellor gave the client information about HIV/AIDS
and the transmission of HIV from mother to child. As she desired to undergo a voluntary HIV testing,
attitudes and style of functioning.
12. Summarize and conclude the module objectives and questions, Slides 23-24

she was given pretest counselling and was referred for voluntary HIV testing at the clinic. The voluntary
HIV testing result was positive. During the post test counselling the counsellor informed the client
about her HIV positive status. The information was shocking to the client. She suffered from trauma
and started feeling guilty about her HIV positive status. The client was advised for partner notification
and testing. The client informed her husband but he refused to undergo HIV testing for him.
The counsellor also observed that the client’s three-year old daughter had rashes on her body.
Therefore, the counsellor suggested to the client that she should get voluntary HIV testing of her
daughter. The HIV testing revealed that the daughter was also HIV positive. During the post test
counselling, after the client came to know the result of HIV test of her daughter, the counsellor discussed
with the client about the options available to her either to go for ART treatment or to opt for MTP. After
further discussions and careful consideration of the options, the client decided that she should undergo
MTP. The client informed that she did not have any other sexual partner besides her husband.

30 Training Module on Counselling for Trauma, Guilt and Self Esteem Revisiting Counselling 31
 Module 1
1.2. ACTIVITY SHEET FOR THE PARTICIPANTS The participants will be divided into small groups and initially they should be encouraged to work
individually and then share their responses with the small group. They should choose a representative who
Activity 1: Trust Walk can put together the group’s response to the existing skills mentioned by the member and also the
expertise the participants want to develop in future.
Time allotted: 30-45 minutes The responses will be collated and presented by respective group representatives, followed by a
discussion on skills counsellors have in common and the further skills they need to develop then.
Material: Scarf or a long length of material for a blindfold.
The large group will be divided into two groups, one as a blindfolded walker and another as a guide. The
purpose is to take a blindfold walk in the designated place and to guide the blindfolded partner. The guides Activity 3. Large Group Brainstorming for Counsellors’ Qualities and Attitudes
will provide instruction for the safety of the blindfolded walkers and to reach the designated area without
touching the obstacles in the path. The guide should ensure the safety of the partner. Time allotted: 30 minutes

Instructions: Rules of brainstorming: Each person shares one view/opinion/point at a time. Every person gets the
Pair the trainees, with one being blindfolded and the other acting as the guide. In complete silence, the chance and the rounds will start with the first person until every person ‘passes’.
guide should lead the blindfolded person to an outdoor/indoor designated area. Guides should follow the The participants could be given a card to jot down their responses, which could assist them during the
instructions given by the facilitators. A guide walker should clearly understand the instructions provided brainstorming exercise. The viewpoints expressed during the brainstorming session should be noted down
by the facilitators before starting the walk. on the flip chart by the facilitator.

Debrief:
The facilitator asks the trainees to arrange their chairs in a circle and asks them what they thought or felt Activity 4. Challenges and Contradictions in Counselling
during the exercise.
Time allotted: 60-90 minutes

Activity 2. My existing and future counselling expertise and skills The most important component of counselling is to achieve counselling goals by sustaining motivation of the
client for a change in behaviour. Despite mastering counselling skill, counsellors face several difficulties in achieving
Time allotted: 30-45 minutes counselling goals. This activity will help the counsellor to identify the challenges they come across in their set ups.

This activity will help the trainees to understand what skills of counselling are being used by them in The participants initially will be working independently and will be provided with 8-10 flash cards
their routine practice and which skills need to be developed during this training. For example the for this activity and the following instructions are to be given:
counsellors can say that they are good listeners, maintain eye contact, use appropriate words and A. ‘On the cards provided write challenges you came across as a counsellor. Write only one challenge on
language, they are warm and respect their client etc. However, they may say that they want to learn how one card and you can use as many flash cards as you wish’.
to reflect feelings, paraphrase the sentences etc. B. ‘On another set of cards, write the methods and techniques which should not be used while counselling.
Write only one statement on a card’.
Instructions: After the participants have given their responses, gather the large group in a circle and divide the
In the left column, list personal skills and that you believe are the strength as a counsellor. In the right responses on mutually agreed following of the 3 categories for both A & B sets of reactions.
column, list skills and expertise you look forward to develop in the future.
For responses A:
List personal skills that you believe List skills you look forward to develop ■ Most difficult to handle

■ Sometimes can be handled

■ Mostly handled

For responses B:
■ Mostly should be avoided

Note: Make sure you list some of the skills that you wish to develop, as it will guide the facilitator to clarify ■ Sometimes to be avoided

and demonstrate those expertises you are looking forward to be learning.

32 Training Module on Counselling for Trauma, Guilt and Self Esteem Revisiting Counselling 33
 Module 1
■ Should be used as a counselling technique Activity 5. Practicing Counselling Skills, Qualities and Stages
Invite participants by rotation to place their responses in the mutually agreed categories and complete
the activity by going through the entire group. There will be some common responses, which could be Time allotted: 60-90 minutes
eliminated as the group processes are in progress.
The participants will be practicing the six stages of counselling with role plays. Some practical examples
Some practical examples are given below followed by the procedure to conduct the activity by role plays.
Procedure Content
Role Play
Initial contact and first meeting ■ Communicating warmth and acceptance: The large group will be divided into the triads. For each triad 3 case studies will be needed.
Remember to use your body language to show acceptance and warmth
The case studies will be provided by the facilitator or they will be asked to use one of the case studies
and say: “I welcome you to this centre for seeking our services, kindly be
seated.” “I am a counsellor in this centre; we help people to overcome from their clients’ real life experiences. The participants shall play the role of a client.
problems of various types.” “Whatever discussion we have here will be
kept confidential.” (Ask personal details at this point e.g. name, age, Preparation and Procedure:
marital status, place of residence, occupation etc.) “Could you please ■ Organize the class into triads (groups of threes). Each triad will comprise a ‘counsellor’, a ‘client’ and an
tell me what brought you here today?” ‘observer’. Explain that all trainees will rotate between the roles of ‘counsellor’, ‘client’ and ‘observer’.
“It seems you have some concerns that we will talk about today.”
■ There will be three rounds of cases. One case is to be conducted per round.
■ Reflecting the feelings: ■ At the conclusion of all rounds, every participant will have participated as a ‘counsellor’, a ‘client’ and
The client may say, “I am worried that I may be pregnant for the second
an ‘observer’.
time in one year, and won’t be able to take care of the young child.” The
■ Three case vignettes which will be given to the participants are real case studies from FPA settings.
counsellor can say ‘you seem to be worried about taking care of your
young child in case you are pregnant.”
Assessment and analysis of Ask open ended questions like: Note: The following instructions should be issued per round:
the problem “I would like to understand the issue that concerns you.” ■ Instruct ‘counsellors’ to use the counselling stages, process and skills discussed in the role play for

“I want to know what you know about contraception.” the different case studies.
“Tell me why you feel that you are at a risk of getting pregnant.” ■ ‘Observers’ should follow the observer’s guide given below. ‘Observers’ are to observe the process of
“What do you know about abortion?” the role play and provide feedback to the ‘counsellor’ at the conclusion of the role-play.
“Tell me more about yourself so that I can understand the risk you have
■ Facilitators should remind observers that they are not to interrupt the role play.
about HIV/STI infection.”
■ Each ‘client’ is issued a case and is asked not to share the details of the case with the ‘counsellor’ or
Provision of ongoing supportive “I wish to know how you handle stress. What did you do in the past
‘observer’. They are permitted only to disclose whether they are role playing a ‘client’ of a different
counselling that helped you?”
“I understand what you are feeling right now.” gender. Emphasize that it is up to the ‘counsellor’ to ask questions in such a way that they get the
“In the situation you are at the moment, any one will feel miserable. information from the client.
However, one has to find ways to come out of the crisis.” ■ Allow a maximum of twenty minutes for the role-play.
“It is ok if you cry as it will help you to ventilate your feelings and ■ At the conclusion of each round of the role-play, ask the triad to provide a brief feedback to each
I am here to understand your sentiments and difficulty.” other on what they experienced during the role play. Allow only five minutes for this activity.
“We cannot change the situation and circumstances but we can look for
other options to deal with the complications you are facing at the moment.”
This is to be followed by requesting the class to regroup and ask the participants to discuss the following:
Planning and initiation of steps “Since the methods you used so far to adjust and deal with the situation
1. What made the client feel comfortable?
have not worked, we should look for other options”; “I would suggest we
make a list of things which are under our control and those which 2. What skills employed by the counsellor were particularly important?
aren’t. We can then work on things which are under our control”. 3. How did the trainees manage to balance the provision of information with being responsive to the need
The counsellor can also mention statements like “We can only make of the client’s emotions?
this work if you are willing to change. It is difficult to change the world
around us, so what would you like to work on today?” ■ The small group debriefing should last no longer than 10 minutes for each round.
Implementation of the plan After selecting a course of action, the counsellor can encourage the
client by saying “I am confident in your ability to handle the situation”
or use metaphors about how one should keep trying to succeed.

34 Training Module on Counselling for Trauma, Guilt and Self Esteem Revisiting Counselling 35
 Module 1
Observer’s Guide 1.3. HANDOUT FOR THE PARTICIPANTS
(The observer should make a note in the table provided, which will help during the feedback session, either
in the triads or when the class regroups after the role play) Session Objectives:

Observers detailed comments on skills The participants will be able to:

■ Recap the basic skills of counselling.
Key Counsellor Tasks Task Addressed? Comments and Recommendations ■ Review the requirements of counsellors for their settings.

■ Analyze the counselling qualities and skills they have used so far.

■ Identify the skills and techniques of counselling they want to develop.

■ Demonstrate practicing stages and process of counselling by using skills of counselling in a given

case study through role play.

Introduction:
Observers Detailed Comments on Process and Stages Being a counsellor is a dynamic profession and regardless of the type of training one has undergone,
there is a scope to learn new skills. The counsellors attending this training have evidently undergone
counselling training and thus the basics of counselling are well established. However, during the course of
this training we will revisit other practical modalities and expertise in counselling techniques.

Defining Counselling
There are a number of approaches and definitions to understand counselling. Let us review some of the
definitions frequently used.
Observers Detailed Comments on Qualities of Counsellor According to Nelson and Jones (1994), counselling is a process whose aim is to help clients to help
themselves by making better choices and by becoming better choosers. The helper’s repertoire of skills
include those of forming an understanding relationship, as well as interventions focused on helping clients
change specific aspects of their feeling , thinking and acting.
As per FHI, ’Counselling may be defined as an interaction in which the counsellor (helper) offers another
person(s) the time/ attention/ respect necessary to explore, discover, and clarify ways of living more
resourcefully. Counselling is an issue-centred and goal-oriented interaction and involves carrying on a
dialogue and providing options for decision-making and behaviour change’. Good counselling helps another
person to be autonomous (i.e., able to choose, make decisions, and be responsible for his or her own actions).
WHO in the context of HIV defines counselling as a confidential dialogue between a client and
counsellor aimed at enabling the client to cope with stress and take personal decisions relating to
problems arising from HIV/AIDS. The counselling process includes the evaluation of personal risk of HIV
transmission, facilitation of preventive behaviour and evaluation of coping mechanism when the client is
confronted with a positive result.’
Thus, counselling is an ongoing process wherein the client and counsellor work together to assist the
client and resolve their problems. In this process, the counsellor enables clients to get a better perspective
of their problems and facilitates to generate possible alternatives to resolve them. Within the given support
of the counselling relationship, the client feels comfortable enough to initiate relevant alternatives to
change attitude and behaviour.

What is not Counselling?

The primary difference between counselling and other forms of helping is the way in which the

36 Training Module on Counselling for Trauma, Guilt and Self Esteem Revisiting Counselling 37
 Module 1
counsellor and client communicate and relate. At times counselling becomes a generic word and also gets is discussed with the client with some focused outcomes.
diluted. Thus it is essential to know what is not counselling. E.g.: A depressed person can be helped in understanding how change in behaviour leads to change in feeling.
■ Counselling is not giving advice: Advice is mainly one-way. Counselling is a two-way interaction.
■ Counselling is not guidance: The counsellor avoids telling the client how to solve the problems or Some techniques are:
what decisions to make or actions to take. Self monitoring: Keeping a detailed log of activities so that the counsellor knows what the client is
■ Counselling is not health education: Although education can be an important part of counselling, the doing the whole day.
information provided in counselling is tailored to the needs of an individual client. Schedule of new activities: This is where the client and counsellor work together to develop new
■ Counselling is not ongoing therapy: The counselling intervention focuses on an immediate problem. activities that will provide the client with chances for positive experience.
■ Counselling is not a mere conversation: It is not just people exchanging information and opinions. Role playing: The counsellor and client practice with each other how to face a social situation.
■ Counselling is not interrogation: The client is not being questioned to find out the truth.

■ Counselling is not preaching: It should not be a forum to voice or promote a counsellor’s opinions. ■ Supportive Therapy:
■ Counselling is not a confession: The client is not being pardoned or absolved. Counselling is used in dealing with acute crisis issues. Helps build motivation and break down
■ Counselling is not just information giving: The client does not come to the counsellor solely for resistances. It allows building of close and supportive relation between the counsellor and client.
information, though information may be given sometimes. In the time of crisis which may result from gender based violence, knowing HIV status, early marriage,
unmarried and adolescent pregnancies, exposure to sexual violence, are some of the examples where
Role of Counselling in IPPF MAs supportive therapy can be used. The counsellor ‘supports’ the client’s ego and gives her/him the resource
tools to help and deal with the difficulty
Counselling plays two important roles in IPPF MAs:
1. Promoting preventive behaviour, safe sexual practices through information on the RCH/SRH for the E.g.: A woman with home based violence is reminded of similar past situations where she was able to
related problems faced by the attendees. handle the task effectively and felt her skills were successful. Those self- skills can be discussed to
2. Providing psychosocial support to people attending the centre for various problems, including gender develop confidence for dealing with the current situation effectively.
based violence.
■ Cognitive Therapy:
Types of Counselling: It helps the client to uncover and alter distortion of thoughts and perceptions which cause psychological
There are different models of counselling which can be used by the counsellors. However, one has to problems. The counsellor guides the client to change maladaptive thoughts to adaptive ones.
select the method as per the needs and issues related to the problems: Cognitive therapists work with the person to challenge his/her thinking pattern. The therapist or counsellor
helps the client to review the situation from another perspective. The client works on alternative ways of
■ Psycho Educational Model: viewing a situation and ultimately the thoughts change from maladaptive to adaptive mode.
Involves active listening, encourages client participation, helps remove misconceptions.
In this technique, the counsellor uses directive methods for helping and provides information related to ■ Family Counselling:
the issues for enhancing understanding of the clients. The counsellor focuses on the needs of the client Family counselling concentrates on the role of family for resolving the client’s problem by involving
and spends time for understanding the needs for which active listening, empathy and effective significant people in the family. The family members are given an active role to jointly review the
communication skills are used. situation and make decisions for resolving the current issue or problems. It is problem focused and the
counsellor does not probe deeply to make in-depth analysis. The counsellor focuses in the here and now
E.g.: In contraception counselling, girls and women often have myths and misconceptions about of the situation and focuses on the problem from the interpersonal context.
contraception. According to the above model, the counsellor should inquire what the main problem is, and
listen without bias or forming any conclusions. The counsellor should then scientifically educate the client ■ Group Counselling:
about the benefits and limitations of all contraceptive methods, offer different types of family planning Cost effective, helps normalize and reduce negative feelings. Group counselling is most effective while
methods and provide the client the freedom to choose. working with people with similar problems e.g. women attending reproductive health clinics, individuals
attending programmes for rehabilitation from alcohol and drug use and groups of other vulnerable
■ Behaviour Therapy: population. In group counselling clients learn about themselves by interacting with others. They also
Issue focused, solution oriented, helps client arrive at own decision. come to understand that they are not alone in their problems. In addition, they learn social and
Behaviour therapy focuses on changing behaviour for a target or issue. Steps are explained and process communication skills that allow them to make better use of self-help programmes.

38 Training Module on Counselling for Trauma, Guilt and Self Esteem Revisiting Counselling 39
 Module 1
Qualities and attitudes of an effective counsellor: explain the purpose, ground rules, outcomes and intentions. Such explanations will help the counsellor to
The counsellor can learn the skills by practice and observation but in order to become an effective overcome barriers which may arise during establishing a counselling relationship.
counsellor it is essential to have certain qualities which can make the client feel comfortable and confident This stage is facilitated by a congenial atmosphere with adequate privacy, good seating arrangement,
to work for self development. Following are some of the practical qualities and attitude required for and establishing eye contact with the client.
successful counselling:
2. Assessment and Analysis of the Problem
■ Understands and respects the client’s rights. A skillful counsellor conducts a good assessment before drawing a treatment plan. Taking a detailed
■ Demonstrates patience and tolerance. history of the client and focusing specifically on the problem is the first step. The best counsellors identify
■ Has vast knowledge about human behaviour and issues concerning the clients. and assess the gravity of the client’s problem by actively listening to the client. The counsellor creates a
■ Earns the client’s trust by showing genuine interest. condition whereby the client tells his/her story without interference and thus collects information to set
■ Understands the cultural and emotional factors that affect a client. counselling goals.
■ Uses non judgmental approach. The counselling goal at this point is to understand the client. The counsellor should be alert and ask
■ Listens actively. questions related to the clients focal concerns. A counsellor should not only hear the spoken message but
■ Understands the effects of non- verbal communication. also pay attention to the non verbal cues. It is not important what a client says, but, how one says. Course
■ Recognizes his/her limits and is willing to make referrals when needed. of action and plan can be drawn once the client is able to articulate and understand the facts related to
his/her condition.
The counselling process:
Stages of Counselling: The counselling process goes through different stages in a sequential manner. 3. Provision of Ongoing Supportive Counselling
After exploring the needs of the client from the perspective of the client, the counsellor should respond
These stages are: with empathy and understanding. The counsellor should not be prescriptive and provide a solution.
1. Initial contact and first meeting Instead with the full participation and involvement of the client, options should be identified. During this
2. Assessment and analysis of the problem phase there may be emotional outbursts and ambivalence. Counsellors should give assurance of help and
3. Provision of ongoing supportive counselling support to the client by being with him/her. In the process the existing coping skills need to be identified
4. Planning and initiation of steps and the counsellor should explore how in the past the crisis situations were faced by the client. A
5. Implementation of the plan counsellor can also look into developing a new set of coping skills as the situation demands.
6. Termination and follow-up Brainstorming and working together will help to facilitate the process of exploring options and also
develop confidence in the client.
1. Initial Contact and First Meeting Remember that ownership of options and actions to be taken are the decisions of the client. It is the
The counsellor should convey the traditional style of greetings and provide full attention to the client client who has to think and feel that lifestyle changes are to be made, to deal effectively with the current
and this should be followed by a self introduction of one another. Acceptance of and a non judgmental situation. A counsellor works together with the client to support and guide him/her through the crisis
presence during the initial contact gives the client a feeling of comfort and hope. This does not require so situation and to make decisions for lifestyle changes.
many words, but can be communicated with a simple genuine smile with appropriate eye contact and body A counsellor provides support to monitor the behaviour change and alter and modify the plans as per
gestures. Greeting the client in the traditional style and offering a place with warmth gives the message arising needs and situations. The counsellor also fills the gap by providing information for referrals to other
of welcome to the client. Forming an initial rapport helps in gaining the client’s trust and further assuring services for treatment, care and support.
confidentiality facilitates the process of understanding the core issues of vulnerability and the issues to be
addressed. Warmth in the atmosphere allows the client to ventilate and express her/his fears and concerns. 4. Planning and Initiation of Steps
This is the first step in exploring the needs of the clients. It sets the stage to explore the inner world of Counselling is an ongoing process and not restricted to one or two meetings. After an initial exploration
the client with the problems in hand and clarifying the client’s expectations of counselling. Further it helps of options and skills shown by the client, the counsellor should assist in setting attainable and achievable
in describing what the counsellor can offer and their method of working. Do remember that it is the goals. At this stage, the client needs to be motivated for behaviour change. Options need to be assessed
counsellor who is responsible for the emotional safety of the client. One has to keep the ethics of and evaluated along with its implications and outcomes before moving forward. A counsellor should
confidentiality in mind to ensure the respect and concern for the client. The counsellor does not speak encourage participatory discussions with actions to be taken.
what comes to mind but carefully chooses words based on the relevance of the situation.
Sometimes clients do not know much about counselling and may be nervous. It may be a good idea to

40 Training Module on Counselling for Trauma, Guilt and Self Esteem Revisiting Counselling 41
 Module 1
5. Implementation of the Plan Procedure Content
After planning, ways of implementations need to be examined. There would be consequences and
effects on the client as well as on the significant others. At times it is distressing to face the altered Assessment and analysis of Ask open ended questions like:
reactions of others. Clients would require a lot of support and reassurance from the counsellor during the the problem “I would like to understand the issue that concerns you.”
process of coping with arising needs and situations. There may not be one best solution or a single plan of “I want to know what you know about contraception.”
action. One has to select one of the options from the many available. A counsellor must help the client to “Tell me why you feel that you are at a risk of getting pregnant.”
select a plan of action and ways of implementing it. After a few successful or unsuccessful attempts it will “What do you know about abortion?”
“Tell me more about yourself so that I can understand the risk you have
be possible to put a feasible plan into action and sequence the intervention activities. The counsellor
about HIV/STI infection.”
should monitor the behaviour changes and ways of adaptable measures taken by the client in follow up
sessions. The clients require sufficient hand holding, assurance, encouragement and emotional support Provision of ongoing supportive “I wish to know how you handle stress. What did you do in the past
during the transition phase of implementation of strategies. counselling that helped you?”
“I understand what you are feeling right now.”
6. Termination and Follow Up “In the situation you are at the moment, any one will feel miserable.
However, one has to find ways to come out of the crisis.”
As mentioned before, the ownership of decision taken for behaviour change should be that of the client;
“It is ok if you cry as it will help you to ventilate your feelings and
a counsellor is just a facilitator of change. The counsellor should assist in assessing the progress of behaviour I am here to understand your sentiments and difficulty.”
change and the coping resources. Follow up counselling is important to reinforce by ensuring that: “We cannot change the situation and circumstances but we can look for
other options to deal with the complications you are facing at the
■ The client is acting on plans moment.”
■ The client is continuing to maintain the gains achieved so far
■
Planning and initiation of steps “Since the methods you used so far to adjust and deal with the situation
The client is managing and coping with daily functioning, and
have not worked, we should look for other options”; “I would suggest we
■ The client has a support system, which is being accessed make a list of things which are under our control and those which
aren’t. We can then work on things which are under our control”.
The termination of counselling should not be abrupt and must be phased out by increasing the duration The counsellor can also mention statements like “We can only make
between the sessions. Assurance should be provided to the client of the option of returning to counselling this work if you are willing to change. It is difficult to change the world
as and when necessary. Referrals and after care arrangements should be made as per the needs of the client. around us, so what would you like to work on today?”

Implementation of the plan After selecting a course of action, the counsellor can encourage the
Some practical examples client by saying “I am confident in your ability to handle the situation”
Procedure Content or use metaphors about how one should keep trying to succeed.

Initial contact and first meeting ■ Communicating warmth and acceptance: Benefits of Counselling in IPPF MAs:
Remember to use your body language to show acceptance and warmth ■ Addresses psycho social elements related to sexual and reproductive health
and say: “I welcome you to this centre for seeking our services, kindly be
■ Improves health
seated.” “I am a counsellor in this centre; we help people to overcome
■ Increases acceptance
problems of various types.” “Whatever discussion we have here will be
kept confidential.” (Ask personal details at this point e.g. name, age, ■ Reduces conflicts and helps client make decisions
marital status, place of residence, occupation etc.) “Could you please ■ Removes misconceptions
tell me what brought you here today?” ■ Promotes effective compliance with treatment of reproductive health
“It seems you have some concerns that we will talk about today.” ■ Increases client satisfaction
■ Improves self esteem and confidence
■ Reflecting the feelings:
■ Improves quality of life
The client may say, “I am worried that I may be pregnant for the second
time in one year, and won’t be able to take care of the young child.” The
counsellor can say ‘you seem to be worried about taking care of your Challenges in Counselling
young child in case you are pregnant.” The most important component of counselling is to achieve counselling goals by sustaining the
motivation of the client for the behaviour change. The most compelling dilemma a counsellor faces is high

42 Training Module on Counselling for Trauma, Guilt and Self Esteem Revisiting Counselling 43
 Module 1
attrition rate of clients. Other challenges are overdependence of clients on the counsellor, inability to Acknowledging difficult feelings: The presence of difficult feelings is a substantial and unavoidable
follow up and maintain regular monitoring of counselling outcomes. Counselling sessions sometimes component of counselling. To help address difficult feelings, counsellors should:
remain inconclusive and incomplete due to the following reasons:
■ Diverse cultural practices ■ Be aware of their own feelings
■ Touching on very sensitive issues without adequate background e.g. sexual practices which people ■ Acknowledge clients’ feelings and realities
are inhibited to open up ■ Understand that it is not the counsellor’s job to take feelings away or to fix them
■ Inadequate training for handling sex and sexuality ■ Articulate and respond to non-verbal messages

■ Insufficient supervision ■ Normalize and validate clients’ feelings

Elements of Good Counselling Offering acceptance: For clients to be honest in describing their problems and concerns during counselling,
it is critical that he/she feel acceptance. The counsellor can facilitate this by being non-judgmental and
Several agreed-upon elements are necessary to ensure effective counselling: accepting, irrespective of socioeconomic, ethnic or religious background, occupation, or personal relationships.
Counsellors should recognize feelings such as anger, sadness and fear in a direct, unemotional way, indicating
Sufficient time: Providing the client with adequate time is important from the very beginning. The in words and behaviour, “Your feelings are very strong. I accept them, and I accept you.”
counselling process cannot be rushed: time is necessary to build a helping relationship.
Using a non-directive approach: Exploring options rather than issuing directives minimizes the chance
Acceptance: Counsellors should not be judgmental of clients, but rather should try to accept clients, a power struggle between the counsellor and client. When discussing behaviour change, counsellors
regardless of their socioeconomic, ethnic, or religious background, occupation, or personal relationships. should avoid such directive statements as, “You have to use a condom every time you have sex!” Instead
they can put responsibility in the client’s hands by asking, for instance, “What do you think you could do
Accessibility: Clients need to feel they can ask for assistance or call on a counsellor at any time. Counsellors to protect yourself?”
need to be available to clients at appropriate times and should have systems in place to respond to clients’
needs as appropriate (e.g., provide services after hours or work during lunchtime on a rotating system). Counsellors’ Self Awareness
It is useful for counsellors to assess their own needs and feelings continually and discuss them with peers
Consistency and accuracy: Information provided through counselling should be consistent both in and supervisors. The following questions will aid counsellors in increasing self-awareness:
content and over time.
■ ‘Do I feel uncomfortable with a client or with a particular subject area?’
Confidentiality: Trust is the most important factor in the counsellor-client relationship. Effective Often, counsellors are uneasy with a certain type of client, or with controversial subjects such as drugs or
counselling involves, trust, communication, empathy, understanding, and action. sex. It is important for counsellors to recognize this discomfort and decide on an honest approach to deal with
it. If a counsellor feels he/she cannot overcome an issue, the client should be referred to another counsellor.
Showing empathy: The ability to empathize is one of the most essential counselling skills. Empathy
involves identifying with the client, understanding their thoughts and feelings, and communicating that ■ ‘Am I aware of my own avoidance strategies?’
understanding to the client. Empathy requires sensitivity and a moment-by-moment awareness of fear, It is important for counsellors to recognize when they avoid certain topics. Counsellors aware of their
rage, tenderness, confusion, or whatever the client may be experiencing. To understand what the client is own avoidance strategies can say to themselves, “This seems to be really bothering me. I’d better figure out
feeling, the counsellor must be attentive to the client’s verbal and nonverbal cues. what’s going on so that I can really be helpful to this client.” Counsellors unaware of their own avoidance
strategies will not be able to serve the client properly because they will skip over important topics.
The counsellor needs to ask himself/herself: “What feelings is the client expressing?” “What experiences
and behaviours underlie these feelings?” “What is most important in what the client is saying to me?” ■ ‘Can I be completely honest with the client?’
For example if the client is narrating an incident which has caused her/him a great emotional pain and Counsellors want to be liked and accepted like most people. Counsellors who have a strong need to be
the client is also crying A few words like ,” I can understand what you are going through “, “ It is perfectly liked may offer reassuring, supportive responses too often, thereby diminishing the clients’ ability to
ok if you cry, it hurts when you have undergone such experience.” develop responsibility and independence. Thus, it is important that counsellors are able to say things the
As discussed earlier reflection technique is a powerful technique to make a client feel that she/he has client may not like, to ensure that the client has the right information. By agreeing with the client when
been accepted and understood. he or she should differ, the counsellor gives the false impression that the client is on the right track.

44 Training Module on Counselling for Trauma, Guilt and Self Esteem Revisiting Counselling 45
 Module 1
■ ‘Do I always need to be in control of the situation?’
1.4. Power Point Slides
While counsellors may prefer a degree of structure and direction to achieve goals and objectives, it is
also important to pay attention to how they feel when a client disagrees or wants to pursue a different Session Objectives
The participants will be able to:
topic. For example, there may be times when the counsellor wants to change the approach but the client ■ Recap the basic skills of counselling

refuses. Instead of feeling angry or rebuffed, the counsellor should try to accept the client’s feelings and ■ Review the requirements of counsellors for their settings
and region
propose alternatives. Responsive listening is a safeguard against controlling. Through self-reflection, ■ Analyze the counselling qualities and skills they have
counsellors must learn to distinguish clearly between themselves and their clients, between what “belongs” Revisiting Counselling used so far
■ Identify the skills and techniques of counselling they
to the counsellor and what ‘belongs’ to the client.
want to develop
■ Demonstrate practicing stages and process of

How can a Counsellor Develop Self Awareness? counselling by using skills of counselling in a given case
study through role play
Slide 1 Slide 2
To develop self awareness, a counsellor can use the following strategies:

Self-disclosure: Sharing something about one’s self the other person doesn’t know is self disclosure. The
counsellors should be encouraged to form a peer group where they could have a platform for self disclosure Why Revisiting Counselling?
and peer support for enhancing their counselling skills.
Activity 1 The counsellors attending this training have already
undergone training for counselling and thus the basics of
Introspection: Reflecting one’s own feelings and reactions with either peers or seniors is another counselling are well established. However, during the
Walking up with the blind fold course of this training we will revisit counselling
method to be aware of their own knowledge, attitudes and perceptions. Workshops and meetings for self
knowledge and expertise and take it further for
searching initiatives are forums which gives one an opportunity to look within and develop oneself for advancement and for additional progression.
better performance.
Slide 3 Slide 4
Accepting feedback: As an ongoing activity learning from others how one’s behaviour affects them,
is the best method of self awareness. Occasional surveys, responses from clients about satisfaction of
services and developing systems for monitoring of services would facilitate feedback at individual or at Activity 2
service delivery levels.
My existing and future counselling
expertise and skills What is Counselling?
References and Further Reading:
Corey, G. Theory and Practice of Counselling and Psychotherapy, Brooks/Cole Publishing Company USA, In the left column of the format given in the activity sheet, Understanding counselling through large
1977. list personal skills that you believe are the strength of a group discussion.
counsellor.
Kottler, J. Brown, R.W. Introduction to Therapeutic Counselling, Voices from the Field, Brooks/Cole In the right column, list skills you look forward to develop
in the future.
Publishing Company, USA, 2000.
Slide 5 Slide 6
Nelson-Jones, R. Human Relationship Skills, Holt, Rinchart and Winston New York, 1986.

Voluntary HIV Counselling and Testing Manual for Training of Trainers Part I, World Health Organization What is Counselling?
Regional Office for South-East Asia New Delhi, India, 2004.
Counselling is an ongoing process wherein the client and
counsellor work together to assist the client to resolve Activity 3
his/her problems. In this process, the counsellors enable
clients to get a better perspective of their problems and Large group brainstorming for
facilitate to generate possible alternatives to resolve them. Counsellors’ Qualities and Attitudes
Within the given support of the counselling relationship,
the client feels comfortable enough to initiate relevant
alternatives to change attitudes and behaviours.

Slide 7 Slide 8

46 Training Module on Counselling for Trauma, Guilt and Self Esteem Revisiting Counselling 47
 Module 1
Qualities and Attitudes of an The Counselling Process
Effective Counsellor Elements of Good Counselling
Stages of Counselling
■ Understand and respect the rights of the client. Earn the ■ Sufficient time The counselling process goes through different stages in a Activity 5
client’s trust ■ Acceptance sequential manner.
■ Understand the cultural and emotional factors that ■ Accessibility These stages are: Practicing Counselling Skills and Stages
effect a client ■ Consistency and accuracy 1. Initial contact and first meeting
■ Use non judgmental approach ■ Confidentiality 2. Assessment and analysis of the problem Participants should refer to the activity sheet for the
■ Listen actively ■ Showing empathy 3. Provision of ongoing supportive counselling understanding of their roles
■ Understand the effects of nonverbal communication. ■ Acknowledging difficult feelings 4. Planning and initiation of steps
■ Recognizes his/her limits and is willing to make referrals ■ Using a non-directive approach 5. Implementation of the plan
when needed. 6. Termination and follow-up
Slide 9 Slide 10 Slide 17 Slide 18

Activity 4 Benefits of Counselling in FPAs

What is Not Counselling? ■ Addresses psyco social elements related to sexual and
reproductive health
Challenges and Contradictions in Counselling ■ Counselling is not giving advice ■ Improves health
Counsellors’ Self Awareness
■ Counselling is not guidance ■ Increases acceptance
Instructions-2 sets of cards will be provided ■ Counselling is not health education ■ Reduces conflicts and helps client make decisions
Some useful questions:
A. On one set of cards, write challenges you came across ■ ‘Do I feel uncomfortable with a client or with a
■ Counselling is not ongoing therapy ■ Removes misconceptions
as a counsellor. Write only one challenge on one card. ■ Counselling is not a mere conversation ■ Promotes effective compliance with treatment of
particular subject area?’
You can use as many flash cards as you wish. ■ ‘Am I aware of my own avoidance strategies?’
■ Counselling is not interrogation reproductive health
B. On another set of cards, write the methods and ■ ‘Can I be completely honest with the client?’
■ Counselling is not preaching ■ Increases client satisfaction
techniques which should not be used while counselling. ■ ‘Do I always neet to be in control of the situation?’
■ Counselling is not a confession ■ Good decision making
Write only one statement on a card. ■ Counselling is not just information giving ■ Self esteem and confidence
■ Improves quality of life
Slide 11 Slide 12 Slide 19 Slide 20

Types of Counselling
■ Psycho Educational Model: Involves active listening,
encourages client participation, helps remove misconceptions.
Family Counselling Self Awareness through Value Exploration
■ Behaviour Therapy: Issue focused, solution oriented,
■ Concentrates on the role of the family for resolving the
How can a Counsellor Develop Self-Awareness?
helps client arrive at own decision. Counsellers deal with people of all types, races, tribes and
■ Supportive Therapy: Counselling is used in dealing with
client’s problem by involving significant people. ■
■ The family members are given an active role to jointly
Self-disclosure: Sharing something about one’s self that ages. The social environment where people grow up plays
acute crises issues. Helps build motivation and break the other person doesn’t know. a role in developing stereotypes and prejudices about
review the situation and make decisions ■ Introspection: reflecting one’s own feeling and reactions.
down resistances. Allows building of close and ■ It is problem focused and counsellor does not probe into
other people and groups that have a major impact on
supportive relation between counsellor and client. ■ Accepting feedback: learning from others how one’s social and interpersonal interactions with others. Thus, it
■ Cognitive Therapy: Helps client to uncover and alter
deeper level to make in depth analysis
■ The counsellor focuses in here and now of the situation and
behaviour affects them. is important to understand how stereotypes, prejudices,
distortion of thoughts and perceptions which causes beliefs, values, and culture impact the counselling process.
focuses on the problem from the interpersonal context.
psychological problems. The counsellor guides the client
to change maladeptive thoughts to adaptive ones.
Slide 13 Slide 14 Slide 21 Slide 22

Challenges in Counselling
Group Counselling ■ High attrition rate of clients
■ Overdependence of clients on the counsellor
Conclusion: Key points
■ Cost effective ■ Inability to follow up and maintain regular monitoring of
■ Group therapy is most effective in working with people ■ Explored the existing skills and counselling practices
counselling outcomes. ■
with similar problems e.g. women attending family Revisited counselling definitions, skills and process
planning clinics and individuals attending programmes. ■ Revisited counsellors’ attitude and approach
Questions and Answers
■ They come to understand that they are not alone in their
Following could be the reasons: ■ Reviewed challenges
■ Diverse cultural practices
problems. ■ Practiced counselling stages and process through role play
■ Touching on very sensitive issues e.g. sexual practices
■ They learn social and communication skills that allow ■ Understood the importance of self awareness
which people are inhibited to open up
them to make better use of self-help programmes. ■ Inadequate training for handling sex and sexuality
■ Insufficient supervision
Slide 15 Slide 16 Slide 23 Slide 24

48 Training Module on Counselling for Trauma, Guilt and Self Esteem Revisiting Counselling 49
 Module 2
2.1. SESSION PLAN FOR THE FACILITATOR
Session Objectives:

The participants will be able to:

■ Understand the impact of trauma on the wellbeing of individuals attending reproductive health/

family planning clinics

■ Learn the signs and symptoms of trauma through case discussion and experience sharing

■ Practice the techniques of trauma counselling by role play, activities and demonstration

Time allotted: 8-9 hours

Training materials
■ LCD projector and screen

■ CD with slides
■ 4-5 flip charts to discuss brainstorming and activity

■ Stationary for the participants to write down points for case study
■ Handouts and activity sheet

Session Instructions for Facilitators:

Start the session with the power point presentation, Slide 2 and then continue as specified below. The
matter given in the power points is elaborated in the handouts and the activities are elaborated in the
session plan below for you. A separate activity sheet is available to participants. The activities are
interwoven with the theory.

1. Present objectives of the session, Slide 2

2. Conduct activity 1, Slide 3

Module 2
Counselling for Trauma
Activity 1. Self Refection
Time allotted: 30 minutes

The objective of this activity is to help the participants experience how a traumatic or stressful situation
can impact our physical and psychological well being.
Invite the participants to consider the following on their own for a few minutes.
‘Think back on your own life and identify any occasion when you experienced a shock, jolt, and blow
which had a lasting impression. When you recall the experience, notice the emotions associated and how
it feels today?
It may have been a small trauma (t) or a big trauma (T), but it had an impact on you at the time.’
After a few minutes, ask everyone to choose a partner and share as much of their experience as they
wish. Each person should talk for a few minutes and then listen to the partner’s story.
Invite everyone to join the full circle. Encourage them to explore links between how people deal with

Counselling for Trauma 51

 Module 2
trauma and ways in which it may affect their life. After collating the above on a flip chart from the group representatives of each group, any three of the
We all experience some trauma/disturbance/shock at some time. participants could be invited to share a case study.
Then invite participants to link this discussion with their counselling work. How can they understand These trauma ridden outcome based stories are built as cases for practicing the counselling skills for the
the clients experience and its consequences? subsequent sessions using supportive techniques for crisis intervention, cognitive behaviour modification
and family intervention.
Debrief and summarize
4. Continue with Slides 5-19 explaining various facets of trauma and approaches of supportive and
3. Conduct activity 2-Slide 4 crisis intervention
5. Conduct activity 3, Slide 20

Activity 2. Building a Demographic Profile of a Family

Activity 3. Role Play for Supportive Technique and Crisis Intervention
Time allotted: 60 minutes
Time allotted: 45 minutes
During this activity participants will discuss how families are tied up in a social network and relate to
the lifestyle of their culture. The objective of this activity is to practice supportive counselling techniques in crisis situation.
Building a demographic profile of a family is a small group activity to develop a case study by using Use the same vignettes that emerged from the participants’ contributions of Activity 2. Practice skills
projection. Participants should be divided into 3-4 groups depending on the number of the participants and of counselling learned so far.
availability of time.
Guidelines in Crisis Counselling
Step I. Cut outs of human figures of different age groups to be provided to the groups and the members ■ Remain calm and show confidence
are instructed to pick up any number of figures they need to build a story of a family. Group members have ■ Listen actively
to weave a story by using their imagination and projection for a family of x members which are decided ■ Show acceptance and be non-judgemental
by the group. ■ Show empathy and reflection of feelings
■ Provide a relaxing atmosphere/an office
Step II. The stories are then shared by the members of other groups by inviting them to their table or floor ■ Allow the clients to speak freely, with minimal interruption
where figures are placed and one of the group members tells the story of the family with detailed ■ Allow ventilation of feelings
demographic information of their family members to the large group. ■ Explore immediate crisis rather than underlying causes
■ Assess the symptoms experienced
Step III. Facilitator asks the group to leave the room and puts a red dot at the back of one of the family ■ Assess suicide risk, ask the client about suicidal feelings
members. The facilitator then calls the group back to the classroom to join the same group and tells the ■ Do not minimize the crisis
group member to imagine one of the ‘A’ (AIDS, Abortion, Adolescent trauma including sexual abuse) ■ Agree on a plan of action; do not prescribe
occurring to the specified family member who has got a red dot put at the back. The group members are ■ Prioritize; agree on aspects that can easily be dealt with
encouraged to discuss the consequences keeping in mind the sign and symptoms of trauma and its impact ■ Avoid going into the past and attend to immediate concerns
on the family members and weave back the story as per the trauma experienced by a particular member ■ Have local resources to help, consider the available support system.
or the whole family.
Instructions for the Participants:
The group will be instructed to discuss the following: The participants will be divided into triads (groups of 3). Each group will practice with the same 3 cases
■ The traumatic event that is faced by the various members of the family. discussed during activity 2. In each group, one person will play the role of the counsellor; the other 2 will
■ The symptoms reported by family members. be the client and the observer respectively. The roles of each will be reversed for every case so that each
■ The distinctive features of the family and their attitude changes towards the family member person will get the opportunity to play all 3 roles.
experiencing the trauma. Participants should remember to practice the counselling process and use counselling skills while
■ How the family members reacted to the traumatic event? conducting this activity and review the helpful hints given above for guidelines in crisis counselling. At the

52 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Trauma 53
 Module 2
conclusion of each round of the role play, each triad should provide a brief feedback to each other and log ■ Analyzing how these thoughts are interweaving and blocking the process of healing
them down too on what they experienced in the role-play (with an emphasis on their observations, ■ Changing and replacing maladaptive thoughts with adaptive thoughts
thoughts, opinions and feelings). ■ Cognitive rehearsal and listening to the inner voice
■ Step by step practice to change the self talk
Helpful Hints for Role-Play ■ Creating safe space
Role of client: Read the case history carefully. Identify yourself as a client and try to act naturally. You ■ Encouraging self care techniques
can add your own few details to maintain the flow of communication with the counsellor. ■ Making note of the changes experienced due to changed self talk, following safe space and self care
techniques
Role of observer: Observe the counsellor and the client. Do not interrupt while the role play is in ■ Monitoring the changes by home work assignment
progress. Make notes if possible to provide feedback and discuss at the end of each role play. Fill the ■ Seeking social support and increasing outreach
following checklist: ■ Engaging in other productive activities
■ Relaxation and stress reduction technique
Observing on the following topics How was the Comments and ■ Follow up for sustained change
(to observe the counsellor and client) task addressed? recommendations ■ Developing referrals and linkages for care and support
Rapport building
Listening skills Remember, any traumatic event does not have the same impact across individual. Thus, it is essential to
assess and evaluate before progressing for intervention. Following are some of the points to be kept in mind:
Non verbal skills/body language,
■ What was the incident?
eye contact etc
■ How did it affect the individual?
Questioning
■ How did the person react emotionally, physically, behaviourally and socially?
Assessment of the symptoms
Assessment of suicidal thoughts Observing on the following topics How was the Comments and
(to observe the counsellor and client) task addressed? recommendations
Assessment of coping skills
Assessment and cognitive appraisal
Assessment of social support
Recognizing beliefs and thoughts associated
Any other observations including
with the event
immediate safety
Changing and replacing maladaptive thoughts
with adaptive thoughts
6. Continue with Slides 21-23: Cognitive and Behavioural Approach Creating safe space
7. Conduct activity 4., Slide 24
Encouraging self care techniques
Home work assignment
Activity 4. Role Play for Practicing Cognitive and Behavioural Approach Seeking social support and increasing outreach
Engaging in other productive activities
Time allotted: 45 minutes
Follow up for sustained change

During this activity participants will be able to practice cognitive and behavioural approaches of Developing referrals and linkages for care
and support
counselling in a given case study.
The same triads and case studies could be used with participants in each group and they should follow
the guidelines given below for practicing cognitive and behavioural approach. 8. Continue with Slides 25-26, counselling approaches for system strengthening of the family.
9. Conduct activity 5, Slide 27
■ Assessment and cognitive appraisal
■ Recognizing beliefs and thoughts associated with the event

54 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Trauma 55
 Module 2
Activity 5. Demonstration and Role Play for Family Counselling 2.2. ACTIVITY SHEET FOR THE PARTICIPANTS
Time allotted: 60 minutes Activity 1. Self Reflection

During this activity the participants will observe the techniques of family counselling to deal with a Time allotted: 30 minutes
situation which arises due to some traumatic experience shared by the family as a unit. This activity will
be demonstrated by the facilitator. The objective of this activity is to help the participants experience how a traumatic or stressful situation
can impact our physical and psychological well being.
Following are the steps and processes of family counselling: Invite the participants to consider the following scenarios on their own for a few minute. ‘Think back
on your own life and identify any occasion when you experienced a shock, jolt, and blow which had a
■ Initial contact with counsellor: Initiated by a family member or through referrals. lasting impression. When you recall the experience, notice the emotions associated and how it feels today?
■ First interview: Rapport, ‘ice-breaking’, introduction of all members, understanding their positions It may have been a small trauma (t) or a big trauma (T), but it had an impact on you at the time’.
and the power they hold on one another. After a few minutes, ask everyone to choose a partner and share as much of their experience as they
■ Family functioning evaluated in the ‘here and now’ with focus on current issues in the clients’ and wish. Each person should talk for a few minutes and then listen to the partner’s story.
their families’ lives. Invite everyone to join the full circle. Encourage them to explore links between how people deal with
■ Less emphasis on diagnosis of trauma. trauma and ways in which it may affect their life.
■ Establishing ground rules: The counsellor should avoid getting trapped in situations wherein Then invite participants to link this discussion with their counselling work. How can they understand
confidential information is given by any one member of the family. The counsellor should also not be the clients experience and its consequences?
prejudiced by information given by one family member about the other.
■ Focus to be shifted from the individual to the family.
■ Restructure the family system. Activity 2. Building a Demographic Profile of a Family
■ The ‘blame’ game should be discouraged and prevented as far as possible.
Time allotted: 60 minutes
Family Counselling Essentially uses the Basic Stages of Counselling as
1. Rapport-building During this activity participants will discuss how the families are tied up in a social network and relate
2. Assessment of the problem(s) to the lifestyle of their culture.
3. Analysis of the problem(s) Building a demographic profile of a family is a small group activity to develop a case study by using
4. Planning and initiating steps projection. Participants should be divided into 3-4 groups depending on the number of the participants and
5. Implementation availability of time.
6. Termination and follow-up
Step I. Cut outs of human figures of different age groups are to be provided to the groups and the members
Participants will be requested to volunteer for the role play and participate in a discussion after the are instructed to pick up any number of figures they need to build a story of a family. Group members have
demonstration is over. to weave a story by using their imagination and projection for a family of x members which are decided
by the group.
10. Continue with Slides 28-33
11. Encourage question answers, Slide 34 Step II. The stories are then shared by the members of other groups by inviting them to their table or floor
12. Conclude the session by discussing the key points, Slide 35 where figures are placed and one of the group members tells the story of the family with detailed
demographic information of their family members to the large group.

56 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Trauma 57
 Module 2
Activity 3. Role Play for Supportive Technique and Crisis Intervention Observing on the following topics How was the Comments and
(to observe the counsellor and client) task addressed? recommendations
Time allotted: 45 minutes Rapport building
Listening skills
The objective of this activity is to practice supportive counselling technique in crisis situation. Non verbal skills/body language, eye contact etc
Use the same vignettes that emerged from the participants’ contributions from Activity 2. Practice skills Questioning
of counselling learned so far. Assessment of the symptoms
Assessment of suicidal thoughts
Guidelines in Crisis Counselling
■
Assessment of coping skills
Remain calm and show confidence
■ Listen actively Assessment of social support
■ Show acceptance and be non-judgemental Any other observations including immediate safety
■ Show empathy and reflection of feelings
■ Provide a relaxing atmosphere/an office Activity 4. Role Play for Practicing Cognitive and Behavioural Approach
■ Allow clients to speak freely, with minimal interruption
■ Allow ventilation of feelings Time allotted: 45 minutes
■ Explore immediate crisis rather than underlying causes
■ Assess the symptoms experienced During this activity participants will be able to practice cognitive and behavioural approaches of
■ Assess suicide risk, ask the client about suicidal feelings counselling in a given case study.
■ Do not minimize the crisis The same triads and case studies could be used with participants in each group and they should follow
■ Agree on a plan of action; do not prescribe the guidelines given below for practicing cognitive and behavioural approach.
■ Prioritize; agree on aspects that can easily be dealt with
■ Avoid going into past and attend to immediate concerns ■ Assessment and cognitive appraisal
■ Have local resources to help, consider the available support system. ■ Recognizing beliefs and thoughts associated with the event
■ Analyzing how these thoughts are interweaving and blocking the process of healing
Instructions for the Participants: ■ Changing and replacing maladaptive thoughts with adaptive thoughts
The participants will be divided into triads (groups of 3). Each group will practice with the same 3 cases ■ Cognitive rehearsal and listening to the inner voice
discussed during Activity 2. In each group, one person will play the role of the counsellor; the other 2 will ■ Step by step practice to change the self talk
be the client and the observer respectively. The roles of each will be reversed for every case so that each ■ Creating safe space
person will get the opportunity to play all 3 roles. ■ Encouraging self care techniques
Participants should remember to practice the counselling process and to use the counselling skills while ■ Making note of the changes experienced due to changed self talk, following safe space and self care techniques
conducting this activity and review the helpful hints given above for guidelines in crisis counselling. At the ■ Monitoring the changes by home work assignment
conclusion of each round of the role-play, each triad should provide a brief feedback to each other and log ■ Seeking social support and increasing outreach
them down too on what they experienced in the role-play (with an emphasis on their observations, ■ Engaging in other productive activities
thoughts, opinions and feelings). ■ Relaxation and stress reduction technique
■ Follow up for sustained change
Helpful Hints for Role-Play: ■ Developing referrals and linkages for care and support
Role of client: Read the case history carefully. Identify yourself as a client and try to act naturally. You can
add your own few details to maintain the flow of communication with the counsellor. Remember, any traumatic event does not have the same impact across different individuals. Thus, it is
essential to assess and evaluate before progressing for intervention. Following are some of the points to
Role of observer: Observe the counsellor and the client. Do not interrupt while the role play is in progress. be kept in mind:
Make notes if possible to provide feedback and discuss at the end of each role play. Fill the following checklist: ■ What was the incident?
■ How it affected the individual?

■ How did the person react emotionally, physically, behaviorally and socially?

58 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Trauma 59
 Module 2
Observing on the following topics How was the Comments and Family counselling essentially uses the basic stages of counselling as
(to observe the counsellor and client) task addressed? recommendations
1. Rapport-building
Assessment and cognitive appraisal 2. Assessment of the problem(s)
Recognizing beliefs and thoughts associated with the event 3. Analysis of the problem(s)
Changing and replacing maladaptive thoughts 4. Planning and initiating steps
with adaptive thoughts 5. Implementation
Creating safe space 6. Termination and follow-up
Encouraging self care techniques
Participants will be requested to volunteer for the role play and participate in a discussion after the
Home work assignment demonstration is over.
Seeking social support and increasing outreach
Engaging in other productive activities
Follow up for sustained change
Developing referrals and linkages for care and support

Activity 5. Demonstration and Role Play for Family Counselling

Time allotted: 60 Minutes

During this activity participants will observe the techniques of family counselling, to deal with a
situation which arises due to some traumatic experience shared by the family as a unit.
This activity will be demonstrated by the facilitator.

Following are the steps and processes of family counselling:

■ Initial contact with counsellor: Initiated by a family member or through referrals.

■ First interview: Rapport, ‘ice-breaking’, introduction of all members, understanding their positions

and the power they hold on one another.

■ Family functioning evaluated in the ‘here and now’ with focus on current issues in the clients’ and

their families’ lives.

■ Less emphasis on diagnosis of trauma.

■ Establishing ground rules: The counsellor should avoid getting trapped in situations wherein

confidential information is given by any one member of the family. The counsellor should also not be
prejudiced by information given by any one family member about the other.
■ Focus to be shifted from the individual to the family.

■ Restructure the family system.

■ The ‘blame’ game should be discouraged and prevented as far as possible.

60 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Trauma 61
 Module 2
2.3. HANDOUT FOR THE PARTICIPANTS Responses to Trauma
How can an event cause an emotionally traumatic response in one person and not in another? There is
Session Objectives: no clear answer to this question, but it is likely that one or more of these factors are involved:
■ The severity of the event ( e.g., A woman who has been raped may be more traumatized than a

The participants will be able to: woman who has been verbally abused)
■ Understand the impact of trauma on the wellbeing of individuals attending reproductive ■ The individual's personal history (e.g., A person who was abused as a child will experience more

health/family planning clinics distress if she has a violent husband who also abuses her. Her coping skills will be different as
■ Learn the signs and symptoms of trauma through case discussion and experience sharing compared to a non abused woman)
■ Practice the techniques of trauma counselling by role play, activities and demonstration ■ The larger meaning the event represents for the individual (which may not be immediately evident.)

e.g., An individual who has seen a car crash may experience more symptoms than say a person who
Introduction was abused. This is because the individual who has witnessed the crash may have unresolved issues
‘Trauma’ has both a medical and a psychiatric definition. Medically, ‘trauma’ refers to a serious or critical of the past and poorer coping skills.
bodily injury, wound, or shock. In psychiatry, ‘trauma’ has assumed a different meaning and refers to an ■ Coping skills, values and beliefs held by the individual. Some individuals have temperaments and

experience that is emotionally painful, distressful, or shocking, which often results in lasting mental and personalities which make them more dependent or which make them more aggressive. In these cases
physical effects. their response to trauma may be entirely different as compared to another individual with a more
The word trauma brings to mind the effects of such major events as war, rape, kidnapping, abuse, or stable personality profile.
surviving a natural disaster. The emotional aftermath of such events, recognized by the medical and ■ The reactions and support from family, friends, and/or professionals

psychological communities, and increasingly by the general public, is known as Post-Traumatic Stress
Disorder (PTSD). Now there is a new field of investigation ‘emotional or psychological trauma.’ Anyone can become traumatized. Even professionals, who work with trauma, or other people close to a
Trauma and abuse are correlated. Abuse could be emotional, physical or sexual by nature. traumatized person, can develop symptoms of ‘vicarious’ or ‘secondary’ traumatization. Developing symptoms
Trauma begins with an event or experience that overwhelms an individual’s normal coping mechanism. Trauma is never a sign of weakness. Symptoms should be taken seriously and steps should be taken to heal, just as one
is any stressor that occurs in a sudden and forceful way and the experience is overwhelming. Women who have would take action to heal these symptoms from a physical ailment. And just as with a physical condition, the
experienced traumatic events describe feelings of intense fear, helplessness, and horror (Covington, 2003). amount of time or assistance needed to recover from emotional trauma will vary from one person to another.

What is Emotional or Psychological Trauma? What are the Symptoms of Emotional Trauma?
The ability to recognize emotional trauma has changed radically over the course of history. Recent There are common effects or conditions that may occur following a traumatic event. Sometimes these
research has revealed that emotional trauma can result from such common occurrences as an auto responses can be delayed, for months or even years after the event. Often people do not initially associate
accident, the breakup of a significant relationship, a humiliating or deeply disappointing experience, the their symptoms with the precipitating trauma. The following are symptoms that may result from a more
discovery of a life-threatening illness or disabling condition, or other similar situations. Traumatizing commonplace, unresolved trauma, especially if there were earlier, overwhelming life experiences.
events can take a serious emotional toll on those involved, even if the event did not cause physical damage. Symptoms of Emotional Trauma
Women and Trauma Symptoms Characteristics
Compared to men, women are more likely to be exposed to physical abuse, rape, sexual molestation, ■ Eating disturbances (more or less than usual)
childhood parental neglect and childhood physical abuse. Although women are at greater risk for negative ■ Sleep disturbances (more or less than usual)
consequences following traumatic events, many often hesitate to seek mental health treatment. Survivors ■ Sexual dysfunction
■ Low energy
often wait for years to receive help, while others never receive treatment at all.
■ Chronic, unexplained pain
Untreated post-traumatic symptoms not only have tremendous mental health implications, but can also ■ Fatigue, headache and exhaustion
lead to adverse effects on physical health. Female survivors may encounter physical symptoms including Physical ■ Gastrointestinal distress
headaches, gastro-intestinal problems, and sexual dysfunction. ■ Somatic complaints
Although the mental and physical symptoms of post-traumatic stress can be quite debilitating, trauma ■ Infertility

is often undiagnosed by health professionals due to a lack of training, time, and resources. ■ Impotency
■ Change in menstrual cycles
■ Increased risk of blood pressure and diabetic mellitus
■ Decreased resistance to infections

62 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Trauma 63
 Module 2
Symptoms Characteristics Symptom Characteristics
Emotional numbing and avoidance ■ Amnesia
■ Depression, spontaneous crying, despair and hopelessness ■ Avoidance of situations that resemble the initial event
■ Anxiety
■ Detachment
■ Panic attacks
■ Depression
■ Fearfulness
■ Guilt feelings
Emotional ■ Compulsive and obsessive behaviours (repetitive behaviour which one tries to
■ Grief reactions
control but is unsuccessful, and leads to anxiety) ■ An altered sense of time
■ Feeling out of control
■ Irritability, anger and resentment Increased arousal ■ Hyper-vigilance, jumpiness, an extreme sense of being "on guard"
■ Emotional numbness ■ Overreactions, including sudden unprovoked anger
■ Withdrawal from normal routine and relationships ■ General anxiety
■ Insomnia
■ Memory lapses, especially about the trauma ■ Obsession with death
■ Decreased ability to concentrate
■ Confusion
■ Disorientation Phases of Traumatic Reactions
Cognitive ■ Recurring dreams or nightmares regarding traumatic events ■ Warning of Threat
■ Precipitations with traumatic events
■ Impact: During the impact phase, some people respond in a way that is disorganized and are stunned,
■ Trouble in attention, concentration and remembering things
■ Difficulty in decision making
and they may not be able to respond appropriately to protect themselves. Such disorganized or
apathetic behaviour may be transient or may extend into the post disaster period, so that people may
■ Isolated from society
■
be found wandering helpless in the devastation afterwards. These reactions may reflect cognitive
Disturbed marital and family life
Social ■ Difficulty to perform his or her job and education distortions in response to the severe disaster stressors and may for some indicate a level of dissociation.
■ Poor interpersonal relationship ■ Rescue or Heroic: Emotional reactions will be variable and depend on the individual's perceptions
■ Economical problems and experience of the different stressor elements noted earlier. Necessary activities of the rescue
■ Addictive behaviour which effect client’s social life phase may delay these reactions, and they may appear more as the recovery processes get under way.
■ Sleep problems Reactions may include:
■ Crying or weeping ■ Numbness
■ Avoiding reminders ■ Denial or Shock
■ Restlessness and irritability
■ Flashbacks and Nightmares
Behavioural ■ Difficulty in assertiveness
■ Grief Reactions to Loss
■ Increased conflicts with family members
■ Anger ■ Anger

■ Addiction ■ Despair
■ Unsafe sexual behaviour ■ Sadness

■ Hopelessness

The following additional symptoms of emotional trauma are commonly associated with a severe Conversely, relief and survival may lead to feelings of elation, which may be difficult to accept in the
precipitating event, such as a natural disaster, exposure to war, rape, assault, violent crime, major car or face of the destruction the disaster has wrought.
airplane crashes, or child abuse. Extreme symptoms can also occur as a delayed reaction to the traumatic event.
■ Reconstruction and Recovery: The recovery phase is the prolonged period of adjustment or return to
Additional Symptoms Associated with a Severe Precipitating Event equilibrium that the community and individuals must go through. It commences as rescue is completed
Symptom Characteristics and individuals and communities face the task of bringing their lives and activities back to normal.
Much will depend on the extent of devastation and destruction that has occurred as well as injuries and
Re-experiencing the trauma ■ Intrusive thoughts
■ Flashbacks or nightmares lives lost (Raphael, 1993). A disillusionment phase may soon follow when the disaster is no longer on
■ Sudden floods of emotions or images related to the traumatic event the front pages of newspapers, organized support starts to be withdrawn, and the realities of losses,
bureaucratic constraints, and the changes wrought by the disaster must be faced and resolved.

64 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Trauma 65
 Module 2
What are the Possible Effects of Emotional Trauma? ■ Deal with the individual, his/her family and social network
Even when unrecognized, emotional trauma can create lasting difficulties in an individual's life. One ■ Focus on the client’s present problems
way to determine whether an emotional or psychological trauma has occurred, perhaps even early in life ■ Be reality-oriented, should enable the client to have a clear cognitive perception of the situation
before language or conscious awareness were in place, is to look at the kinds of recurring problems one ■ Help the client develop more adaptive mechanisms for coping with future problems and crises
might be experiencing. These can serve as clues to an earlier situation that caused a deregulation in the
structure or function of the brain. Guidelines in Crisis Counselling
■ Remain calm and show confidence

Common Personal and Behavioural Effects of Emotional Trauma ■ Listen actively

■ Substance abuse ■ Show acceptance and be non-judgemental

■ Compulsive behaviour patterns ■ Show empathy and reflection of feelings

■ Self-destructive and impulsive behaviour ■ Provide a relaxing atmosphere/an office

■ Uncontrollable reactive thoughts ■ Allow client to speak freely, with minimal interruption

■ Inability to make healthy professional or lifestyle choices ■ Allow ventilation of feelings

■ Dissociative symptoms (‘splitting off’ parts of the self) ■ Explore immediate crisis rather than underlying causes

■ Feelings of ineffectiveness, shame, despair, hopelessness ■ Assess the symptoms experienced

■ Feeling permanently damaged ■ Assess suicide risk, ask the client about suicidal feelings

■ A loss of previously sustained beliefs ■ Do not minimize the crisis

■ Agree on a plan of action; do not prescribe

Common Effects of Emotional Trauma on Interpersonal Relationships ■ Prioritize; agree on aspects that can be easily dealt with

1. Inability to maintain close relationships or choose appropriate friends and mates ■ Avoid going into past and attend to immediate concerns

2. Sexual problems ■ Have local resources to help, consider the available support system.

3. Hostility
4. Arguments with family members, employers or co-workers 2. Cognitive and behavioural approach
5. Social withdrawal
6. Feeling constantly threatened ■ Assessment and cognitive appraisal
During the history taking phase, the counsellor should ask questions to understand what the impact of
Techniques of Dealing with Trauma trauma on the client is. The impact of the same event differs from client to client. The impact depends
upon the way the client perceives the situation. Understanding the thought process of the client is
1. Supportive Technique and Crisis Intervention known as cognitive appraisal.
Generally soon after the traumatic event, personal attempts at solving the problem fail. There seems to
be no satisfactory solution to the problem. The individual feels a sense of helplessness and loss of control. ■ Recognizing beliefs and thoughts associated with the event
The client may desire to be helped by others; they are amenable to outside intervention as they know that Based on the impact of an event, the counsellor should explore the beliefs and thoughts of the client.
coping without support is difficult Simple questions can be asked, e.g. “when you think of the incident what thought comes to your mind?”

Principles of crisis counselling ■ Analyzing how these thoughts are interweaving and blocking the process of healing
One can use an eclectic approach while counselling in a crisis situation arising out of trauma. The The counsellor should explore if the thoughts are repetitive and makes the client unable to find solutions. The
counsellor should focus on the immediate concerns of the client and should not spend more time in history counsellor can ask the client, “how often do these thoughts occur to you and how do they affect your daily life?”
taking and assessment. The assessment should be problem focused and the approach should be to give
quick relief to the disturbance based on the experience. ■ Changing and replacing maladaptive thoughts with adaptive thoughts
Use of some of the ABC technique explained in the module of overcoming “Guilt and Shame”
Counselling should:
■ Be brief ■ Cognitive rehearsal and listening to the inner voice
■ Be directive; it requires the counsellor to play an active and direct role Cognitive rehearsal helps the client to practice the adaptive thoughts which have emerged during the session.

66 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Trauma 67
 Module 2
■ Step by step practice to change the self talk initially work with the affected individual and if the concern of family involvement is perceived by the
Encouraging the client to practice positive self talk in a role play situation counsellor, it is advisable to conduct family counselling.
Due to interdependence if any family member undergoes a crisis situation it causes concerns for the
■ Creating safe space entire unit. A counsellor while working with the family needs to view the problem from the larger
The clients should be taught to relax by closing the eyes and focusing on breathing using deep breathing perspective. When a crisis situation arises, e.g. due to HIV infection of one of the member, intra familial
techniques and scanning their body and being aware of any physical discomfort. While in a relaxed dynamics affect the relationship between the family members. Often there is a breakdown in the structure
position, they should be asked to imagine a real or imaginary comforting situation where the client feels and systems become weak, thus the crisis becomes unmanageable.
secure and comfortable. The safe place created should be used as a comfort zone whenever the Family counselling can be defined as a systematic effort to produce beneficial changes in a family unit
discomfort level is high. Clients are asked to use this safe place exercise even when they are alone and by introducing changes in the patterns of interaction between members of the family. Its aim is the
feel helpless. establishment of more satisfying ways of living for the entire family and for individual members.

■ Encouraging self care techniques Following are the steps and processes of family counselling:
The clients should be encouraged to explore the methods they can use to make them feel relaxed and free
from traumatic thoughts. Usually clients prefer different methods as some prefer home based methods e.g. ■ Initial contact with counsellor: Initiated by a family member or through referrals
reading, cooking, sewing, playing with children or watching TV or outdoor activities e.g. going for walks, ■ First interview: Rapport, ‘ice-breaking’, introduction of all members, understanding their positions
exercises (gym), swimming, movies depending on the social, cultural and economic conditions. and the power they hold on one another
The responsibility of the counsellor is to ensure that the clients take time out from the routine where ■ Family functioning evaluated in the ‘here and now’ with focus on current issues in the clients’ and
the disturbing thought reoccurs most of the time. their families’ lives
■ Less emphasis on diagnosis of trauma
In order to see the long term effect of the trauma counselling, following methods can be used: ■ Establishing ground rules: The counsellor should avoid getting trapped in situations wherein
confidential information is given by any one of the family members. The counsellor should also not
■ Making note of the changes experienced due to changed self talk, following safe space and self care be prejudiced by information given by one family member about the other
techniques ■ Focus to be shifted from the individual to the family
■ Monitoring the changes by home work assignment ■ Restructure the family system
■ Seeking social support and increasing outreach ■ The ‘blame’ game should be discouraged and prevented as far as possible.
■ Engaging in other productive activities
■ Relaxation and stress reduction technique Family counselling essentially uses the basic stages of counselling as
■ Follow up for sustained change 1. Rapport-building
■ Developing referrals and linkages for care and support 2. Assessment of the problem(s)
3. Analysis of the problem(s)
Assessment and appraisal 4. Planning and initiating steps
Remember, any traumatic event does not have the same impact across individuals. Thus it is essential to 5. Implementation
assess and evaluate before progressing for intervention. Following are some of the points to be kept in mind: 6. Termination and follow-up

■ What was the incident? Position of the counsellor in family counselling

■ How did it affect the individual? ■ The counsellor and co-counsellor form an integral part of family counselling

■ How did the person react emotionally, physically, behaviourally and socially? ■ The counsellor facilitates identification and definition of the problem
■ The counsellor has to involve all concerned family members and significant others in the counselling

3. Counselling Approaches for System Strengthening for the Family process

The traumatic incident/event may occur to an individual or to more members of the family. Many times ■ The counsellor is the facilitator and provides support to the family

the trauma impacts the whole family or a part of the family. Dealing with family should be done with
caution and for the best interest of the individual. Remember if the perpetrator is a family member, there
will be power dynamics and engaging the family to help the client may prove undesirable. It is prudent to

68 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Trauma 69
 Module 2
The counsellor should avoid the following
2.4. Power Point Presentations
■ Condescending attitude and negative opinions towards the trauma affected person

■ Inhibitions and personal prejudices (isolating/avoiding) against any family members involved in the
Session Objectives
session
■ Discussing sensitive details of abuse particularly if it is sexual abuse The participants will be able to:
■ Understand the impact of trauma on the wellbeing of
■ Encouraging the affected individual to repeat the traumatic event in front of the other family
individuals attending reproductive health/family
members Counselling for Trauma planning clinics
■ Learn the signs and symptoms of trauma through case
discussion and experience sharing
Techniques Used in Family Counselling ■ Practice the techniques of trauma counselling by role play
■ Role-play: Re-enactment activities and demonstration
■ Homework: Noting behavioural patterns in the family Slide 1 Slide 2
■ Skills training/facilitation of interpersonal communication
■ Cognitive restructuring: This involves recognizing and changing unclear or incorrect thoughts with
clear and correct thoughts, which will help the client adjust to the situation
Activity 1
■ Group therapy: Learning from each other’s experience
■ Behaviour counselling Small group discussion
Activity 2
‘Think back on your own life and identify any occasion
References and Further Reading when you experienced shock, jolt, and blow which had a
lasting impression. When you recall the experience, notice Building a demographic profile of a family
Covington, S. S. Beyond Trauma, A Healing Journey for Women, Hazelden, USA, 2003.
the emotions associated and how it feels today?
It may have been a small trauma (t) or a big trauma (t), but
Excerpted from Raphael, Disaster Mental Health Response Handbook, NSW Health, 2000. it had an impact on you at the time.’

Haley, J. Problem Solving Therapy, Harper and Row, New York, 1976. Slide 3 Slide 4

Haley, J. The First Therapy Session, Jossy-Bass, San Francisco, 1980.

Parnell, L. EMDR in The Treatment of Adult Abused as Children, W. W. Nortan and Co, NY, London, 1999. What is Emotional or Psychological Trauma?
Emotional trauma can be caused by any man made or
Shapiro, F. Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures natural disaster which displaces people from normal life Traumatizing events can take a serious emotional toll on
(2nd ed.), Guilford Press, NY, London, 2001. style. It can also result from such common occurrences as: those involved, even if the event did not cause physical
■ An auto accident
damage.
■ The breakup of a significant relationship
■ A humiliating or deeply disappointing experience
■ The discovery of a life-threatening illness or disabling
condition

Slide 5 Slide 6

Traumatic event does not to have uniform Symptoms of Emotional trauma

Physical
impact because of: ■ Eating disturbances (more or less than usual)
■ Sleep disturbances (more or less than usual)
■ The severity of the event ■ Sexual dysfunction
■ The individual’s personal history (which may not even be ■ Low energy
recalled) ■ Chronic, unexplained pain
■ The larger meaning the event represents for the
■ Fatigue, Headache and Exhaustion
individual (which may not be immediately evident) ■ Gastrointestinal distress
■ Coping skills, values and beliefs held by the individual
■ Miscellaneous somatic complaints
(some of which may have never been identified) ■ Change in menstrual cycles
■ The reactions and support from family, friends, and/or
■ Increased risk of blood pressure and diabetic mellitus
professionals ■ Decreased resistance to infections
Slide 7 Slide 8

70 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Trauma 71
 Module 2
Symptoms of Emotional Trauma Symptoms of Emotional Trauma Supportive Technique and Crisis Intervention
Emotional
■ Depression, spontaneous crying, despair and hopelessness
Cognitive
Guidelines in crisis counselling
■ Anxiety
■ Memory lapses, especially about the trauma Techniques of Dealing with Trauma ■ Remain calm and show confidence
■ Decreased ability to concentrate
■ Panic attacks ■ Listen actively
■ Confusion ■ Crisis intervention
■ Fearfulness ■ Show acceptance and be non-judgemental
■ Disorientation ■ Cognitive and behavioural approach
■ Compulsive and obsessive behaviours ■ Show empathy and reflection of feelings
■ Recurring dreams or nightmares regarding traumatic events ■ Family counselling
■ Feeling out of control ■ Provide a relaxing atmosphere/an office
■ Precipitations with traumatic events
■ Irritability, anger and resentment ■ Allow client to speak freely, with minimal interruption
■ Trouble in attention, concentration and remembering things
■ Emotional numbness ■ Allow ventilation of feelings
■ Difficulty in decision making
■ Withdrawal from normal routine and relationships

Slide 9 Slide 10 Slide 17 Slide 18

Symptoms of Emotional Trauma Guidelines in Crisis Counselling

Symptoms of Emotional Trauma
Behavioural ■ Explore immediate crisis rather than underlying causes
Social ■ Crying or weeping ■ Assess the symptoms experienced
■ Isolated from society ■ Avoiding reminders ■ Assess suicide risk, ask the client about suicidal feelings
Activity 3
■ Disturbed marital and family life ■ Restlessness and irritability ■ Do not minimize the crisis
■ Difficult to perform his or her job and education ■ Difficulty in assertiveness ■ Agree on a plan of action; do not prescribe
Role play on Supportive Technique and
■ Poor interpersonal relationship ■ Increased conflicts with family members ■ Prioritize; agree on aspects that can be easily dealt with
Crisis intervention
■ Economical problems ■ Anger ■ Avoid going into past and attend to immediate concerns
■ Addictive behaviour which effect client’s social life ■ Addiction ■ Have local resources to help, consider the available
■ Unsafe sex behaviour support system
Slide 11 Slide 12 Slide 19 Slide 20

Distinctive Features Cognitive and Behavioural Approach

Distinctive Features Cognitive and Behavioural Approach
Emotional numbing and avoidance ■ Assessment and cognitive appraisal
Re-experiencing the trauma ■ Amnesia ■ Recognizing beliefs and thoughts associated with the event ■ Step by step practice to change the self talk
■ Intrusive thoughts ■ Avoidance of situations that resemble the initial event ■ Analyzing how these thoughts are interweaving and ■ Creating safe space
■ Flashbacks or nightmares ■ Detachment blocking the process of healing ■ Encouraging self care techniques
■ Sudden floods of emotions or images related to the ■ Guilt feelings ■ Changing and replacing the maladaptive thoughts with ■ Making note of the changes experienced due to changed
traumatic event ■ Grief reactions the adaptive thoughts self talk, following safe space and self care techniques
■ An altered sense of time ■ Cognitive rehearsal and listening to the inner voice

Slide 13 Slide 14 Slide 21 Slide 22

Distinctive Features Cognitive and Behavioural Approach

Phases of Traumatic Reactions
Increased arousal ■ Monitoring the changes by home work assignment Activity 4
■ Hyper-vigilance, jumpiness, an extreme sense of being ■ Warning of threat ■ Seeking social support and increasing outreach
“on guard” ■ Impact ■ Engaging in other productive activities Role play on Cognitive and
■ Overreactions, including sudden unprovoked anger ■ Rescue or heroic ■ Relaxation and stress reduction technique Behavioural Approach
■ General anxiety ■ Reconstruction and recovery ■ Follow up for sustained change
■ Insomnia ■ Developing referrals and linkages for care and support

Slide 15 Slide 16 Slide 23 Slide 24

72 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Trauma 73
 Module 2
Counselling Approaches for System Techniques used in Family Counselling
Counselling Approaches for System Strengthening for the Family
■ Role-play: Re-enactment
Strengthening for the Family Remember if the perpetrator is a family member, there ■ Homework: Noting behavioural patterns in the family Questions & Answers
will be power dynamics and engaging a family to help ■ Skills training/facilitation of interpersonal communication
The traumatic incident/event may occur to an individual ■ Cognitive restructuring: This involves recognizing and
the client may prove undesirable.
or to more individuals from a family. Many times the changing unclear or incorrect thoughts with clear and Any clarifications on family counselling and
trauma impacts the whole family or a part of the family.
Dealing with family should be done with caution and for
It is prudent to initially work with the affected individual correct thoughts, which will help the client adjust to the techniques being used
and if the concern of family involvement is perceived by situation
the best interest of the individual. ■ Group therapy: Learning from each other’s experience
the counsellor, it is advisable to conduct family
counselling. ■ Behaviour counselling

Slide 25 Slide 26 Slide 33 Slide 34

Steps and Processes of Family Counselling Conclusion: Key Points

■ Initial contact with counsellor: Initiated by family ■ Discussed how a traumatic event can impact people
Activity 5 member or through referrals differently
■ First interview: Rapport, ‘ice-breaking’, introduction of ■ Reviewed the signs and symptoms of trauma
Demonstration and role play on all members, understanding their positions and power ■ Practiced counselling stages and process through role
Family Counselling they hold on one another play by using the following techniques:
■ Family functioning evaluated in the ‘here and now’ with – Crisis intervention
focus on current issues in the clients’ and their families’ lives – Cognitive and behavioural approach
■ Less emphasis on diagnosis of trauma – Family counselling

Slide 27 Slide 28 Slide 35

Steps and Processes of Family Counselling

■ Establishing ground rules: The counsellor should avoid
Stages of Counselling in the Family
getting trapped in situations wherein confidential
1. Rapport-building
information is given by any one of the family members.
2. Assessment of the problem(s)
The counsellor should also not be prejudiced by
3. Analysis of the problem(s)
information given by one family member about the other
■ Focus to be shifted from the individual to the family
4. Planning and initiating steps
■ Restructure the family system
5. Implementation
■ The ‘blame’ game should be discouraged and prevented
6. Termination and follow-up
as far as possible.
Slide 29 Slide 30

Position of the Counsellor in Family

Counselling The counsellor should avoid the following
■ The counsellor and co-counsellor form an integral part ■ Moralizing attitude and negative opinions towards the
of family counselling trauma affected person
■ Counsellor facilitates identification and definition of the ■ Inhiitions and personal prejudices (isolating/avoiding)
problem against any family members involved in the session
■ The counsellor has to involve all concerned family ■ Discussing sensitive details of abuse particularly if it is
members and significant others in the counselling sexual abuse
process ■ Encouraging the affected individual to repeat the
■ The counsellor is the facilitator and provides support to traumatic event in front of the other family members
the family
Slide 31 Slide 32

74 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Trauma 75
 Module 2
2. 5. Relaxation Technique
Relaxation restores harmony and helps to create conditions for optimum living. It is the releasing of
physical and mental tensions. Some people need help and training to understand how to release physical
and mental tensions.
Relaxation therapy has a range of techniques to create a profound level of relaxation and through them,
into an enhanced psychological integration.

Techniques:

Cool air in, warm air out

First close your eyes and start breathing deeply. As you breathe in, become aware of the air coming in
your nostrils. As you breathe out, be aware of the sensations of the air passing back out. Perhaps you notice
that the air coming in tends to be cooler and the air you breathe out tends to be warmer. Just be aware
of cool air in; warm air out.

Relaxation of muscles
Continue breathing deeply and concentrate on your feet and legs. If you find any tenseness in them,
start loosening the muscles slowly. Concentrate on your breathing. Now move upward towards your thigh,
buttock muscles, stomach. (The facilitator has to cover the whole body, till all the muscles are relaxed)

OR

Breathing tensions away

Gently focus your attention on your feet. As you take in a slow, deep breath, imagine collecting all the
tension in your feet and legs, breathing them into your lungs and expelling them as you exhale. Then with
a second deep breath, all the tensions in your trunk, hands and arms, expel that. With a third one, collect
and expel all those in your shoulders, neck and head. With practice, some people are able to collect tension
in the entire body in one deep inhalation.

Ideal relaxation
After the body is relaxed, with your eyes closed, take a moment to create, in your mind’s eye, an ideal
spot for relaxation. You can make it any place, real or imagined. Perhaps it is a favourite room, a beautiful
meadow, an ocean beach, or a floating cloud. See yourself in comfortable clothes. Now, once you have
created it, go back there and tell yourself, ‘I am at peace’, ‘I am relaxed here’.
Concentrate on your breathing and gradually open your eyes.

76 Training Module on Counselling for Trauma, Guilt and Self Esteem

 Module 3
3.1. SESSION PLAN FOR THE FACILITATORS
Session Objectives:
The participants will be able to understand:

■ The constituents and elements of guilt and shame

■ How guilt and shame affect the wellbeing of the person
■ The linkage between the thoughts and feelings which constitute the inner strength
■ How we hold our feelings which block our thinking and functioning
■ The ABC approach to overcome strong feelings
■ How to help clients to dispute their irrational beliefs and replace them with empowering self position
and disposition

Time allotted: 7-8 hours

Training materials:
■ LCD projector and screen
■ CD with slides
■ 4-5 flip charts to discuss brainstorming and activity

■ Stationary for participants to write down the points for case study
■ Handouts and activity sheet

Session Instructions for Facilitators:

Start the session with the power point presentation, Slide 2 and then continue as specified below. The
matter in the presentations is elaborated in the handouts and the activities are elaborated in the session
plan below for you. A separate activity sheet is available to the participants. The activities are interwoven

Module 3
with the theory,

1. Present objectives of the session, Slide 2

2. Conduct activity 1, Slide 3
Counselling for Guilt and Shame
Activity 1. The Observer Self

Time allotted: 15-20 minutes

The objective of this activity is to allow the participants to be in touch with their thoughts, feelings and
body awareness particularly while passing through a situation of guilt or shame.

Instruction:
Recall any recent or past situation where you felt ashamed or guilty. Now close your eyes and get totally
involved in the scene of the situation. Keep your focus on the situation and notice the discomfort in your
body. Be aware of the thoughts which occur while visualizing the situation. Make note of the words which

Counselling for Guilt and Shame 79

 Module 3
can define and describe your thoughts. Observe the feelings associated with the situation and the You can do the same thing with any emotion: Choose to let it go.
thoughts. Make a note of and give word to your feelings. Take a deep breath and open your eyes. Sticking with this same analogy: If you walked around with your hand open, wouldn’t it be very
difficult to hold on to the pen or any other object you’re holding? Likewise, when you allow or welcome a
Kindly put down your experience in the given table feeling, you are opening your consciousness, and this enables the feeling to drop away all by itself—like
the clouds passing in the sky or smoke going up a chimney with the flue open. It is as though you are
What was the What were your How did you Body sensations removing the lid from a pressure cooker.
situation? spontaneous feel? and where it Now, if you took the same object- a pencil, pen, or pebble- and magnified it large enough, it would appear
thoughts? feels?
more and more like empty space. You would be looking into the gaps between the molecules and atoms. When
you dive into the very core of a feeling, you will observe a comparable phenomenon: nothing is really there.
Encourage discussion and participation for sharing the experience of each participant.

5. Explain ABC technique using Slides 10-11

6. Conduct activity 3, Slide 12

Invite feedback from some of the participants on their introspection and debrief them explaining the Activity 3. Knowing your Irrational and Rational Beliefs
link between their thoughts and feelings.
Time allotted: 30- 40 minutes
3. Continue with Slides 4-7 introducing guilt and shame and what is their impact on self growth.
4. Conduct activity 2, Slides 8-9 This activity helps counsellors to understand the difference between irrational and rational beliefs.
To initiate this activity prepare twenty cards indicating ten rational and ten irrational beliefs. Mix them
up and distribute them in a random order to the participants and ask them not to discuss in advance what
Activity 2. Let it Go is written on the card. Prepare two stations at a distance, one for rational beliefs and the other for
irrational beliefs indicated by a signage. Invite the participants to sit in a circle and ask them to see the
Time allotted: 15-20 minutes cards one by one and place each in the station it belongs to. After the designated participant has placed
the belief card, invite the opinion of the rest of the participants and discuss the appropriateness of the
The purpose of this activity is to make the participants understand that they are in charge of holding placement of the card. Go as per the majority view to put the card in the proper section.
their feelings. After all the cards are placed you should check from the handout the appropriateness of their position
and explain irrational beliefs as the cause of emotional problems.
Following Instructions to be Given:
‘Pick up a pen, a pencil, or some small object that you would be willing to drop without giving it a second 7. Discuss irrational beliefs Slides 13-14
thought. Now, hold it in front of you and really grip it tightly. Notice the pain or discomfort it causes you’. 8. Elaborate the application of ABC technique from Slides 15-17.
Debrief by saying, ‘Now, open your hand and roll the object around in it. Notice that you are the one 9. Discuss the case of Sheila using Slides 18-20 and review the ABC context from the handouts in detail.
holding on to it; it is not attached to your hand. The same is true with your feelings, too. Your feelings are
as attached to you as this object is attached to your hand.’
Discuss that we hold on to our feelings and forget that we are holding on to them. It’s even in our CASE STUDY
language. When we feel angry or sad, we don’t usually say, “I feel angry,” or, “I feel sad.” We say, “I am
angry,” or, “I am sad.” Without realizing it, we are misidentifying that we are the feeling. Often, we believe
a feeling is holding on to us. This is not true… we are always in control and just don’t know it.
S heila, a 31 years old married woman who had been sexually abused during her childhood
constantly thinks that it was her fault as she did not take care of herself. She has never shared
her past experience with anyone who is significant in her life as she feels that it was her mistake
that led to the situation. Informing others will not help to resolve any problem. She thinks that
Now, let the object go. sharing with others will make her more vulnerable. She blames her destiny and is always doubtful of
What happened? You let go of the object, and it dropped to the floor. Was that hard? Of course not. her actions. She always consults significant others for all her decisions.
That’s what we mean when we say “let go.”

80 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Guilt and Shame 81
 Module 3
She tries to please everyone around because she feels that she may get into some kind of trap if
Activity 4. Working as Pairs with Role Play for ABC Techniques
she disobeys anyone around. She is oversensitive and generalizes her fears to other situations. She
Time allotted: 60-90 minutes
fears meeting and facing all men and occasionally doubts her ability to protect herself from any
outside harm. She is self doubting and guilt ridden. She is unable to understand her self defeating
This activity will help the participants to apply ABC technique in a role play simulation.
ideas and in spite of her high level of education prefers to stay at home and do household chores
with dedication. Sheila has two children, a girl aged 5 and a boy aged 2. She overprotects them and
does not permit them to do several normal things children at their age should be doing. She blames
Case study for the role play:
Peter, a 35 years old male approached the reproductive health centre for counselling. He is married and
herself for any behavioural problems of her children and her self talk is that “I am a useless mother,”
has two young children aged 4 and 2. His wife is pregnant and regularly comes to the centre for her checkups.
“I am responsible for not giving happiness to others,” “I should improve my behaviour otherwise…..,”
He has decided to take an HIV test at the suggestion of his friend. He reluctantly reports that he often has
“I am not as lucky as others,” “this is not the time for me to enjoy,” “I should do my duties diligently.”
sex with other women, the most recent occasion being 3 weeks ago. He reports that this usually occurs when
At home, her husband constantly ridicules and often beats her for her ‘inefficiency’. Her in-laws
he has been drinking alcohol and that he does not use condoms. His wife is unaware of his sexual practices.
blame her for the ‘poor upbringing’ of the children as they are not ‘socially apt’ and for not being an
He does not use condoms with his wife. He most recently had sex with his wife 2 weeks ago. He is unsure
‘efficient’ housewife. Sheila takes all the blame in a submissive way and hardly asserts herself for any
what he would do if he tested HIV positive. He is particularly concerned about how he would tell his wife and
issues that arise in her family. Sheila at this stage does not want to get pregnant and she wants to
how she may react. He is worried about his family and has recurrent thoughts of ending his life.
seek guidance for contraception and approaches the family planning clinic. Sheila needs help.
Reiterate ABC Technique before Starting the Practice Session:
Some examples for ABC techniques: Sheila attended family planning/ reproductive health centre for A Activation agent or situation
contraception counselling and the counsellor finds out through her case history that she is suffering from B Belief towards A
guilt and shame due to some past incidents. In order to work in ABC context the counsellor can proceed C Consequences or the experienced emotions
by taking the following steps.
Situation/activating agent Beliefs towards A Experienced Emotions/consequences
Some examples to understand ABC paradigm from the story of Sheila:
Who What did she/he think? What did she/he feel?
Situation Beliefs Experienced Emotions What What did she/he assume? How did it affect her/him?
Who What did I think? What did I feel? When What did she/he imagine? What was her/his experience?
(I was sexually abused (It was my fault, I can’t take care ( I felt ashamed, guilty and
Where What did she/he believe? Where did it cause discomfort?
during childhood ) of myself, how can I take care of depressed)
my children? I am a sinful person)
What What did I assume? How did it affect me? Applying ABC Technique:
(My husband hits me) (I am not worthy of being a (I am ashamed of myself)
good wife) After analyzing A, B and C we should add D, E and F for behaviour change
When What did I imagine? What was my experience? D Your changed belief by disputing the original belief (B)
(My in laws accuse me of (They are bad people and do not (I feel rejected and dejected) E Your effective rational belief
not taking care of home love me) F Your feelings and behaviour after effective rational beliefs
and children) Based on your understanding work on changing the irrational beliefs in a given format:
Where What did I believe? Where did it cause discomfort?
(I have come to the clinic for (My life is full of miseries as I (My head feels heavy most of the Event in an Your thoughts/ Your associated Your changed Effective Feeling and
preventing more childbirths) can’t keep people happy, I can’t time, I get cramps in my stomach) abbreviated beliefs towards emotions/ belief by rational behaviour
make right decisions, I am not sure
form A consequences disputing the beliefs
original
what to do? I should learn to take
care of myself and my children, (A) (B) (C) (D) (E) (F)
I am ignorant, stupid, useless)

10. Conduct activity 4, Slide 21

82 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Guilt and Shame 83
 Module 3
Check the list given below to identify some of the irrational thoughts. 7. Feel your emotions with your changed beliefs.
8. Notice the changes in your reactions, behaviour and emotions.
Irrational Thinking Involved in Shame and Guilt Feelings: 9. Maintain a work book/diary.

■ I was responsible for the bad things that happened to me in my childhood. Divide the participants into pairs and both should discuss the case of Peter. Role play alternatively as a
■ How can I face others with what happened to me? counsellor and a client following all the steps of ABC technique.
■ I am an awful person for that to have happened to me.
■ I must have asked for what I got in the past. 11. Gather the participants and ask for their experience and encourage questions on the ABC
■ I am a bad person for what happened to me in the past. technique, Slide 22.
■ I can never tell others what happened to me in my past. 12. Conduct activity 5, Slide 23.
■ I do not deserve to be happy.
■ I am responsible for my family's (spouse's) happiness.
■ There is only one “right'’ way to do things. Activity 5. Case Discussion on the Premise of ABC Technique
■ It's bad to feel hurt and pain.
■ My children should never suffer in their childhood like I did in mine. Time allotted: 30-40 minutes
■ My kids should have more material things than I did.
■ It is my fault if others in my life are not happy. Divide the participants into 3-4 groups and ask them to carefully study the case study given below. They
■ If my kids fail in any way, it's my responsibility. should analyze the situation, thoughts & beliefs, consequences. After reviewing the A, B & C they should
■ It is wrong to be concerned about myself. work in the above format for completing D, E & F for the expected outcomes.
■ People are constantly judging me, and their judgment is important to me.
■ It is important to save face with others.
■ It is wrong to accept the negative aspects of my life without believing that I am responsible for them myself. CASE STUDY
■ I am responsible if either positive or negative events happen to the members of my family.
■

■
I must not enjoy myself during a time when others expect me to be in mourning, grief, or loss.
I must never let down my guard; something I'm doing could be evil or wrong.
R ebbeca, an 18-year-old girl studying in the 12th standard is an adopted child. She has a brother
and a sister, who were born after her adoption. As the years passed her parents started showing
discrimination towards her while showering affection on their ‘own’ children. Rebbeca grew up in an
■ I must always be responsible, conscientious, and giving to others. insecure environment, so she avoided talking to people around her and particularly to strangers and
■ How others perceive me is important as to how I perceive myself. didn’t make friends with anyone.
■ No matter what I do, I am always wrong. She was not doing well in her academics and was not interested in any extra curricular activities.
■ I should never feel shame and guilt. Robert, a young boy from the neighborhood entered her life three years back, when she was 15.
■ If you feel shame and guilt, then you must be or have been wrong. Gradually they became close. Robert supported Rebbeca in her studies, by helping her do her
homework, in solving mathematical problems etc. and motivated her to do better in her studies and
Review the Steps of ABC Technique: also to take part in extra curricular activities.
Robert introduced Rebbeca to his parents and other family members and expressed his earnest
Steps for ABC Techniques: wish to marry Rebbeca. The no-objection to their friendship from Robert’s parents, led to mutual
caressing and physical intimacy the same afternoon.
(Please refer to the case study of Sheila) Robert met with a road accident and he died on the spot.
1. Assess study and analyze the situation which has caused one discomfort (situational analysis of Robert’s death was a great shock to Rebbeca in addition to the feeling of guilt about indulging in
activating agent). sex before marriage. She was tense and worried about her missing periods. She was worried whether
2. Be aware of your thoughts and beliefs and take responsibility for your own thoughts. she had become pregnant, And if yes, what would happen next? How would she face her parents?
3. Review the consequences, the resulting emotions and their link with your beliefs. What should she do?
4. Notice the impact on your body and behaviour by becoming a self observer.
5. Dispute your thoughts and beliefs and tell yourself that I am capable of controlling my own thoughts.
6. Revisit your changed beliefs for consequent emotions. 13. Conclude the session with key points, Slide 24

84 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Guilt and Shame 85
 Module 3
Rational and Irrational Beliefs 3.2. ACTIVITY SHEET FOR THE PARTICIPANTS
I wanted to be loved and approved of, but I can’t be loved by everyone.
Activity 1. The Observer Self
I want to do things well, but I accept I will occasionally make mistakes.
Time allotted: 15-20 minutes
I must be loved or liked and approved of by everyone.
The objective of this activity is to allow participants to be in touch with their thoughts, feelings and
body awareness particularly while going through a situation experiencing guilt or shame.
I must be competent, never make mistakes and achieve all the time if I have to be considered worthwhile.
Instruction:
Most of us do bad things, but making myself upset will not change that.
‘Recall any recent or past situation where you felt ashamed or guilty. Now close your eyes and get
totally involved in the scene of the situation. Keep your focus on the situation and notice the discomfort
Many people are bad, wicked or evil and they should be punished for that.
you feel in the body. Be aware of the thoughts which occur while visualizing the situation. Make note of
the words which can define and describe your thoughts. Observe the feelings associated with the situation
I can cope if things are just not right.
and the thoughts. Make a note of and give word to your feelings. Take a deep breath and open your eyes.’
It is the end of the world when things are not how I want them to be. Kindly put down your experience in the given table:

Problems may be influenced by the factors outside my control, What was the What were your How did you Body sensations
situation? spontaneous feel? and where it
but my reactions to them are under my control. thoughts? feels?
My bad feelings are caused by things outside my control.

Worrying about something won’t stop it happening. But I can prepare for possible problems.

I should worry a lot about things that might be dangerous or unpleasant.

Putting off problems does not make them any easier to face up to.

It is easier to put off difficult or unpleasant things than to face them.

The only person I really need to rely on is myself.

I need to depend on someone stronger than myself.

Activity 2. Let it Go
My problems may stem from the past, but what keeps it (them)
going now are my own thoughts and actions.
Time allotted: 15-20 minutes
My problems were caused by events in my past, so I can’t do anything about it.
Pick up a pen, a pencil, or some small object that you would be willing to drop without giving it a second
thought. Now, hold it in front of you and really grip it tightly. Notice the pain or discomfort it causes to you.
I won’t be able to help people in trouble if I become miserable over them.
Now, open your hand and roll the object around in it. Notice that you are the one holding on to it; it is
not attached to your hand. The same is true with your feelings, too. Your feelings are as attached to you
I should be upset by other people’s problems and difficulties.
as this object is attached to your hand.
We hold on to our feelings and forget that we are holding on to them. It’s even in our language. When

86 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Guilt and Shame 87
 Module 3
we feel angry or sad, we don’t usually say, “I feel angry,” or, “I feel sad.” We say, “I am angry,” or, “I am Some examples for ABC techniques: Sheila attended family planning centre for contraception counselling
sad.” Without realizing it, we are misidentifying that we are the feeling. Often, we believe a feeling is and counsellor finds out through her case history that she is suffering from guilt and shame due to some past
holding on to us. This is not true… we are always in control and just don’t know it. incidents. In order to work in ABC context the counsellor can proceed by taking the following steps.
Now, let the object go. Some examples to understand ABC paradigm from the story of Sheila:
What happened? You let go of the object, and it dropped to the floor. Was that hard? Of course not.
That’s what we mean when we say “let go.” Situation Beliefs Experienced Emotions
You can do the same thing with any emotion: choose to let it go. Who What did I think? What did I feel?
Sticking with this same analogy: If you walked around with your hand open, wouldn’t it be very (I was sexually abused (It was my fault, I can’t take care ( I felt ashamed, guilty and
difficult to hold on to the pen or any other object you’re holding? Likewise, when you allow or welcome a during childhood ) of myself, how can I take care of depressed)
feeling, you are opening your consciousness, and this enables the feeling to drop away all by itself- like my children? I am a sinful person)
the clouds passing in the sky or smoke going up a chimney with the flue open. It is as though you are What What did I assume? How did it affect me?
removing the lid from a pressure cooker. (My husband hits me) (I am not worthy of being a (I am ashamed of myself)
good wife)
When What did I imagine? What was my experience?
Activity 3. Knowing your Irrational and Rational Beliefs (My in laws accuse me of (They are bad people and do not (I feel rejected and dejected)
not taking care of home love me)
and children)
Time allotted: 30-40 minutes
Where What did I believe? Where did it cause discomfort?
(I have come to the clinic for (My life is full of miseries as I (My head feels heavy most of the
Discuss the case of Sheila and review the ABC context from the handouts in detail.
preventing more childbirths) can’t keep people happy, I can’t time, I get cramps in my stomach)
make right decisions, I am not sure
what to do? I should learn to take
CASE STUDY care of myself and my children,
I am ignorant, stupid, useless)
S heila, a 31 years old married woman who had been sexually abused during her childhood
constantly thinks that it was her fault as she did not take care of herself. She has never shared
her past experience with anyone who is significant in her life as she feels that it was her mistake Activity 4. Working as Pairs with Role Play for the ABC Techniques
that led to the situation. Informing others will not help to resolve any problem. She thinks that
sharing with others will make her more vulnerable. She blames her destiny and is always doubtful of Time allotted: 60-90 minutes
her actions. She always consults significant others for all her decisions.
She tries to please everyone around because she feels that she may get into some kind of trap if This activity will help the participants to apply the ABC technique in a role play simulation.
she disobeys anyone around. She is oversensitive and generalizes her fears to other situations. She
fears meeting and facing all men and occasionally doubts her ability to protect herself from any
outside harm. She is self doubting and guilt ridden. She is unable to understand her self defeating CASE STUDY
ideas and in spite of her high level of education prefers to stay at home and do household chores with
dedication. Sheila has two children, a girl aged 5 and a boy aged 2. She overprotects them and does
not permit them to do several normal things children at their age should be doing. She blames herself
P eter, a 35 year old male approached the family planning centre for counselling. He is married and
has two young children aged 4 and 2. His wife is pregnant and regularly comes to the centre for
her checkups.
for any behavioural problem of her children and her self talk is that “I am a useless mother,” “I am He has decided to have an HIV test at the suggestion of his friend. He reluctantly reports that he
responsible for not giving happiness to others,” “I should improve my behaviour otherwise…..,” “I am often has sex with other women, the most recent occasion being 3 weeks ago. He reports that this
not as lucky as others,” “this is not the time for me to enjoy,” “I should do my duties diligently.” usually occurs when he has been drinking alcohol and that he does not use condoms. His wife is
At home, her husband constantly ridicules and often beats her for her ‘inefficiency’. Her in-laws unaware of his sexual practices. He does not use condoms with his wife. He most recently had sex with
blame her for the ‘poor upbringing’ of the children as they are not ‘socially apt’ and for not being an his wife 2 weeks ago. He is unsure what he would do if he is tested HIV positive. He is particularly
‘efficient’ housewife. Sheila takes all the blame in a submissive way and hardly asserts herself for concerned about how he would tell his wife and how she may react. He is worried about his family and
any issues that arise in her family. Sheila at this stage does not want to get pregnant and she wants has recurrent thoughts of ending his life.
to seek guidance for contraception and approaches the family planning clinic. Sheila needs help.

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Reiterate the ABC Technique before Starting the Practice Session: ■ My children should never suffer in their childhood like I did in mine.
A Activation agent or situation ■ My kids should have more material things than I did.
B Belief towards A ■ It is my fault if others in my life are not happy.
C Consequences or the experienced emotions ■ If my kids fail in any way, it's my responsibility.
■ It is wrong to be concerned about myself.
Situation/activating agent Beliefs towards A Experienced Emotions/consequences ■ People are constantly judging me, and their judgment is important to me.
■ It is important to save face with others.
Who What did she/he think? What did she/he feel?
■ It is wrong to accept the negative aspects of my life without believing that I am responsible for them myself.
What What did she/he assume? How did it affect her/him? ■ I am responsible if either positive or negative events happen to the members of my family.
When What did she/he imagine? What was her/his experience? ■ I must not enjoy myself during a time when others expect me to be in mourning, grief, or loss.
Where What did she/he believe? Where did it cause discomfort? ■ I must never let down my guard; something I'm doing could be evil or wrong.
■ I must always be responsible, conscientious, and giving to others.
Applying ABC Technique: ■ How others perceive me is important as to how I perceive myself.
■ No matter what I do, I am always wrong.
After Analyzing A, B and C we should Add D, E and F for Behaviour Change ■ I should never feel shame and guilt.
D Your changed belief by disputing the original belief (B) ■ If you feel shame and guilt, then you must be or have been wrong.
E Your effective rational belief
F Your feelings and behaviour after effective rational beliefs Review the Steps of ABC Technique:
Based on your understanding work on changing the irrational beliefs in a given format:
Steps for ABC Techniques:
Event in an Your thoughts/ Your associated Your changed Effective Feeling and
abbreviated beliefs towards emotions/ belief by rational behaviour (Please refer to the case study of Sheila)
form A consequences disputing the beliefs 1. Assess study and analyze the situation which has caused one discomfort (situational analysis of
original
activating agent).
(A) (B) (C) (D) (E) (F)
2. Be aware of your thoughts and beliefs and take responsibility for your own thoughts.
3. Review the consequences, the resulting emotions and their link with your beliefs.
4. Notice the impact on your body and behaviour by becoming a self observer.
5. Dispute your thoughts and beliefs and tell yourself that I am capable of controlling my own thoughts.
6. Revisit your changed beliefs for consequent emotions.
7. Feel your emotions with your changed beliefs.
8. Notice the changes in your reactions, behaviour and emotions.
Check the list given below to identify some of the irrational thoughts and irrational thinking 9. Maintain a workbook/diary.
involved in shame and guilt feelings:
■ I was responsible for the bad things that happened to me in my childhood. Divide the participants into pairs and both should discuss the case of Peter. Role -play alternatively as
■ How can I face others with what happened to me? a counsellor and a client following all the steps of ABC technique. Gather the participants and ask for their
■ I am an awful person for that to have happened to me. experience and encourage questions on the ABC technique.
■ I must have asked for what I got in the past.
■ I am a bad person for what happened to me in the past.

■ I can never tell others what happened to me in my past.

■ I do not deserve to be happy.

■ I am responsible for my family's (spouse's) happiness.

■ There is only one "right'' way to do things.

■ It's bad to feel hurt and pain.

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Activity 5. Case Discussion on the Premise of ABC Technique 3.3. HANDOUT FOR THE PARTICIPANTS
Time allotted: 30-40 minutes Session Objectives:

Divide the participants into 3-4 groups and ask them to study the case study given below carefully. They The participants will be able to understand:
should analyze the situation, thoughts & beliefs and consequences. After reviewing the A, B & C they ■ The constituents and elements of guilt and shame

should work in the above format for completing D, E & F for the expected outcomes. ■ How guilt and shame affect the wellbeing of the person

■ The linkage between the thoughts and feelings which constitute the inner strength

■ How we hold our feelings which block our thinking and functioning

CASE STUDY ■ The ABC approach to overcome strong feelings

■ How to help clients to dispute their irrational beliefs and replace them with empowering self position

R ebbeca, an 18-year-old girl studying in the 12th standard is an adopted child. She has a brother
and a sister, who were born after her adoption. As the years passed her parents started showing
discrimination towards her while showering affection on their ’own’ children. Rebbeca grew up in an
and disposition

insecure environment, so she avoided talking to people around her and particularly to strangers and Introduction:
didn’t make friends with anyone. When things go wrong, we look for reasons and explanation. We either look outside or turn inward. If
She was not doing well in her academics and was not interested in any extra-curricular activities. we look outside, we may turn on others for our failure and blame them for unwanted outcomes. However,
Robert, a young boy from the neighborhood entered her life three years back, when she was 15. if we look within the blame is turned to one self. Self blame as such is more difficult to deal with than
Gradually they became close. Robert supported Rebbeca in her studies, by helping her do homework, blaming others. If we look closely the emotions from these two types of blame are quite different. The
in solving mathematical problems etc. and motivated her to do better in her studies and in taking responsibility and accountability of results decide the consequences and its impact on our emotions. Anger
part in extracurricular activities. strongly represents the consequence for blaming others and guilt is the result of self blame. Both anger
Robert introduced Rebbeca to his parents and other family members and expressed his earnest and guilt channel our energy towards destruction and they bring in a lot of strong feelings.
wish to marry Rebbeca. The no-objection to their friendship from Robert’s parents, led to mutual Guilt and shame are closely connected emotions. We tend to feel guilty when the outcomes are contrary
caressing and physical intimacy the same afternoon. to our set standards. We feel guilty when we judge ourselves to have done something wrong. If we think
Robert met with a road accident and he died on the spot. we should have not done something and should have behaved differently the consequent thoughts leads
Robert’s death was a great shock to Rebbeca in addition to the feeling of guilt about indulging in us towards feelings of guilt. Generally guilt and shame are not expressed overtly and the person indulges
sex before marriage. She was tense and worried about her missing periods. She was worried whether in activities which suppress and curb ones normal reactions. One tends to withdraw and hesitates to face
she had become pregnant and if yes, what would happen next? How would she face her parents? social situations. In fact, most of us are ashamed about feeling shame. As a result shame is rarely
What should she do? acknowledged to others, or even to oneself.
If the consequences and inner thoughts linger for a sustained period, they begin to turn into self
defeating beliefs. The beliefs of self doubt and thoughts ‘I should not have done it this way‘, ‘I must behave
differently’ lead to belittling the inner self. If such negative beliefs about one persist and self doubting
mechanism prevails, we are victims of guilt. Self criticism thinking is a learned habit. It does not necessarily
reflect the truth about oneself (Fennell 1999).
Shame is often experienced as the inner, critical voice that judges whatever we do as wrong, inferior, or
worthless. Clearly these shaming inner voices can do considerable damage to our self esteem. These self
criticisms, that we are stupid, selfish, a show-off, etc., become, in varying degrees, how we see ourselves.
For some of us, the inner critical judge is continuously providing a negative evaluation of what we are
doing, moment-by-moment. When we feel ashamed we assume that we have done wrong means that we
are ‘not good’, ‘inadequate’, ‘hopeless’, ‘appalling’ ,’awful’, ‘inexcusable’ and often ’horrible’.

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Following are the experiences linked with shame and guilt. takes the pressure off them.)
■ Reinforce your negative self-perceptions, encouraging you to be shame ridden, and guilt ridden and
Alienated Weak
self-judgmental for their benefit.
Inadequate Insecure ■ Build a case with moral absolutes to convince you of the ‘right way’ to do things, avoiding that
Helpless Uncertain negative feeling of shame and guilt for themselves.
■ Set up situations for you in which you will believe your alternatives are limited to that which results
Powerless Shy in the least sense of shame and guilt.
Defenseless Ineffectual ■ Simulate or fake hardship, illness, discomfort, unhappiness, incompetence, or other negative
Inferior Flawed behaviour to arouse your sense of shame and guilt and have you take over those tasks or duties,
bringing imagined negative consequences with them.
Unworthy Exposed ■ Threaten negative consequences, like going to leave home, to the hospital, dying, or divorce. This
Hurt Intimidated manipulation uses your shame and guilt to their benefit.
Defeated Rejected
What can Shame and Guilt do to you?
Dumped Rebuffed Shame and guilt can lead you to become:
Stupid Bizarre ■ Over-responsible. You strive to make life ‘right’. ‘You overwork. You over give yourself. You are willing

to do anything in your attempt to make everyone happy.’

Odd Peculiar
■ Over-conscientious. You worry over every action you take as to its possible negative consequence to

others, even if this means that you must ignore your needs and wants.
What are Shame and Guilt? ■ Over-sensitive. You see decisions about right and wrong in every aspect of your life and become

Shame and guilt are the: obsessed with the shaky nature of all your personal actions, words, and decisions. You are sensitive
■ Feelings of embarrassment, blame and responsibility for negative circumstances that have taken to the cues of others where any implication of your wrongdoing is intimated.
place to yourself or others. ■ Immobilized. You can have the apprehension of doing, acting, saying, or being ‘wrong' that, you

■ Feelings of regret for your real or imagined misdeeds, both past and present. eventually collapse, give in, and choose inactivity, silence, and the status quo.
■ Sense of repentance for thoughts, feelings, or attitudes that were or are negative, uncomplimentary, ■ Poor decision maker. It is so important to always be ’right' in your decisions that you become unable

or non-accepting concerning yourself or others. to make a decision for fear that it may be a wrong one.
■ Feelings of obligation for not pleasing, not helping, or not placating another. ■ Hidden by the mask of self-denial. Because it is less shame and guilt inducing to take care of others
■ Feelings of bewilderment and lack of balance for not responding to a situation in the ‘correct way’. first instead of yourself, you hide behind the mask of self-denial. You honestly believe it is better to
■ Feelings of loss for not having done or said something to someone who is no longer available to you. serve others first, unaware that ‘shame' and ‘guilt' are the motivators for such ‘generous' behaviour.
■ Accepting of responsibility for someone else's misfortune or problem because it bothers you to see ■ Pulled in. You ignore the full array of emotions and feelings available to you. Overcome by shame

that person suffer. and guilt or the fear of them, you can become emotionally blocked or closed off. You are able neither
■ Strong moral sense of right and wrong that inhibits you from choosing a course of action. to enjoy the positive fruits of life nor experience the negative aspects.
■ Driving forces or masks behind which irrational beliefs hide. ■ Motivated to change. Because you feel shame and guilt and the discomfort they bring, you can use

them as an indicator of the need to change things in your life and rid yourself of the shame and guilt.
How do others Play on your Feelings of Shame and Guilt? ■ Hidden by a mask of negative self-belief. You may actually have self-esteem, but claim the reason

People can and sometimes will: for your negativity is the overwhelming sense of shame and guilt you experience.
■ Make you believe they will suffer greatly if you do not respond positively to their requests. ■ Irrational. Because many irrational beliefs lie behind shame and guilt, you may be unable to sort out
■ Call on your shame and guilt to respond to their requests, even when it means violating your rights. your feelings. It is important to be objective with yourself when you are experiencing shame and
■ Respond to your irrational self by reinforcing your irrational thinking, giving you a sense of blame for guilt; be sure that your decisions are based on sound, rational thinking.
past, present, or future actions.
■ Build up a verbal or imagined scenario that portrays you at fault for inaction. Irrational Thinking Involved in Shame and Guilt Feelings:
■ Accuse you of misdeeds, words, or actions to arouse your sense of shame and guilt and make you ■ I was responsible for the bad things that happened to me in my childhood.
believe you are the one with a problem in an interpersonal relationship difficulty. (This effectively ■ How can I face others with what happened to me?

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■ I am an awful person for that to have happened to me. of her actions. She always consults significant others for all her decisions.
■ I must have asked for what I got in the past. She tries to please everyone around because she feels that she may get into some kind of trap if
■ I am a bad person for what happened to me in the past. she disobeys anyone around. She is oversensitive and generalizes her fears to other situations. She
■ I can never tell others what happened to me in my past. fears meeting and facing all men and occasionally doubts her ability to protect herself from any
■ I do not deserve to be happy. outside harm. She is self doubting and guilt ridden. She is unable to understand her self defeating
■ I am responsible for my family's (spouse's) happiness. ideas and in spite of her high level of education prefers to stay at home and do household chores with
■ There is only one ‘right' way to do things. dedication. Sheila has two children, a girl aged 5 and a boy aged 2. She overprotects them and does
■ It's bad to feel hurt and pain. not permit them to do several normal things children at their age should be doing. She blames herself
■ My children should never suffer in their childhood like I did in mine. for any behavioural problems of her children and her self talk is that “I am a useless mother,” “I am
■ My kids should have more material things than I did. responsible for not giving happiness to others,” “I should improve my behaviour otherwise…..,” “I am
■ It is my fault if others in my life are not happy. not as lucky as others,” “this is not the time for me to enjoy,” “I should do my duties diligently.”
■ If my kids fail in any way, it's my responsibility. At home, her husband constantly ridicules and often beats her for her ‘inefficiency’. Her in-laws
■ It is wrong to be concerned about myself. blame her for the ‘poor upbringing’ of the children as they are not ‘socially apt’ and for not being an
■ People are constantly judging me, and their judgment is important to me. ‘efficient’ housewife. Sheila takes all the blame in a submissive way and hardly asserts herself for any
■ It is important to save face with others. issues that arise in her family. Sheila at this stage does not want to get pregnant and she wants to
■ It is wrong to accept the negative aspects of my life without believing that I am responsible for them myself. seek guidance for contraception and approaches the family planning clinic. Sheila needs help.
■ I am responsible if either positive or negative events happen to the members of my family.
■ I must not enjoy myself during a time when others expect me to be in mourning, grief, or loss.
■ I must never let down my guard; something I'm doing could be evil or wrong. Some examples for ABC techniques: Sheila attended family planning/ reproductive health centre for
■ I must always be responsible, conscientious, and giving to others. contraception counselling and counsellor finds through her case history that she is suffering from guilt and
■ How others perceive me is important as to how I perceive myself. shame due to some past incidents. In order to work in ABC context the counsellor can proceed by taking
■ No matter what I do, I am always wrong. the following steps.
■ I should never feel shame and guilt.
■ If you feel shame and guilt, then you must be or have been wrong. Some examples to understand ABC paradigm from the story of Sheila:
Situation Beliefs Experienced Emotions
Overcoming Guilt and Shame
To overcome guilt one has to take stock of the situation and assess the inner self beliefs, thoughts and Who What did I think? What did I feel?
(I was sexually abused (It was my fault, I can’t take care ( I felt ashamed, guilty and
review the feelings associated with it. The ABC approach of Rational Emotive Therapy (Ellis 1972, 1995) during childhood ) of myself, how can I take care of depressed)
is a helpful technique for helping the individual to overcome self defeating demeaning ideas. Let us my children? I am a sinful person)
reflect on ABC paradigm:
What What did I assume? How did it affect me?
(My husband hits me) (I am not worthy of being a (I am ashamed of myself)
A Activation agent or situation good wife)
B Belief towards A When What did I imagine? What was my experience?
C Consequences or the experienced emotions (My in laws accuse me of (They are bad people and do not (I feel rejected and dejected)
not taking care of home love me)
and children)
CASE STUDY
Where What did I believe? Where did it cause discomfort?

S heila, a 31 years old married woman who had been sexually abused during her childhood
constantly thinks that it was her fault as she did not take care of herself. She has never shared
her past experience with anyone who is significant in her life as she feels that it was her mistake
(I have come to the clinic for
preventing more childbirths)
(My life is full of miseries as I
can’t keep people happy, I can’t
make right decisions, I am not sure
(My head feels heavy most of the
time, I get cramps in my stomach)

what to do? I should learn to take

that led to the situation. Informing others will not help to resolve any problem. She thinks that
care of myself and my children,
sharing with others will make her more vulnerable. She blames her destiny and is always doubtful I am ignorant, stupid, useless)

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It is assumed that we can not avert the situation as it may or may not be in our hand. More so it has her sometimes, and she cannot make decisions herself. She has a history of sexual abuse during her
already occurred, thus we have no control over it. The situation leads and triggers the inner mechanism to childhood and blames herself for not taking care of her children as well as for her inability for being an
make one feel miserable however, the control of this consequence lies within us. The beliefs or ideas could ineffective housewife and mother.
be rational or irrational. Let us see the examples given in the given table:
2. Be aware of your thoughts and beliefs and take responsibility of your own thoughts.
Rational ideas Irrational beliefs In this technique the responsibility of the counsellor is to help the client review the thoughts which
keep circulating in the mind and sends the message of one being awful. Generally people don’t like a shift
1. I wanted to be loved and approved of, but I can’t 1. I must be loved or liked and approved of by
in their way of thinking and keep ruminating over the irrational thoughts. As per ABC paradigm the
be loved by everyone. everyone.
thoughts are the main source of misery, thus these thoughts require a rework or alteration. The counsellor
2. I want to do things well, but I accept I will 2. I must be competent, never make mistakes and helps the client to differentiate between the maladaptive thoughts and the situation and link the
occasionally make mistakes. achieve all the time if I am to be considered consequences (emotional disturbance) with the thoughts. For example, if Sheila thinks that she is not a
worthwhile. capable mother and housewife, she blames the circumstances, luck and people for her miseries, her
thoughts are self defeating (see the table above), she has to be made to think that blame, shame, being
3. Most of us do bad things, but by making myself 3. Many people are bad, wicked or evil and they
miserable and guilt feelings arise from the thoughts and not from the incident. She must be taught to
upset nothing will change. should be punished for that.
review the thoughts and be made responsible to have control over her thoughts.
4. I can cope if things are just not right. 4. It is the end of the world when things are not
how I want them to be. 3. Review the consequences, the resulting emotions and their link with your beliefs.
Consequently, the woman stated in the above example needs to be motivated to review and change the
5. Problems may be influenced by factors outside 5. My bad feelings are caused by things outside recurring thoughts with more adaptive ones. Once the client understands that the cause of feeling
my control, but my reaction to them are my control.
miserable are one’s own thoughts, she or he is willing to rethink about the situation. For example the
under my control.
counsellor has to make Sheila think differently if she wants to have positive outcomes. What is important
6. Worrying about something won’t stop it 6. I should worry a lot about things that might be is to make Sheila understand that she is feeling awful because of the thoughts and beliefs and not because
happening. But I can prepare for possible problems. dangerous or unpleasant. of the events that take place in her life.

7. Putting off problems does not make them 7. It is easier to put off difficult or unpleasant 4. Notice the impact on your body and behaviour by becoming a self observer.
any easier to face up to. things than to face them.
There is a connection between the mind and the body. A disturbed mind leads to a dysfunctional body.
8. The only person I really need to rely on is myself. 8. I need to depend on someone stronger than The counsellor helps the client to notice the reactions taking place in the body and makes her or him aware
myself. that irrational thoughts lead to somatic imbalance. For example, Sheila’s headaches and cramps in the
stomach are to be linked with what is going on in her mind as self talk.
9. My problems may stem from the past , but what 9. My problems were caused by events in my
keeps it (them) going now are my own thoughts past, so I can’t do anything about it. 5. Dispute your thoughts and beliefs and tell yourself that I am capable of controlling my own thoughts.
and actions.
Thus, the clients are gradually taught to dispute the maladaptive thoughts and replace them with more
10. I won’t help people in trouble by making myself 10. I should be upset by other people’s problems adaptive ones. The client is actively taught by didactic methods to replace the old maladaptive thoughts
miserable over them. and difficulties. with fresh appropriate thoughts. At this stage the counsellor and the client are both actively involved in
the process and the counsellor uses a directive approach.
For example, the counsellor will have to actively tell Sheila to dispute each of her listed self defeating
Steps for ABC Techniques: thoughts if she wants to provide new thoughts by replacing the existing one. She has to evaluate her self
talk and tell herself “I have to first give up these thoughts to make way for the new adaptive thoughts”.
1. Assess, study and analyze the situation which has caused one discomfort (situational analysis of Alternatively Sheila is assisted to think of adaptive phrases which give her a sense of control, feeling
activating agent). strong, capable, assertive and confident. Some examples are,” when I was sexually abused, I was weak and
The client is guided to review the situation (Activating agent or A) as the consequences related to young, but now I am strong”, “I will take my own decisions as I am educated, intelligent and confident.”
feeling miserable are connected to the situation. For example, Sheila from the above example is being “I will give reasons to my husband and discuss the family matters openly”, “I will ask my in laws what is
accused by her in laws for not taking good care of the house, her husband does not respect her and beats expected from me and will respond accordingly”, “I will ask more questions from my in laws and voice my

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likes and dislikes”, “I will allow my children to play with the neighbouring children but I will keep an eye References and Further Reading:
on them for safety.” Christine, A. Padesky. Clinician’s Guide to Mind Over Body, Guilford Press, New York, 58 - 95, 1995.
Most of the changed thoughts emerge by role play, active discussion and encouraging the clients that
they are capable of thinking for themselves. The counsellor should refrain from giving new thoughts as Ellis, A. Better Deeper and More Enduring Brief Therapy- The Rational Emotive Behavior Therapy Approach,
they may not fit in the context of the client. The client by trial and error will produce the best fitting Brunner/Mazel Publisher, New York, 1995.
thoughts in the prevailing conditions. Ellis, A., & Grieger, R. (ed.), Handbook of Rational Emotive Therapy (Vol 1), Springer New York.

6. Revisit your changed beliefs for consequent emotions Lewis, H. B. Shame and Guilt in Neurosis, International University Press, New York, 1971.
The client is reminded to notice the changes in emotion as a result of changed beliefs, thoughts and
Marsha, M. Linehan. Skill Training Manual for Treating Borderline Personality Disorder, Guilford Press, New
views about self. The counsellor continuously interacts with the client and facilitates the change process.
York, 121 - 134, 1993.
For example, if Sheila can be made aware of the internal changes taking place due to the undergoing
alterations in her thought process, she may begin to feel energized, confident and thus strong. Nathanson, D. (ed.). The Many Faces of Shame, The Guildford Press, New York, 1987.

7. Feel your emotions with your changed beliefs

The client is made to feel the differences in the emotions which have resulted due to changed self talk.
The technique is based on the premise that feelings are results of thoughts and not due to the events. Thus
changed adaptive thoughts pave the way for suitable emotions, thus bringing the equilibrium in the system.
For example, Sheila needs to be reminded to notice the changes in her emotional state with the new
thoughts. She may say “I don’t feel guilty if I think this way.” “I feel strong now and I am sure I will be able
to speak and give reasons when my in laws get angry this time.”

8. Notice the changes in your reactions, behaviour and emotions

The thoughts lead to emotions, which, in turn brings behavioural changes. The body language of the
client often changes once the self talk changes and the confidence level rises. The counsellor reminds the
client to be aware of the mind-body changes through effective control of thoughts.
For example, the counsellor will have to provide feedback to Sheila about the changes in her bodily
reactions and emotional conditions with the changed self talk. Remember the self talk should be
appropriate and applicable to the client.

9. Maintain a workbook/diary
Usually a session ends with a homework assignment to work on several past beliefs and attending to
them one by one, as a practice to develop adaptive pattern of thinking for reacting to the coming events.
It is believed that the clients develop new methods of coping and more lasting results.
For instance, Sheila has to be encouraged to practice at home with her existing thoughts in the form of
home work by using past incidents, original thoughts and later replacing them with the new thoughts and
its consequences first at an imaginable level which could have the properties for being transferred in future
when the client faces a similar situation.
Every time Sheila comes to visit, the counsellor has to review the homework and assess its applicability
and appropriateness and once again practice for lasting changes.

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3.4. Power Point Slides Activity 2
Let it Go ABC Technique
Session Objectives The ABC approach of Rational Emotive Therapy is a
The participants will be able to understand Open you hand and roll the object around it.
helpful technique for helping the indivdual to overcome
■ The constituents and elements of guilt and shame self defeating demeaning ideas:
■ How guilt and shame affect the wellbeing of the person? Notice that you are the one holding on to it; it is not
■ The linkage between the thoughts and feelings which attached to your hand.
A. Activation agent or situation
Counselling for Guilt and Shame constitute the inner strength
■ How we hold back our feelings which block our thinking The same is true with your feelings, too.
B. Belief towards A
and functioning?
■ The ABC approach to overcome strong feelings Your feelings are as attached to you as this object is
C. Consequences or the experienced emotions
■ How to help clients to dispute their irrational beliefs attached to your hand.
and replace them with empowering self position and Slide 9 Slide 10
disposition?
Slide 1 Slide 2

Analyzing ABC Through 10 Irrational Beliefs

Activity 1 What is Guilt? ■ It is hypothesized that cause of our emotions are our
The Observer Self Guilt and shame are closely connected emotions belief systems.
Activity 3
■ Recall any recent or past situation where you felt We tend to feel guilty ■ Although we may focus on the event and the situatuion
■ When the outcomes are contrary to our set standards
and we may like to change or avoid the same.
Knowing your Irrational and Rational Beliefs
ashamed or guilty. Now close your eyes and focus on the ■ We judge ourselves to have done something wrong
situation. Observe the feelings associated with the ■ When we feel, we should have not done something and
siituation and the thoughts. Take a deep breath and ■ Analyzing ABC through irrational beliefs gives an insight
open your eyes. we should have behaved differently. into our faculty thinking.

■
Generally guilt and shame are not expressed overtly.
Kindly put down your experience in the given table. Slide 11 Slide 12
Slide 3 Slide 4

10 Irrational Beliefs 10 Irrational Beliefs

6. I should worry a lot about things that might be
What is Shame? 1. I must be loved or liked and approved of by everyone.
dangerous or unpleasant.
What can shame and guilt do to you? 2. I must be competent, never make mistakes and achieve
■ Shame is often experienced as the inner, critical voice 7. It is easier to put off dificult or unpleasant things than
all the time if I am to be considered worthwhile.
that judges whatever we do as wrong, inferior, stupid, to face them.
Shame and guilt can lead you to become: 3. Many people are bad, wicked or evil and they should be
selfish or worthless. ■ Over-responsible 8. I need to depend on someone stronger than myself.
■ Shaming inner voices can do considerable damage to our punished for that.
■ Over-conscientious
self esteem. ■ Over-sensitive
9. My problems were caused by events in my past, so I
■ For some of us, the inner critical judge is continously
4. It is the end of the world when things are not how I
■ Immobilized
can’t do anything about it.
want them to be.
providing a negative evaluation of what we are doing,
moment-by-moment. 10. I should be upset by other people’s problems and
5. My bad feelings are caused by things outside my control.
difficulties.
Slide 13 Slide 14
Slide 5 Slide 6

Applying ABC Techniques Steps for ABC Technique

Activity 2
What can shame and guilt do to you? Let it Go After analyzing A, B & C we should add D, E & F for ■ Assess study and analyze the situation which has caused
behaviour change
■ Poor decision maker Pick up a pen or pencil, or some small object that you one discomfort (situational analysis of activating agent).
■ Hidden by the mask of self-denial would be willing to drop without giving it a second D. Your changed belief by disputing the original belief (B) ■
■ Pulled in thought. Be aware of your thoughts and beliefs and take
■ Motivated to change responsibility of your own thoughts.
E. Your effective rational belief
■ Hidden by mask of negative self-belief Hold it in front of you and really grip it tightly.
■ Irrational ■ Review the consequences, the resulting emotions and
F. Your feelings and behaviour after effective rational
Notice the pain or discomfort it causes to you. their link with your beliefs.
beliefs
Slide 7 Slide 8 Slide 15 Slide 16

102 Training Module on Counselling for Trauma, Guilt and Self Esteem Counselling for Guilt and Shame 103
 Module 3
Steps for ABC Techniques Activity 3
Brainstorm and identify what shame and guilt has done
■ Notice the impact on your body and behaviour by to Sheila
becoming a self observer. Sheila, a 31 years old married woman who had been
sexually abused during her childhood constantly thinks
■ Dispute your thoughts and beliefs and tell yourself that that it was her fault that she did not take care of herself.
I am capable of controlling my own thoughts. She has not shared her past experiences with anyone who
■ Feel your emotions with your changed beliefs. is significant in her life as she feels that it was her mistake
that led to the situation.Informing others will not help to
■ Notice the changes in your reactions, behaviour and resolve any problem. She thinks that sharing with others
emotions. will make her more vulnerable. She blames her destiny and
is always doubtful of her actions. She always consults
■ Maintain a workbook/diary. significant others for all her decisions.
Slide 17 Slide 18

Contd... She tries to please everyone around because she Contd... She blames herself for any behavioural problems
feels that she may get into some kind of trap if she of her children and herself talk that “I am a useless
disobeys anyone around. She is oversensitive and mother”, “I am responsible for not giving happiness to
generalizes her fears to other situations. She fears others”, “I should improve my behaviour otherwise...”, ”I
meeting and facing all men and occasionally doubts her am not as lucky as others”, ”this is not the time for me to
ability to protect herself from any outside harm. She is enjoy”, ”I should do my duties diligently”. At home, her
self doubting and guilt hidden. She is unable to husband constantly ridicules her for her inefficency. Her
understand her self defeating ideas and in spite of her in laws blame her for the poor upbringing of the children
high level of education prefers to stay at home and do as they are not socially apt. Sheila takes all the blame in
household chores with dedication. Sheila has two a submissive way and hardly asserts herself for any issues
children, a girl aged 5 and a boy aged 2. She overprotects that arise in her family. Sheila at this stage does not
them and does not permit them to do several normal want to seek guidance for contraception and approaches
things children at their age should be doing. the family clinic. Sheila needs help.
Slide 19 Slide 20

Activity 4
Questions, Answers and Clarifications
Role Play Using ABC Technique

Slide 21 Slide 22

Conclusion: Key points

■ Explored our own thoughts, feelings and body sensations
Activity 5 related to guilt and shame.
■ Reviewed the role of irrational thoughts and beliefs.
Case discussion in small groups on using
ABC technique ■ Analyze ABC technique by using examples.
Case study from FPAI for the case discussion ■ Practised ABC technique by role play.
■ Understood the cognitve and behavioural technique of
ABC in the context of FPAs through case discussion.
Slide 23 Slide 24

104 Training Module on Counselling for Trauma, Guilt and Self Esteem
 Module 4
4.1. SESSION PLAN FOR THE FACILITATORS
Session objectives:

Participants will be able to:

■ Understand the importance of self esteem for self enhancement.
■ Understand how self esteem develops.

■ Practice to understand how self critical thinking and self talk shapes our actions.

■ Learn to modify self critical thoughts and experience by developing a practical action plan.

Time allotted: 6-7 hours

Training materials:
■ LCD projector and screen

■ CD with slides
■ 4-5 flip charts to discuss brainstorming and activity

■ Stationary for participants to write down the points for case study
■ Handouts and activity sheet

Session instructions for facilitators:

Start the session with the power point presentation, Slide 2 and then continue as specified below. The matter
in the power points is elaborated in the handouts and the activities are elaborated in the session plan below for
you. A separate activity sheet is available to participants. The activities are interwoven with the theory,

1. Present objectives of the session, Slide 2

2. Continue with Slides 3-4 and encourage the participants to respond, for defining and
understanding self esteem and how it helps personal growth. The focus should be on how one
develops one’s self talk.
3. Conduct activity 1, Slide 5.

Module 4
Developing Self Esteem
Activity 1. Use of Non-Preferred hand

Time allotted: 30 minutes

Participants through this activity will be able to attempt and explore some of the unachievable actions
they can perform if they make an effort.
In the large group each one should write one sentence or their name with their preferred hand. As a
second step, the same sentence or word should be written with the other hand.
Participants should be asked to share their experience and proceed for a debriefing discussion linking
this understanding to explore their hidden talents.

Developing Self Esteem 107

 Module 4
4. Continue with Slide 6 explaining the importance of healthy self esteem. more than 20, participants can be divided into smaller groups and one cut out can be made for each group
5. Conduct activity 2, Slide 7. by requesting any one to be a volunteer. Participants as a group could contribute and build a story of an
imaginary person by writing the attributes on the cut out and then present it to the large group.

Activity 2. Being in Touch with Your Potentials 8. Conduct activity 4, Slide 11.

Time allotted: 30 minutes

Activity 4: Promoting Self Worth
This activity helps the trainees to discover their own achievements which are usually ignored in one’s
day to day life. Time allotted: 60 minutes
Divide the participants in 3-4 groups.
The objective of this activity is to identify self strengths for enhancing self esteem.
Instruction:
Each one of you should make a list of up to 50 things you have accomplished in your life- up to 50 things Materials: Magazines, scissors, glue, paper, markers, pencils
you have learned or done well. Begin with the things you’ve done recently. Then share it with your group. You
will find yourself jotting down forgotten memories, surprising yourself with activities from your childhood. Preparation and Procedure
Share your experiences with the small group and one of the representatives should present the group Introduce the group to advertisements. Talk about their purpose and the method in which
outcomes with the larger group. advertisements get the message across- visually and with words. Advertisements promote positive aspects
of a product, the finer qualities. They also persuade a person into buying the product. The individual's task
6. Continue with Slides 8,9,10 and link the previous two activities with self esteem development with in this project is to come up with an advertisement persuading someone to be their friend. Individuals
early and late life experiences. should depict positive aspects of themselves through pictures, words, or a combination of the two.
7. Conduct activity 3 of body mapping, Slide 11. If an individual has a difficult time thinking of reasons someone would want to be their friend, have
them think of characteristics they look for in a friend. At the end of the session, have participants share
advertisements with one another. Let other participants confirm the positive qualities of the presenter.
Activity 3. Body Mapping
9. Continue with the Slides 12-17 to emphasize on knowing and altering the self talk as basic steps
Time allotted: 60-90 minutes to change self defeating ideas.
10.Conduct activity 5, Slide 18.
The outcome of this activity will be improved self esteem, awareness of one’s self and others, socially 11. Conduct activity 6, Slide 18.
appropriate feedback and team work.

Material: Large roll of paper, scissors, markers Activity 5. Expressing both your Feelings Positive and Negative

Preparation and Procedure: Time allotted: 30 minutes

Participants should lie down on a piece of paper that is as big as their body size. They are encouraged
to lie in the position in which they are most comfortable. Their body is outlined by another participant, and The participants through this activity will be able to articulate their feelings to their partners which will
then this outline is cut out. help them to express their views and thoughts in a relaxed situation.
Participants are then asked to write their first name, and draw a picture or write a word that best
describes what they feel is their most positive attribute. 1. Work in pairs. Imagine a person you are not able to face because you are not comfortable with him/her.
Other participants then ‘make rounds’ around the room, writing something POSITIVE that they feel or Share with your partner the attributes of that person by describing his or her appearance, body
know about that person. All the groups come together to review how this activity helped. language, tone of voice, social position and mannerisms. Ask your partner to behave like a
double/dummy. Sit in front of each other and create a scene where the double/dummy behaves like the
Please Note: This activity can be modified as per the availability of time and group size. In a group size of person you have described. Now try to speak those words that come naturally to your mind, make

108 Training Module on Counselling for Trauma, Guilt and Self Esteem Developing Self Esteem 109
 Module 4
gestures and enact the tone, you have always wanted to. Gather the participants in a circle and ask Worksheet
every one to share their experience. The words I would use to describe the positive aspects of my personality:
2. In the second part of this exercise, think of an event, time of your life when some insight or self 1. ______________ My most positive quality.
understanding became a thrust or driving force for a significant enduring change. Talk to your partner 2. ______________
and associate your thoughts and beliefs and explain how this event / experience has made a difference 3. ______________
in your life. 4. ______________
5. ______________
6. ______________
Activity 6. Self Instruction Training 7. ______________
8. ______________
Time allotted: 30-40 minutes 9. ______________
10. ______________ My least positive quality.
This exercise helps the trainees to introspect about their uniqueness and qualities. Additionally, one
proceeds to prepare an action plan for self enhancement. After filling the above worksheet the partners should sit together and the following questions
Divide the participants into pairs. Ask them to work on the given worksheet and complement their should be asked to one another:
partner during the exercise. ■ Give reasons, why you chose those words to describe yourself.

■ Think of situations where you experience the positive aspects of your personality.

Worksheet: ■ Spend time thinking about the feelings associated with the above experience.

The words I would use to describe the negative aspects of my personality: ■ How can you spend more time by thinking and self talking about your good qualities and accordingly

1. ______________ The feeling I experience most. prepare a work plan?

2. ______________
3. ______________ Work together and complement your partner to prepare an action plan in the format given below:
4. ______________
5. ______________ Combating Self Critical Thoughts and Negative Self Talk
6. ______________
7. ______________ Date/ time Situation Emotions and Self critical Alternative Outcome
8. ______________ body sensations thoughts perspective
9. ______________
10. ______________ The feeling I experience the least.

After filling the above worksheet the partners should sit together and the following questions
should be asked to one another:

■ Give reasons, why you chose those words to describe yourself.

■ Think of situations where you experience the negative aspects of your personality.
■ Spend time thinking how you could change the negative to positive.
■ How can you fulfill your expectations by changing your self talk?

Similarly as a second step, one should identify the self valued associates. The best way is to choose the
words from the internal self talk and put them in a serial order:

110 Training Module on Counselling for Trauma, Guilt and Self Esteem Developing Self Esteem 111
 Module 4
Daily Activity Plan: 4.2. ACTIVITY SHEET FOR THE PARTICIPANTS
Time (hrs) Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Activity 1: Use of Non-Preferred Hand
7-9
Time allotted: 30 minutes
9-11
11-13 Participants through this activity will be able to attempt and explore some of the unachievable actions
they can perform if they make an effort.
13-15
In the large group each one should write one sentence or their name with their preferred hand. As a
15-17 second step, the same sentence or word should be written with the other hand.
Participants should be asked to share their experience and proceed for a debriefing discussion linking
17-19
this understanding to explore the hidden talents.
19-21
21-23
Activity 2. Being in Touch with your Potentials

12.Conclude with the following slogan, Slide 19. Time allotted: 30 minutes

Practice everyday a self help method developed by Emile Coue in the 1920s, using this daily mantra This activity helps the trainees to discover their own achievements which are usually ignored in one’s
twice, ‘Everyday, and in everyway, I am becoming better and better’. day to day life.
Divide the participants into 3-4 groups.

Instruction:
Each one of you should make a list of 50 things you have accomplished in your life- 50 things you have
learned or done well. Begin with the things you’ve done recently. Then share it with your group. You will
find yourself jotting down forgotten memories, surprising yourself with activities from childhood.
Share your experience with the small group and one of the representatives should present the group
outcomes to the larger group.

Activity 3. Body Mapping

Time allotted: 60-90 minutes

The outcome of this activity will be improved self esteem, awareness of self and others, socially
appropriate feedback and team work.

Training materials: Large roll of paper, scissors, markers

Preparation and Procedure:

Participants lie down on piece of a paper that is as big as their body size. They are encouraged to lie in
a position in which they are most comfortable. Their body is outlined by another participant, and then this
outline is cut out. Participants are then asked to write their first name, and draw a picture or write a word

112 Training Module on Counselling for Trauma, Guilt and Self Esteem Developing Self Esteem 113
 Module 4
that best describes what they feel is their most positive attribute. Other participants then ‘make rounds’ Activity 6. Self Instruction Training
around the room, writing something POSITIVE that they feel or know about that person. All the groups
come together to review how this activity helped. Time allotted: 30-40 minutes

This exercise helps the trainees to introspect about their uniqueness and qualities. Additionally, one
Activity 4. Promoting Self Worth proceeds to prepare an action plan for self enhancement.
Divide the participants into pairs. Ask them to work on the given worksheet and complement their
Time allotted: 60 minutes partner during the exercise:

The objective of this activity is to identify self strengths for enhancing self esteem. Worksheet
The words I would use to describe the negative aspects of my personality:
Training materials: Magazines, scissors, glue, paper, markers, pencils 1. ______________ The feeling I experience most.
2. ______________
Preparation and Procedure: 3. ______________
Introduce the group to advertisements. Talk about their purpose and the method in which 4. ______________
advertisements get the message across - visually and with words. Advertisements promote positive aspects 5. ______________
of a product, the finer qualities. They also persuade a person into buying the product. The individual's task 6. ______________
in this project is to come up with an advertisement persuading someone to be their friend. Individuals 7. ______________
should depict positive aspects of themselves through pictures, words, or a combination of the two. 8. ______________
If an individual has a difficult time thinking of reasons someone would want to be their friend, have 9. ______________
them think of characteristics they look for in a friend. At the end of the session have participants share 10. ______________ The feeling I experience the least.
advertisements with one another. Let other participants confirm the positive qualities of the presenter.
After filling the above worksheet the partners should sit together and the following questions
should be asked to one another:
Activity 5. Expressing both your Feelings Positive and Negative
■ Give reasons, why you chose those words to describe yourself.
Time allotted: 30 minutes ■ Think of situations where you experience the negative aspects of your personality.
■ Spend time thinking how you could change the negative to positive.
The participants through this activity will be able to articulate their feelings to their partners which will ■ How can you fulfill your expectations by changing your self talk?
help them to express their views and thoughts in a relaxed situation
Similarly as a second step, one should identify the self valued associates. The best way is to choose the
1. Work in pairs. Imagine a person you are not able to face because you are not comfortable with him/her. words from the internal self talk and put them in a serial order:
Share with your partner the attributes of that person by describing his or her appearance, body
language, tone of voice, social position and mannerisms. Ask your partner to behave like a Worksheet
double/dummy. Sit in front of each other and create a scene where the double/dummy behaves like the The words I would use to describe the positive aspects of my personality:
person you have described. Now you should try to speak those words that come naturally to your mind, 1. ______________ My most positive quality.
make gestures and enact the tone you have always wanted to. Gather the participants in a circle and 2. ______________
ask every one to share their experience. 3. ______________
4. ______________
2. In the second part of this exercise, think of an event, time of your life when some insight or self 5. ______________
understanding became a thrust or driving force for significant enduring change. Talk to your partner 6. ______________
and associate your thoughts and beliefs and explain how this event/experience has made a difference 7. ______________
in your life. 8. ______________

114 Training Module on Counselling for Trauma, Guilt and Self Esteem Developing Self Esteem 115
 Module 4
9. ______________ Daily Activity Plan:
10. ______________ My least positive quality.
Time (hrs) Monday Tuesday Wednesday Thursday Friday Saturday Sunday
After filling the above worksheet the partners should sit together and the following questions 7-9
should be asked to one another:
9-11
■ Give reasons, why you chose those words to describe yourself. 11-13
■ Think of situations where you experience the positive aspects of your personality.
13-15
■ Spend time thinking about the feelings associated with the above experience.
■ How can you spend more time by thinking and self talking about your good qualities and accordingly 15-17
prepare a work plan?
17-19
Work together and complement your partner to prepare an action plan in the format given below 19-21
21-23
Combating Self Critical Thoughts and Negative Self Talk
Date/ time Situation Emotions and Self critical Alternative Outcome Conclude with the following slogan: Practice everyday a self help method developed by Emile Coue in
body sensations thoughts perspective the 1920s, using this daily mantra twice, ‘Everyday, and in everyway, I am becoming better and better’.

116 Training Module on Counselling for Trauma, Guilt and Self Esteem Developing Self Esteem 117
 Module 4
4.3. HANDOUT FOR THE PARTICIPANTS Some of the early experiences contributing to self image are:
■ Early childhood shaping through reward and punishment.

Session Objectives: ■ Parental dispute and inconstancies in disciplining.

Participants will be able to: ■ Controlled parenting and failing to meet parental expectation.

■ Understand the importance of self esteem for self enhancement. ■ Comparison with other siblings or peers.
■ Understand how self esteem develops. ■ School pressure and neglect by teachers.
■ Practice to understand how self critical thinking and self talk shapes our actions. ■ Peer pressure and inability to live up to their expectation.

■ Learn to modify self critical thoughts and experience by developing a practical action plan. ■ Belonging to a social group which is the focus of prejudice.

■ Lack of acceptance by siblings and peers.

Introduction:
Self esteem has an influence over the way we feel about ourselves as well as others. A high self esteem Some late experiences are:
enables the individual to deal confidently with issues in non-threatening ways, build healthy relationships ■ Exposure to traumatic experience.

and find success in various aspects of life. An individual with high self esteem is confident, dynamic, ■ Workplace stressors.

appreciative, achievement-oriented, content and open to change. On the contrary, research has shown that ■ Competition and detrimental interpersonal relationship with colleagues.

low self esteem is linked with feelings of hopelessness and suicidal tendencies. If one does not value or ■ Marital conflicts and family disputes.

cherish oneself, then there is no incentive to protect or work for the progress of that self. ■ Mid age crisis.

Self esteem is essential for psychological survival. Numerous definitions of self esteem have been ■ Mental illness.

proposed depending on the particular focus. In its broadest sense, self esteem refers to one’s sense of self
worth. It is related to concepts of self concept (of which self esteem is a subset) and self efficacy (which Impact of Life Experiences on your Self Talk
translates self esteem into willingness to act and confidence in gaining an expected outcome). The interaction with significant others from the family or outside during the developmental phase
Self esteem basically is a driving force built within the individual. Generally speaking what we think contributes to one’s self image, self concept, self perception, self acceptance, self worth, self respect, self
about our self constitutes self esteem. If our self talk consists of encouraging contents (e.g. I like myself confidence and other corollaries. The bottom line e.g. the conclusions, judgments and views about oneself
as I am, I can do it, I am worth it, I am confident, I am capable, I am sure of myself, I am presentable, I are established. Some of the samples from self talk are:
look beautiful/handsome, I like my friends and associates, everyone loves me and I am so lucky), we have ■ I am bad and awful

high self esteem. If we have discouraging self concept (e.g. I am not very talented. I don’t have sufficient ■ I am not capable

skills, I don’t have confidence, I can’t make my decisions, I need to be helped, I am not being loved, I am ■ I can’t do it

not good looking and I am not OK), one suffers from low self esteem. ■ I am a burden on others
■ I am not worthy

A healthy self esteem is based on: ■ I am stupid

■ An ability to assess the self accurately ■ I am ____.

■ An ability to accept and value the self unconditionally.

■ Realistically acknowledge strengths and limitations The Impact of Self Criticism

■ Accepting the self as worthy and worthwhile without conditions or reservations. People with low self esteem are hard on themselves. People with low self esteem criticize themselves
for all the things they should be doing and also for all the things they should not be doing. They live with
How does Low Self Esteem Develop? the conviction that ‘I am not ok, you are ok.’
No one is born with low self esteem. Just like many other attitudes and beliefs, low self esteem builds Generally speaking self criticism paralyzes you and blocks your ability to learn new things as your self
up with one’s experiences and with the process of evolution. In other words, judgments about our self talk will be ‘I can’t do it,’ ‘I am not capable’ etc.
worth are learned. Learning comes from many sources – direct experiences e.g. success and failures,
observation, media, listening to what people around us say and watching what they do. Generally it is Following are the ways, we criticize ourselves:
believed that early experience and some of later life experiences contribute to your thinking about you as ■ We compare ourselves unfavorably with other people.

a person and self perception. ■ We degrade ourselves by sweeping comments rather than being specific e.g. ‘I am not good’ rather

than ‘I am not good at ____’.

■ We say to ourselves, ’I am not worth it but you are’.

118 Training Module on Counselling for Trauma, Guilt and Self Esteem Developing Self Esteem 119
 Module 4
■ We believe that other people have a right to exist but not me/us. 5. ______________
■ We believe what other people say to us. 6. ______________
■ We rely too much on others approvals, such as our peers. 7. ______________
■ We believe that our success is due to luck, while other people’s success is due to ability. 8. ______________
■ We believe that being submissive and passive is culturally appropriate. 9. ______________
■ We believe that people in authority are always right 10. ______________ The feeling I experience the least.

The counsellor can help the client to identify self critical thoughts as a first step towards modifying their Following questions should be asked after completing the above exercise.
inner world. Given below is the chart to assist the client to prepare a log for the identification of self ■ Give reasons, why you chose those words to describe yourself.

critical talks and association reaction at behaviour level. ■ Think of situations where you experience the negative aspects of your personality.

■ Spend time thinking how you could change the negative to positive.
■ How can you fulfill your expectations by changing your self talk?
Spotting Self Critical Thoughts
Date/time Situation Emotions Self critical Self Similarly as a second step, the counsellor should ask the client to do the reverse. The client should be
and body thoughts defeating asked to identify the self valued associates. The best way is to ask the client to choose the words from the
sensations behaviour
internal self talk and put them in a serial order:

The words I would use to describe the positive aspects of my personality:

1. ______________ My most positive quality.
2. ______________
3. ______________
4. ______________
5. ______________
6. ______________
7. ______________
8. ______________
9. ______________
Importance of knowing how to self talk as the first step for changing your beliefs and behaviour 10. ______________ My least positive quality.
Low self esteem distorts judgments about self perception. The knowledge about one’s self critical
thinking is the first step in helping to modify one’s belief system which leads to formation of strong Following questions should be asked after completing the above exercise.
convictions. It is not necessary that self perception and reality are at the same level. ■ Give reasons, why you chose those words to describe yourself.

■ Think of situations where you experience the positive aspects of your personality.

Steps and techniques to refute and modify self talk ■ Spend time thinking about the feelings associated with the above experience.

Once the bottom line is understood and the individual is aware of self defeating ideas, the counsellor ■ How can you spend more time by thinking and self talking about your good qualities and accordingly

can take further steps to alter the self talk and inner messages, which will bring about behaviour changes. prepare a work plan?
The first step a counsellor should take is to identify the self negating associates. The best way is to ask
the client to choose the words from the internal self talk and put them in a serial order: Practice everyday a self help method developed by Emile Coue in the 1920s, using this daily mantra
twice: ‘Everyday, and in everyway, I am becoming better and better’.
The words I would use to describe the negative aspects of my personality:
1. ______________ The feeling I experience most.
2. ______________
3. ______________
4. ______________

120 Training Module on Counselling for Trauma, Guilt and Self Esteem Developing Self Esteem 121
 Module 4
Combating Self Critical Thoughts and Negative Self Talk References and further reading:
Fennell, M. Overcoming Low Self Esteem, Robinson Publishing Ltd. United Kingdom, 1999.
Date/ time Situation Emotions and Self critical Alternative Outcome
body sensations thoughts perspective Nelson -Jones, R. Human Relationship Skills, Holt, Rinchart and Winston, New York, 1986.

Silveira, D. M. Personal and Professional Growth- A Competency Based Approach, Classic Publishers Private
Limited, Mumbai, 1998.

Thomas, A. Harris. I’m OK- You’re OK, Harper and Row New York, 1969.
Waitley, D. The New Dynamics of Winning, Nicholas Brealey Publishing, London, 1996.

William, S. Building Self Esteem- How to Replace Self-Doubt with Confidence and Well Being, Jaico
Publishing House, Mumbai, 2003.

Daily Activity Plan:

Time (hrs) Monday Tuesday Wednesday Thursday Friday Saturday Sunday
7-9
9-11
11-13
13-15
15-17
17-19
19-21
21-23

122 Training Module on Counselling for Trauma, Guilt and Self Esteem Developing Self Esteem 123
 4.4. Power Point Slides Early Experiences and Self Esteem Late Experience and Self Esteem
Some of the early experiences contributing to self Some late experiences:
Session Objectives image are: ■ Exposure to traumatic experiences.
■ Early childhood shaping through reward and punishment.
■ Workplace stressors.
Participants will be able to ■ Parental dispute and inconsistencies in disciplining.
■ Understand the importance of self esteem for self ■ Controlled parenting and failing to meet parental ■ Competition and detrimental interpersonal relationship
enhancment. expectations. with colleagues.
■ Comparison with other siblings or peers.
Counselling for Developing Self Esteem ■ Understand how self esteem develops. ■ School pressure and neglect by teachers. ■ Martial conflicts and family disputes.
■ ■ Peer pressure and inability to live up to their expectations.
Practice to understand how self critical thinking and self ■ Mid age crisis.
■ Belonging to a social group which is the focus of prejudice.
talk shapes our actions.
■ Lack of acceptance by siblings and peers. ■ Mental illness.
■ Learn to modify self critical thoughts and experience by Slide 9 Slide 10
developing practical action plan.
Slide 1 Slide 2
Impact of Life Experiences on Your Self Talk

Self Esteem and its Development The bottom line e.g. the conclusions, judgements and
views about oneself are established
Defining Self Esteem ■ I am bad and awful
■ Self-esteem refers to one’s sense of self-worth. It is
related to self-concept and self-efficacy.
Activity 3 & 4 ■ I am not capable
Self esteem is the value we place on ourself. A high self ■ I can’t do it
esteem is a positive value, a low self esteem results from ■ No one is born with low self esteem. Just like many other Body Mapping Promoting your Self Worth
■ I am a burden on others.
attacking negative value to ourselves. High self esteem attitudes and beliefs, low self esteem builds up with
facilitates the indiviual to face difficulties and setback in one’s experience and with the process of evolution. ■ I am not worthy
life, whereas a low self esteem seems to be linked to ■ I am stupid
■ Generally it is believed that early experiences and some
pessimism and lowered expectations.
of later life experiences contribute to your thinking ■ I am.....
about you as a person and self perception. Slide 11 Slide 12
Slide 3 Slide 4

Importance of knowing how to self talk as Steps and techniques to refute and modify
the first step for changing your beliefs and self talk
Importance of Self Esteem behaviour The first step a counsellor should take is to identify the
self negating associates.
An individual with a high self esteem is confident, The best way is to ask the client to choose the words
■ Low self esteem distorts judgement about self
dynamic, appreciative, achivement-oriented, content and from the internal self task and put them in a serial order.
open to change. perception.
Activity 1 The words I use to describe the negative aspects of my
On the contrary, reserach has shown that low self esteem ■ The knowledge about one’s self critical thinking is the personality:
Using preferred and non-preferred hand first step in helping to modify one’s belief system which 1. -------- The feeling I experience the most.
is linked with feelings of hopelesness and sucidal
tendencies. lead to formation of strong convictions. 2. --------
3. --------
■ It is not necessary that self perception and reality are at
If one does not value or cherish oneself, then there is no 4. --------
incentive to protect or work for the progress of that self. the same level. 5. -------- The feeling I experience the least.
Slide 13 Slide 14
Slide 5 Slide 6

Following questions should be asked Second Step

Self Esteem and its Basis The counsellor should ask the client to do the reverse. The
■ Give reasons, why you chose those words to describe client should be asked to identify the self valued associates.
A healthy self-esteem is based on: yourself. The best way is to ask the client to choose the words
■ An ability to assess the self accurately. from the internal self talk and put them in a serial order.
Activity 2 ■ Think of situations where you experience the negative The words I use to describe the negative aspects of my
■ An ability to accept and value the self unconditionally. aspects of your personality. personality:
Being in touch with your Potentials ■
■ Spend time thinking how you could change the negative 1. -------- My most positive quality.
Realistically acknowledge strengths and limitations. 2. --------
to positive.
■ Accepting the self as worthy and worthwhile without 3. --------
■ How can you fulfill your expectations by changing your 4. --------
conditions or reservations.
self talk? 5. -------- My least positive quality.
Slide 7 Slide 8 Slide 15 Slide 16

124 Training Module on Counselling for Trauma, Guilt and Self Esteem Developing Self Esteem 125
 Module 4
Following questions should be asked
■ Give reasons, why you chose those words to describe
yourself.
■
Activity 5 & 6
Think of situations where you experience the positive
aspects of your personality.
Expressing both your feelings, positive
■ Spend time thinking about the feelings associated with
the above experience. and negative Self instruction training
■ How can you spend more time by thinking and self
talking about your good qualities and accordingly
prepare a work plan?
Slide 17 Slide 18

A Note to Remember

Practice everyday a self help method developed by Emile

Coue in the 1920s, using this daily mantra twice:

‘Everyday, and in everyway,

I am becoming better and better’

Slide 19

126 Training Module on Counselling for Trauma, Guilt and Self Esteem
 Annexures
SAMPLE TRAINING PROGRAMME SCHEDULE
(The schedule may begin at 09.00 and conclude at 17.30 hours. The schedule assumes adherence to the
specified break times: 10.30 - 10.45 morning tea; 13.00 - 14.00 lunch; 15.00 - 15.15 afternoon tea. The
schedule is tentative and subject to change as per the local norms.)

Day 1 Revisiting Counselling

08.00 09.00 Registration and welcome

09.00 09.30 Introduction, orientation and expectations
09.30 10.30 Revisiting counselling (PPT and activity)
10.30 10.45 Morning Tea
10.45 13.00 Overview of counselling (PPT, discussion and role plays)
13.00 14.00 Lunch
14.00 15.00 Overview of counselling (PPT, discussion and role plays)
15.00 15.15 Afternoon Tea
15.15 16.30 Qualities of counsellors (PPT, practice sessions)
16.30 17.30 Questions and answers

Day 2 Revisiting Counselling and Counselling for Trauma

09.00 09.15 Participants Summary

09.15 10.30 Steps and phases of counselling (practice session)
10.30 10.45 Morning Tea
10.45 13.00 Steps and phases of counselling (practice session)
13.00 14.00 Lunch
14.00 15.00 What is Trauma? Understanding trauma and expressions of
trauma (PPT and group work)

Annexures 15.00
14.00

17.00
15.15
17.00

17.30
Evening tea
Assessment of trauma and setting goals (case work and practice
sessions)
Questions and answers

Day 3 Counselling for Trauma

09.00 09.15 Participants summary

09.15 10.30 Counselling approaches and techniques for trauma
(demonstration, case work and role play)
10.30 10.45 Morning Tea

Annexures 129
 Annexures Glossary
10.45 13.00 Counselling approaches and techniques for trauma Glossary
(demonstration, case work and role play)
13.00 14.00 Lunch Aggression: It refers to behaviour that is intended to cause harm or pain. Aggression can be physical,
mental, or verbal emotions.
14.00 15.00 Counselling approaches for developing resources, (practice sessions)
15.00 15.15 Evening Tea
Anger: It is an emotional state that may range from minor irritation to intense rage. Anger becomes the
15.15 17.00 Counselling approaches for system strengthening for the family predominant feeling when a person makes the conscious choice to take action to immediately stop the
(demonstration and practice session) threatening behaviour of another outside force.
17.00 17.30 Questions and answers
Arousal: to awaken, or stimulate.
Day 4 Counselling for Guilt and Shame
Beliefs: It is the simplest form of mental representation and therefore one of the building blocks of
09.00 09.15 Participants summary conscious thought.
09.15 10.30 Understanding guilt among subgroups, guilt and emotional
Cognitive appraisal: personal interpretation of a situation.
correlates (group work)
10.30 10.45 Morning Tea Cognitive thinking: It is used in several loosely related ways to refer to a faculty for the human-like
10.45 13.00 Understanding belief system and working through ABC processing of information, applying knowledge and changing preferences. It can be used for intelligence,
techniques (demonstration and practice session) reasoning and learning.
13.00 14.00 Lunch
14.00 15.00 Case discussion and role play for ABC technique Compulsive behaviour: It is a psychiatric anxiety disorder most commonly characterized by a subject's
obsessive, distressing, intrusive thoughts and related compulsions (tasks or ‘rituals’) which attempt to
15.00 15.15 Evening Tea
neutralize the obsessions. E.g., An obsession for cleanliness and the compulsive behaviour involves
15.15 17.00 Practice session for ABC approach washing hands numerous times, even though it is unnecessary.
17.00 17.30 Questions and answers
Condescending: patronizing or arrogant.
Day 5 Counselling for Enhancing Self Esteem
Confession: an admission of misdeeds or faults
09.00 09.15 Participants summary
09.15 10.30 What is self esteem and self image, assessment and goal setting Confidential dialogue: interaction between client and counsellor which is like a secret and not to be
disclosed to outside parties
(PPT, demonstration, role play and group work)
10.30 10.45 Morning Tea
Conscientious: careful and meticulous.
10.45 13.00 Behaviour change techniques (PPT, role plays and case
demonstration) Empathy: the capacity to recognize or understand another's state of mind or emotion. It is often
13.00 14.00 Lunch characterized as the ability to ‘put oneself into others shoes’.
14.00 15.00 Self instruction techniques ( PPT, role play and practice sessions)
15.00 15.15 Evening Tea Feelings: It is a conscious subjective experience of emotion.
15.15 16.00 Practice session
Guilt: In ordinary language, guilt is a state in which one experiences conflict at having done something
16.00 17.30 Questions and answers, programme evaluation, discussions and
that one believes one should not have done (or conversely, having not done something one believes one
feedback should have done). It gives rise to a feeling that does not go away easily.

130 Training Module on Counselling for Trauma, Guilt and Self Esteem Glossary 131
 Glossary
Inhibition: to be reserved, shy or self conscious. Termination: to end

Insomnia: inability to sleep. Thoughts: It is a higher brain function which helps us to problem solve, make decisions and analyze the
world around us.
Introspection: the mental self observation and reporting one’s inner thoughts and sensations. It can also
be called contemplation of one's self and used synonymously with self reflection. Tolerance: is the appreciation of diversity and the ability to live and let others live

Non-directive: attributed to Carl Rogers, this therapy is designed to allow the individual in emotional Vigilance: attentive, watchful.
turmoil to talk out problems and resolve difficulties with a minimum of direction being provided by the
person serving as counsellor.

Non-judgmental: not to pass opinions or give advice. To let people have their own beliefs and approach
towards issues
Overt: not hidden or concealed.

Perception: It is the process of attaining awareness or understanding of sensory information.

Post traumatic stress disorder (PTSD): It is an anxiety disorder that can develop after exposure to one or
more terrifying events in which grave physical/ psychological harm occurred or was threatened. It is a
severe and ongoing emotional reaction to an extreme psychological trauma.

Reasoning: It is the cognitive process of looking for reasons for beliefs, conclusions, actions or feelings.

Self disclosure: sharing information about oneself

Self esteem: self-esteem reflects a person's overall self-appraisal of his or her own worth.

Sexual molestation: a term defining offences in which an adult engages in non-penetrative activity with
a minor or adult for the purpose of sexual gratification: groping and touching a woman’s private parts.

Shame: is the consciousness or awareness of dishonor, disgrace, or condemnation.

Simulate: to replicate or imitate.

Stressors: an event or context that elevates adrenaline and triggers the stress response because it throws
the body out of balance and forces it to respond; for example: daily stress events (e.g. traffic, lost keys),
environmental stressors, life changes (e.g. divorce, bereavement). A stressor can also be an event that
provokes stress.

Substance abuse: overindulgence in a drug or other chemical leading to effects that are detrimental to the
individual's physical and mental health, or the welfare of others.

132 Training Module on Counselling for Trauma, Guilt and Self Esteem Glossary 133
 Abbreviations
List of Abbreviations

AIDS Acquired Immuno Deficiency Syndrome

ANC Antenatal Care

ART Anti Retroviral Therapy/Treatment

HIV Human Immuno Deficiency Virus

IPPF SARO International Planned Parenthood Federation South Asia Regional Office

MA Member Association

MTP Medical Termination of Pregnancy

NGO Non Governmental Organisation

PTSD Post Traumatic Stress Disorder

RCH Reproductive and Child Health

SRH Sexual and Reproductive Health

134 Training Module on Counselling for Trauma, Guilt and Self Esteem
International Planned Parenthood Federation
South Asia Regional Office

IPPF House, 66 Sunder Nagar

New Delhi 110003, India
www.ippfsar.org
91-11-24359221-6