PREPARATION OF COUNSELORS- TRAINING AND QUALIFICATION

A balanced and sound training program should include the following:

 Basic theoretical preparation: Understanding of motivation, psychodynamics of
human adjustment, learning principles and other concepts that underlie
counseling, psychodiagnostics principles and procedures, psychopathology,
social psychology, principles and process of counseling, and counseling theory.
 Technical and applied knowledge: Knowledge of test use and interpretation,
interviewing skills and competencies in specialized procedures of intervention.
 Practical training: A broad-based practicum and training for enabling the
counselors to meet any exigencies.

The program should subscribe to the developmental-reflective model for

professional preparation of counselors. It must provide the students with the
theoretical understanding of healthy as well as unhealthy human growth and
development, with focus on the application of mental health, psychological, and
human development principles through various cognitive, affective, behavioral,
and systemic intervention strategies that address wellness, personal growth, and
career development, as well as pathology.
The program should also provide the students with strategies to integrate the
theoretical knowledge base with ongoing self-reflective development. Continued
active professional development is the ultimate goal. The students should be
helped to develop a theory-based approach that is congruent with their unique
personal qualities. The theory developed should include personal, cultural, social,
vocational, psychological, and educational concerns.
Finally, the emerging counselor must be familiar with the cultural background of
the clients. Multicultural counseling is now gaining significance in any society, as
all societies are becoming more and more pluralistic. Counselors need to have a
sound knowledge and critical understanding of individual differences and their
significance. The impact of culture on human development is very important. The
belief and value systems of the individual need to be understood well in order to
design good intervention strategies.
For further specialization, a desirable counseling program must include educational
and vocational counseling, group approaches, and counseling of special groups.
At the end of the theory cum training program, the counselors should possess the
list of the following counseling competencies:
 Knowledge of human development, the both normal and abnormal
 Understanding the theories of counseling and personality
 Knowledge of and sensitivity to social, cultural, and ethnic issues
 Knowledge of ethical and legal aspects of counseling
 Knowledge of the learning process
 Knowledge of decision making and transmission models
 Ability to diagnose client’s problems
 Ability to help clients learn problem-solving and decision-making skills
 Ability to facilitate groups and workshops
 Knowledge of effective instructional methods and strategies
 Ability to provide crisis intervention and support
 Ability to provide mental health counseling and a referral to community
resources
 Knowledge of career development matters, techniques, and instruments
 Knowledge of the use and misuse of assessment instruments and test data
Practical Training
Besides, counseling consists of practices and skills involving several counseling
processes. Interviewing, case taking, choosing and administering tests, interpreting
test results, etc. are important skills to be acquired by the students. These skills
cannot be mastered by mere intellectual learning and didactic understanding. The
acquisition of these skills of empathizing, diagnosing, resolving conflicts,
understanding feelings, ideas, content, and a host of other subtle and sensitive
skills needs to be done through practicum work, stress on supervised counseling
sessions, and verbatim supervision. This constitutes training. Counseling is a
science and an art. It involves theoretical preparation as well as practical training.
Counseling efficiency is closely related to the quality of counselor preparation and
training. The programs must be carefully drawn. This will result in better
counseling service. It is sometimes argued that counseling skills are inborn rather
than acquired. There is no opposing the fact that counseling is both an art and a
science.
The objectives of counseling can be succinctly stated as follows:
1. To identify the problem areas or difficulties of individuals, their
potentialities and limitations
 2. To assist people to understand themselves and their situational factors as
fully as is practicable
3. To help develop the potential of individuals through a greater self-
understanding, to enable them to take full advantage of the environmental
resources
4. To help mitigate suffering, reach appropriate solutions, take responsible
decisions and thus enable clients to become self-actualized individuals.

PHILOSOPHY AND ATTITUDE OF A PROFESSIONAL COUNSELOR

The counselor is a trained professional who should manifest the following personal
and professional characteristics:
1. The belief that counselees are unique individuals of significant value
2. The knowledge of how an effective individual functions
3. The belief that counselees are capable of change
4. That their knowledge and skills are necessary to help individuals overcome
functional limitations
5. The willingness to become involved in this interpersonal process
6. The understanding of oneself and one’s own skills and limitations
7. Non-judgmental acceptance of people
8. Belief that peoples are basically good
9. Acceptance of and positive use of transference
10.Helping the person see reality, encourage objectivity
11.The purpose is to remove the veil of ignorance

Belief
1. Belief that Counselees are Unique Individuals of Significant Value

All human beings are worthwhile, valuable, and unique. This is an essential
conviction that every counselor must have in order to relate to each
counselee in a positive and constructive manner. Moreover, this acceptance
of, and a sincere belief in the counselee, must be felt as an experience and
 not an abstract philosophical concept. It means that the counselor must have
a genuine interest in the counselee and the presenting issues. It does not
mean that one must not approve or disapprove of a particular act or like or
dislike a particular trait manifested by a counselee; but rather that, in spite of
these, the counselor should have a genuine interest in the counselee, and
respect the counselee as an important, valuable, and worthwhile human
being. This is what Carl Rogers called “unconditional positive regard”.

The counselor must understand that a counselee’s perceptions about self, and
perceptions of the world constitute reality for that person. The counselee’s
problem should be approached from that frame of reference. The
socioeconomic, religious and cultural background, education, and family
factors of the counselee are of utmost importance when we try to understand
where he or she is coming from. The beliefs, attitudes, feelings, and
impressions that the counselee has about self and of the environment
strongly influence the way the person behaves. A counselor needs to focus
on understanding these perceptions and comprehending the meaning of the
counselee’s behavior. Understanding where the counselee is coming from,
his or her internal frame of reference, will give valuable clues to his or her
problem.

The counselee’s sense of worth and uniqueness has to be appreciated and

encouraged. This will create a feeling of trust between the counselor and the
counselee. The counselor’s belief in the counselee and in his sense of self-
worth is expressed verbally, para-verbally, and non-verbally. Nonverbal
expressions are promptness, posture, and facial expressions. Paraverbal
expressions are tonal quality. And verbal expressions are responses that are
sensitive to the feelings and attitudes of the counselee.
2. Belief that counselees are capable of change
When someone asked me, “Do you think he will change?” My answer was,
“I wouldn’t be in this business if I did not believe that.” It is true. We are all
capable of change. We will have to make that decision on our own. It only
requires determination to do so. A counselor’s theoretical orientation and
basic assumptions about the nature of human beings strongly influences the
counselor’s belief regarding the kind of change and amount or degree of
change possible for any individual counselee. Counselors may hold distinct
and varied opinions on the kinds of change that they believe are possible.
 But it is important for all counselors to believe that counselees are capable of
change.

A counselor has to be optimistic. The belief that all counselees can, at least
to some extent, modify their feelings, attitudes, cognitive structure, and
behavior is imperative to all counselors if they have to prove themselves
helpful to the process. Change is never easy. They need to recognize that it
is not easy to help people change. And it is not possible to help all people to
change. Sometimes a counselee may just not be ready; he or she may not be
willing to change. There may not be any necessity for the counselee to
change, rather it may be the counselee’s surroundings that need to change or
be changed.

As a counselor one must communicate to the counselee this belief that he or

she can change. Without the counselee’s cooperation it would not be
possible to achieve a change. Thus, it is not enough if the counselor believes
that the counselee can change, it is equally important that the counselee
believes that he or she can change.

Broad skills in the counseling process

 Releasing empathic sensitivity
 Responding in a range of ways that assist the counselee’s focusing
 Releasing a widening portfolio of ways of communicating warmth
 Releasing congruent responsiveness
 Communicating clearly and openly
 Addressing difficult issues, even underlying issues, directly
 Expressing confusion where that persists
 Challenging the counselee in ways that encourage the counselee’s congruent
response
 Developing ways of tapping the counselee’s experience of the process and the
relationship
 Maintaining empathy across a range of “difficult” counselees
 Experiencing a consistent congruent non-judgmental attitude across a range of
counselees
 Establishing psychological “contact” with counselees who are “difficult to
reach”
 Establishing psychological “contact” with different parts of the counselee’s self
(where such boundaries have already been symbolized by the counselee)
 Relating unself-consciously with the counselee
 Achieving “stillness” to meet the counselee
 Entering the counselee’s world with willingness, confidence and noninvasive
respect
 Comprehending and responding to a range of counselee’s “personal languages”
 Focusing on self to identify personal issues that may be projected into the
counselee material
 Remembering important matters of fact about the counselee Remembering key
personality dynamics, conditions of worth, introjections, discovered denials and
other constituents of the counselee’s self-structure
 Remembering precisely the words used by the counselee to describe aspects of
his self-structure and elements of his experience
 Remembering the changes and development in nomenclature used by the
counselee to denote aspects of his self-structure and experiences
 Becoming aware of the degree of externalization or internalization of the
counselee’s locus of evaluation
 Developing an ability to stay close to the counselee’s expression where relevant
(for example, in the case of a counselee whose locus of evaluation is highly
externalized)
Basic communication skills for counselors
1. Attending: The counselor’s posture, gestures, facial expression and voice
send out non-verbal messages to the counselee.

Gerard Egan, in his book The Skilled Helper talks about the SOLER
attending model.

S –Face your counselees squarely. This says that the counselor is available
fully for the counselee.

O- Adopt an open posture. This says that you are open to your counselees
and non-defensive.

L- Lean toward the counselee at times. This underscores your attentiveness

and lets the counselee know that you’re with them.
 E- Maintain good eye contact without staring. This tells your counselee of
your interest in them.

R- Remain relatively relaxed with counselees. This indicates your

confidence in what you are doing and also helps counselees relax.

Listening and responding skills:

Listening is about focusing on the person who is speaking. An active listener needs
to focus full attention on the person who is speaking. Listening and responding
well are skills that require practice. In order to get the information, you need to
help a counselee, you must listen attentively. This technique involves
communicating, without words, your interest in the needs the counselee expresses.
You can open up communication by using silence. You can let the counselee know
that you are listening by maintaining eye contact, leaning forward, occasionally
saying words like “yes,” “uh-huh,” and “please continue” — these are signs of
respect and generate a feeling of well-being in the person who is being heard.
There are good listening skills, and there are bad listening skills. Good listening is
active listening.

Active listening
Active listening involves listening to feelings and facts, the verbal and nonverbal
communication of the counselee. It involves certain micro skills, such as the
following:
1. Desire to listen: Want to listen to the information being delivered.
2. Note taking: Always being prepared to take notes when necessary. That
means having writing tools readily available.
3. Clarification: Repeating the information you heard by saying, “I hear you
saying ... Is that correct? If the speaker does not agree, repeat the process to
ensure understanding.
4. Probing: Remain curious and ask questions to determine if you accurately
understand the speaker. Most of the time, ask open-ended questions in order
give the counselee more scope to answer clearly and accurately.
Active-listening questions intend to do the following:
 Clarify meanings: “I hear you saying you are frustrated with Johnny,
is that right?”
 Learn about others thoughts, feelings, and wants: “Tell me more about
your ideas for the project.”
 Encourage elaboration: “What happened next?” or “How did that
make you feel?”
 Encourage discovery: “What do you feel your options are at this
point?”
 Gather more facts and details: “What happened before this fight took
place?”
5. Listening by using the ears to hear the message, the eyes to read body
language (when listening in person), the mind to visualize the person
speaking (when on the telephone), and intuition to determine what the
speaker is actually saying.
6. Paraphrasing: Repeating in your own words what the counselee is saying,
tentatively; almost like a question. Paraphrasing is a tool you can use to
make sure that you understand the message that you think your counselee is
sending. It is restating the information you just received to make sure you
understand it. For example, your counselee says, “I hate math and the
teacher because she never lets us do anything cool!” You might say, “It
sounds like you’re having a hard time with math and that makes you feel
frustrated and bored.”

This technique helps counselors and counselees communicate in several

ways.

 First, it helps counselors make sure they understood the message

correctly.
 Second, by restating or paraphrasing, counselors draw further
information from their counselee.
  Third, paraphrasing allows the counselee to know that the counselor
has heard them and is interested in what he or she has to say.
 Fourth, it allows the counselee an opportunity to correct any
misunderstanding immediately.
7. Being silent: Silence is the technique by which the counselor encourages the
counselee to comment by remaining completely silent and waiting for the
counselee to go on.
8. Acceptance or non-judgmental listening: This is the non-directive technique
through which you try to indicate that you are interested in what the
counselee is saying. It is important not to interrupt the continuity of thought
of the counselee.
9. Simple reflection: It is the technique of acting as a mirror for verbal
expression. In this technique, the counselor restates the last words of the
counselee. Showing the counselee how s/he sounds encourages the
counselee to clarify and expand on her remarks.
10.Reflection of feeling: In this technique, the counselor tries to express
verbally the attitudes of the counselee. This is an extremely important lead
used to bring feelings to the surface and to get more verbalization by the
counselee. It serves to bring problems into focus without the counselee
feeling that he or she is being probed or pushed by the counselor. Reflective
listening can be a powerful tool of communication. In reflective listening,
you simply reflect to the counselee what you think you heard, making sign
to reflect their feelings.
11.Thinking and mentally summarizing: Weighing the evidence, listening
between the lines to tones of voice and evidence.
12.Paraphrasing, summarizing, and clarifying: This technique involves
repeating, synthesizing, or summarizing in other words what the counselee
has told you. This helps the provider clarify what the counselee is saying,
and helps the counselee to feel that he or she has been heard.
13.Reflecting and validating feelings: This technique involves clarifying the
feelings the counselee expresses in order to help understand his or her
emotions. It is helpful to counselees to let them know that their reactions to a
situation are normal, and that those feelings are common to other people in
similar situations. You can communicate that the feelings are valid.
14.Giving clear information: Before you give any information, it is helpful to
ask questions to determine how much the counselee already knows. It is
important to provide information using words that the counselee can
 understand. Ask counselees to repeat the information you have given them
to verify that they understood.
15.Arriving at agreement: This technique involves clarifying and summarizing
the decisions that a counselee has made during the counseling session.
16.Power of reflective listening: The power of reflective listening lies in three
distinct forces:-
 As the counselor processes what the counselee is saying through the
counselor’s own experience and reflects it to the counselee in the
counselor’s own words, it lets the counselee know that the counselor
has not only heard the counselee but has understood what has been
said.
 The counselor is telling the counselee what he or she is saying in an
accurate way, it is clear the counselor has been listening and not
distorting what the counselee has told the counselor.
 As the counselor reflects to the counselee what the counselor’s
understanding is, the counselee has an opportunity to hear him or
herself in a new way.
17.Establish rapport by following the counselee.
 Match the momentum, tone of voice, body language, and words used
by the speaker.
 Please use common sense when matching. If the speaker is yelling,
don’t do the same because it will make a bad situation worse.

Poor listening skills:

A poor listener—
 May be abrupt and/or give one-word answers such as no, yes, and maybe.
 Will be easily distracted looking around the room as opposed to focusing on
the speaker’s face.
 Constantly interrupts, making the speaker feel that what he or she has to say
is not important.
 Finishes the counselee’s sentences, implying that the listener already knows
what the speaker is about to say.
 Changes the subject without even realizing it.
 Looks at the watch, signaling that the counselee is wasting time.
Results from active listening:
Active listening takes time and practice and does not produce results overnight.
Usually, each time the counselor and the counselee talk, the conversation will get
easier and will include more active listening, not just from the counselor but from
the counselee too. The counselor has to lead the way.

Empathy and empathetic listening

 “Empathy is the counselor’s ability to sense the counselee’s world the way
the counselee does and to convey that understanding.” —Frank A. Nugent
 “Empathy is the skill of reflecting back to another person the emotions he or
she is expressing so that he or she feels heard and understood.” —
Opendoors.com
 “Empathy involves listening to counselees, understanding them and
communicating this understanding to them so that they might understand
themselves more fully ad act on their understanding.” —Eagan (1994)

The word was first used in English in the early twentieth century to translate the
German psychoanalytic term Einfühlung, meaning “to feel as one with”, though in
practice more closely translating the German Mitgefühl, “to feel with” someone.
The word “empathy” is actually a poor and misleading translation of the German
word “einfuhlung.”
The correct translation would be “in feeling” or “feeling into something” according
to Judy Harrow (1996), it is easy to know when you are being empathic because: -
 your body language and tone match
 your tone and your feelings match
 you are focused on what your counselee is saying and meaning
You are trying to see things from your counselee’s point of view, which requires
that you do the following:
 you do not impose your feelings, thoughts, and ideas any time throughout
the conversation.
 you refrain from immediately giving advice.
 you are tired after listening because it takes a great deal of energy.
  you ask yourself if you would make that same statement to an adult. If not
then think twice about making it.
Decisions are processed logically, but made emotionally. Counselors help
counselees make decisions. And decision-making involves emotions. Empathy is
not a trait, but a skill. It is not something that the counselor is or has, but does. It is
the active process of feeling into the inner world of another.
The first step to empathy is listening openly, without judgment or expectation. This
brings out the objectivity in the counselor. An effective counselor not only conveys
accurate empathy, but also recognizes whether the empathic responses will indeed
be experienced with equal accuracy by the counselee. Research has demonstrated
that empathy increases when counselors modify their empathic response style to fi
t the counselee’s defi nition of helpful, empathic responses (Lambert & Barley,
2001); the ability to do so corresponds to counselor sensitivity to individual and
cultural differences, which is also a determinant of a quality therapeutic
relationship and effective counseling (Sperry et al., 2003).

Effective understanding, communication, and relationships emerge from empathy

and trust. Part of the “empathy process” is establishing trust and rapport.
Establishing trust is about listening and understanding—not necessarily agreeing
(which is different)—to the other person. It is important to know that the counselee
is not the counselor. So, it cannot be a state of total identification with another’s
situation, condition, and thoughts. The counselee comes with his or her own
formative experience which can be very different from the counselors’. The action
of understanding, being aware of, being sensitive to and appreciation of another
person’s problems and feelings needs to be restricted to the cognitive level without
experiencing the same emotional reaction. This is where it is distinguishable from
sympathy, which is usually nonobjective and non-critical. Sympathy is feeling with
the person whereas empathy is feeling for the person.
Carl Rogers emphasized that integral to the counseling process is a special kind of
relationship, focused on the counselee’s feelings and needs, while the counselor
offers consistent empathy, warmth, and respect. Given these “core conditions,”
people seem able to explore their issues, not just the easy ones but those that go
deep, perhaps hurt bad, and potentially release real change.
Commitment and sincerity to the process of counseling cannot be faked or forced.
No one can fake empathy, warmth, or respect which are the essential conditions of
the counseling relationship. Genuineness is one of the most requisite attitudes
which needs to be nurtured and developed over time by the counselors. So, it is
best to be honest about one’s limits and only attempt to enter into counseling
relationships where genuine empathy, warmth, and respect are really possible.
Where theory and practice can meet together and agree there is congruence Judy
Harrow.
Empathy involves two major skills: Perceiving and communicating
Carl Rogers on empathy: “The therapist is sensing the feelings and personal
meanings which the counselee is experiencing in each moment, when he can
perceive these from the inside, as they seem to the counselee, and when he can
communicate that understanding to his counselee, and then the third condition has
been fulfilled.”
The counselor needs to ask himself or herself some of the following questions:
 Will it be possible for me to step into the counselee’s world so completely
that I lose all desire to evaluate and judge it?
 Can I allow myself to enter the counselee’s world and see his or her personal
meanings and feelings as he does?
 Can I be sensitive enough to move freely in the counselee’s world without
trampling on meanings that are precious to him?
 Can I extend this understanding without limit?
 Can I sense it so accurately that I can catch both the obvious meanings as
well as those which are implicit and expressed as confusion?
Empathic listening techniques
1. Encouragers
 These are “continuers”. They communicate listening, the willingness to
listen and the desire to understand more about the counselee’s experience.”
 They can be verbal (giving permission, requesting additional information,
and providing direction), nonverbal (include nodding of head, leaning
forward, making sounds like “umm, ahh,” etc., and facial expressions like
smiles and grimaces) or a mixture.
2. Reflections
 Reflective listening is a powerful tool of communication. When the counselor
simply reflects to the counselee what he or she thinks they have heard in terms
of content and feeling, it helps the client hear himself in a new way, it lets him
know that the counselor has not only heard but has also understood what has
been said, and also lets the counselor clarify whether he has his facts right.

3. Empathic comments
 Through the empathic comment the counselor sends the message to the
counselee that the latter has been heard and understood.
 Rogers (1995) wrote: “To be with another in this way (empathetic)
means that for the time being you lay aside the views and values you hold
for yourself in order to enter another’s world without prejudice. In some
ways it means you lay aside yourself.’
 Empathic comments include using encouragers and reflective listening,
parroting or repeating word for word what the counselee said, summarize
with reflective statements, etc.
Barriers to empathic listening
 Any ongoing personal issues or preoccupations that tend to distract the
counselor
 Cultural differences
 Gender
 Counter transference and therefore role confusion
 The counselor’s inner-world (inscape)
 The counselor’s preconceived ideas and beliefs
 Discomfort in the presence of the counselee’s strong emotions––grief, anger
or pain
EVALUATION OF THE COUNSELING PROCESS
Any problem, situational or fundamental, can be solved through the psycho
educational process of counseling. When one understands the nature of the self all
kinds of problems see the light of solution.
Some of the major benefits of this type of counseling process are:
1. Intellectual satisfaction.
Human beings, at some point in their lives develop a natural curiosity to know
who they are and where they are heading. Mystery is a pain for the intellect. It
cannot stand doubt of any kind. Every thinking individual has the natural urge
to quench curiosity about the Self, goal, purpose, destination and direction of
living.
2. Fulfillment.
The joy of understanding the self. This lifts the insecurities, fears and anxieties.
Peace of mind and ultimately joy descends upon the client.
3. Freedom from dependence.
When one discovers that one is actually not dependent on anything, anyone, or
any situation in which to be happy or secure, there is emotional freedom.
4. Freedom from pain.
Self-knowledge and the resulting joy serve as an emotional cushion when the
going is tough. When there is no dependence, then there is peace of mind. Life
is unpredictable, future is uncertain, past cannot be changed: all this knowledge
is very helpful in modifying, reducing as well as avoiding pain.
5. Achieving a poised mind (emotional maturity).
A poised mind is an efficient mind. An emotionally disturbed mind is
inefficient. It cannot tap on intellectual resources. A poised mind has the
capacity to remain balanced when things are going haywire. It is an emotionally
mature mind which is intellectually available.

WHAT IS PSYCHOLOGICAL FIRST AID?

Counselors are increasingly called to respond to acute emergency and disaster
situations. Immediate counseling interventions in a disaster scenario are by
necessity short, population-based, and supportive of the natural resiliency of
affected individuals and communities (Uhernik, J. A. and Husson, M. A., 2009).
In emergency or disaster situations many injuries can occur. So having the skills
in basic first aid to help the victim is very essential for all helpers. But what
about the injuries that cannot be seen, such as those which are psychological?
Using psychological first aid can be a vital first response. When one works with
people during and after a traumatic situation, it is common to see reactions of
combinations of confusion, fear, hopelessness, helplessness, sleeplessness,
physical pain, anxiety, anger, grief, shock, aggressiveness, mistrustfulness,
guilt, shame, shaken religious faith, and loss of confidence in self or others. The
first responder’s early contact with them can help alleviate their painful
emotions and promote healing and, more importantly, hope.
PFA aims to mollify the painful range of emotions and physical responses
experienced by people exposed to disaster and reduce further harm that can
result from initial reactions to disasters. The goal of PFA is to promote an
environment of safety, calm, connectedness, self-efficacy, empowerment, and
hope.

Psychological first aid (PFA) is as natural, necessary and accessible as medical

first aid. It means assisting people with emotional distress resulting from an
accident, injury or sudden shocking event. Significantly, like medical first aid
skills, one does not need to be a doctor, nurse or highly trained professional to
provide immediate care to those in need.

“Psychological first aid (PFA) refers to a set of skills identified to limit the
distress and negative behaviors that can increase fear and arousal.” (National
Academy of Sciences, 2003). It is an acute mental health intervention, seems
uniquely applicable to public health settings, the workplace, the military, mass
disaster venues, and even the demands of more well circumscribed critical
incidents, e.g., dealing with the psychological aftermath of accidents, robberies,
suicide, homicide, or community violence (Everly, G. S., Jr., and Flynn, B. W.,
2005).

With natural as well as man-created disasters increasing by leaps and bounds,

PFA is fast emerging as the crisis intervention of choice in the wake of such
critical incidents, such as trauma and mass disaster. Research by Center for
Disease Control and Prevention (CDC, 2002) provides insight into the potential
need for acute psychological care in the wake of disasters.

The American Psychiatric Association (APA, 1954) noted that whether a

disaster is a function of nature or enemy attack, people will suffer from a level
of stress not usually encountered. It is important that a disaster worker or first
responders must be familiar with common patterns of reaction and understand
the basic principles for responding effectively with disturbed people. In the
wake of critical incidents such as violence, fatal accidents, and disasters, there
is a significant need to provide some form of psychological support.

As Raphael (1986) notes “. . . In the first hours after a disaster, at least 25% of
the population may be stunned and dazed, apathetic and wandering—suffering
from the disaster syndrome—especially if impact has been sudden and totally
devastating . . . At this point, psychological first aid and triage . . . are
necessary . . ..” (p. 257).

The Institute of Medicine (IOM, 2003) has found the following: “In the past
decade, there has been a growing movement in the world to develop a concept
similar to physical first aid for coping with stressful and traumatic events in life.
This strategy has been known by a number of names but is most commonly
referred to as psychological first aid (PFA). Essentially, PFA provides
individuals with skills they can use in responding to psychological
consequences of [disasters] in their own lives, as well as in the lives of their
family, friends, and neighbors.” (p. 4–5).

Everly and Flynn (2005) have proposed one such model of psychological first
aid (PFA) that may be applied to individuals. The National Child Traumatic
Stress Network and National Center for PTSD (2005) have collaborated to
create a highly useful fi eld manual for mental health personnel in the
administration of PFA to individuals. Parker, Everly, Barnett, and Links (in
press) have even developed specific ‘‘evidence-informed’’ competencies for
training public health personnel in PFA.

IOM (2003) defined PFA as “psychological first aid is a group of skills

identified to limit distress and negative health behaviors. PFA generally
includes education about normal psychological responses to stressful and
traumatic events; skills in active listening; understanding the importance of
maintaining physical health and normal sleep, nutrition, and rest; and
understanding when to seek help from professional caregivers.’’ (p. 7)

Strengths of Psychological First Aid

Whenever there is a disaster, information needs to be gathered to help mental

health specialists make rapid assessments of the survivors’ immediate concerns
and needs and to tailor interventions in a flexible manner.

PFA is evidence informed modular approach for assisting children, adolescents,

parents/caretakers, and families in the immediate aftermath of disaster and
 terrorism (Brymer et al.,). It is designed to reduce the initial distress caused by
traumatic events, and to foster short- and long-term adaptive functioning.

According to The Medical Reserve Corp Psychological First Aid Field

Operations Training Manual (National Center for Child Traumatic Stress
Network, 2006) principles and techniques of Psychological First Aid meet four
basic standards. They are:

1. Consistent with research evidence on risk and resilience following

trauma
2. Applicable and practical in fi eld settings
3. Appropriate for developmental levels across the lifespan
4. Culturally informed and delivered in a flexible manner (which is a
challenge for any mental health professional)

PFA is straightforward, practical and easily understandable and thus, of great

assistance to providers who are often experiencing high levels of stress themselves.
Working in post-disaster environments is quite stressful. It is also consistent with
common sense, prioritizing the actions of the provider very neatly. A very
important strength of PFA is that it does not assume that all survivors will develop
severe mental health problems or long-term difficulties in recovery. Instead, it
focuses on the broad range of early reactions (for example, physical,
psychological, behavioral, spiritual) that the victims experience and may or may
not exhibit. PFA also understands that some of these reactions will cause enough
distress to interfere with adaptive coping, and recovery may be helped by support
from compassionate and caring disaster responders.

PFA offers specific recommendations of actions that seem consistent with our
current scientific understanding of trauma recovery (Vernberg, 2007).
Psychological First Aid includes basic information-gathering and assessment
techniques relying on field-tested, evidence-informed strategies that can be
provided in a variety of disaster settings. It is practical making use of handouts that
provide important information about post-disaster reactions and adversities for
individuals of various ages and cultures for use over the course of recovery. There
is consensus among international disaster experts and researchers that PFA can
help alleviate these painful emotions and reduce further harm that can result from
initial reactions to disasters.
Psychologists concur in the fact that first responders should not go to post -
disaster areas as freelancers, alone. There is the danger of duplicating services,
adding to the confusion, or not knowing where to get further help. It always helps
to be part of an organized response team to maximize efficiency and effort.

Basic objectives of psychological first aid (Brymer et al., 2006)

 Establish a human connection in a non-intrusive, compassionate manner.
 Enhance immediate and ongoing safety, and provide physical and emotional
comfort.
 Calm and orient emotionally overwhelmed or distraught survivors.
 Help survivors to articulate immediate needs and concerns, and gather
additional information as appropriate.
 Offer practical assistance and information to help survivors address their
immediate needs and concerns.
 Connect survivors as soon as possible to social support networks, including
family members, friends, neighbors, and community helping resources.
 Support positive coping, acknowledge coping efforts and strengths, and
empower survivors; encourage adults, children, and families to take an
active role in their recovery.
 Provide information that may help survivors to cope effectively with the
psychological impact of disasters.
 Facilitate continuity in disaster response efforts by clarifying how long the
Psychological First Aid provider will be available, and (when appropriate)
linking the survivor to another member of a disaster response team or to
indigenous recovery systems, mental health services, public-sector services,
and organizations.
From a tactical perspective, according to Everly and Flynn (2005), PFA may be
intended to achieve any of the following:
 The provision of information/education.
 Provision of comfort and support (intervention based on providing soothing
human contact is legitimate and can be universally applied).
 An acceleration of recovery.
 The promotion of mental health.
 The facilitation of access to continued or escalated care.
Raphael (1986) suggests that PFA consists of numerous processes that may be
summarized as follows: -
1. Meeting basic physical needs, such as physical protection establishing a
sense of security provision of physical necessities
2. Meeting psychological needs, such as consolation provision of emotional
support provision of behavioral support allowing emotional ventilation
fostering constructive behavior
3. Fostering social support, such as reuniting victims with friends or family
utilization of acute social and community support networks
4. Fostering ongoing care, such as triage and referral for those in acute need
referral to subacute and ongoing support networks Understanding the
stress reactions to any trauma is important for any care provider.
These can be classified into four reactions: emotional, cognitive, physical
and social.

Emotional effects/ reactions Cognitive effects

 Shock  Impaired concentration

 Anger  Impaired decision-
 Despair making ability
 Emotional numbing  Memory impairment
 Terror  Disbelief
 Guilt  Confusion
 Grief or sadness  Distortion
 Irritability  Decreased self-esteem
 Helplessness  Decreased self-efficacy
 Loss of derived pleasure from regular  Self-blame
activities  Intrusive thoughts and
  Dissociation memories
 Worry
 Defense mechanisms
 Cognitive distortions
Physical Social
 Fatigue  Alienation
 Insomnia  Social withdrawal
 Sleep disturbance  Increased conflict
 Hyperarousal within relationships
 Somatic complaints  Vocational impairment
 Impaired immune response  School impairment
 Headaches  Desire for retaliation
 Gastrointestinal problems  Scapegoating
 Decreased appetite
 Startle response

Factors that influence reactions in a crisis situation:

Pre-trauma factors like multiple traumas, mental illness, lower socio-economic
status, intensity and duration of the exposure, gender and age. Mistrust, stigma,
fear (e.g., fear of deportation), and lack of knowledge about disaster relief
services are important barriers to seeking, providing, and receiving services for
these populations.

Post-trauma factors are on-going support, opportunity to share their story, sense
of closure, media exposure, substance abuse, re-exposure or re-victimization.
Goals of PFA
 Enhance immediate and on-going safety by providing emotional support.
 Offer practical assistance and coping skills to help deal with the
emotional impact of a traumatic event.
 Recognize common stress responses in children/adults, and provide basic
triage skills to know when to refer to professional Behavioral Health
services.
 Recognize the signs and symptoms of personal stress and learn self-care
strategies to increase resilience in yourself and others.
 At the individual level to try to get people to do what they need to do to
take care of themselves and avoid doing things that are not in their best
interest.
  At the health care system level to try to provide for disaster survivors,
and current clients/patients, safeguard staff and first responders, and
respond effectively in a crisis.
 At the community level to trying to promote healthy behaviors, reduce
illness and injury, promote pro-social behavior, reduce fear, and
safeguard the healthcare system.

DELIVERING PFA: PROFESSIONAL BEHAVIOR

The professional needs to understand the basics of PFA: -
 Expect normal recovery
 Assume survivors are competent
 Recognize survivor strengths
 Promote resilience
When delivering PFA the care provider needs to:
 Operate only within the framework of an authorized disaster response
system, and remain within the scope of expertise and designated role.
 Be visible and available and model sound responses; be calm, courteous,
organized, and helpful, maintain confidentiality as appropriate.
 Be knowledgeable and sensitive to issues of culture and diversity (culture
alert): Culture sensitivity is number one on the list of ‘knowledge to be
acquired’ by the professional. As they generally move to the disaster hit
areas which may not necessarily be their familiar hometown, learning a little
about the culture and society of the geographical area beforehand goes a
long way to be able to handle alien issues sensitively. The type of physical
or personal contact considered appropriate may vary from person to person
and across cultures and social groups, for example, how close to stand to
someone, how much eye contact to make or whether or not to touch
someone, especially someone of the opposite sex. Unless you are familiar
with the culture of the survivor, you should not go too close to someone,
make prolonged eye contact, or touch. You should look for clues to a
survivor’s need for “personal space,” and seek guidance about cultural
norms from community cultural leaders who best understand local customs.
 In working with family members, find out who is the spokesperson for the
family and
  Initially address this person.
 Pay attention to one’s own emotional and physical reactions, and actively
manage these reactions. Compassion fatigue is very common among health
care providers. One must take care of himself or herself when starting to
show signs of stress and burnout. Proceeding when not being able to can
seriously compromise the efficacy of the care process and may result in
harm or damage.
 Make referrals as they are important when one is not equipped in terms of
qualifications, experience, training or capability, or transference and
counter-transference issues and additional expertise is needed. In case the
person hints or talks openly of suicide or homicide, when there is any
indication of a medical emergency, when there is a possibility of abuse or
any criminal activity, substance abuse, social isolation, imaginary ideas or
feelings of persecution, difficulty in maintaining real contact with the victim,
recognized signs of mental illness, referral to a specialist is advised. When
doing that one needs to inform the individual about the intentions to refer,
confer with the victim and present different options; assure them that you
will continue to be in touch if they need you, reassure them of your support
until the referral is complete, and arrange for follow up.
Preparing to Deliver Psychological First Aid
In order to be of assistance to disaster-affected communities, the provider must be
knowledgeable about the nature of the event, the post-event circumstances, and the
type and availability of relief and support services.

1. Entering the Setting

PFA begins when a disaster mental health specialist enters an emergency
management setting in the aftermath of a disaster. As mentioned earlier it is
important for the care provider to work within the framework of an
authorized organization in which roles and decision-making are clearly
defined. Communication must be established with authorized personnel or
organizations that are managing the setting and coordinate all activities with
them. One also needs to have accurate information about what is going to
happen, what services are available, and where services can be found.
Effective entry requires that this information be gathered as soon as possible,
 as providing such information is critical to reducing distress and promoting
adaptive coping.
2. Providing Services
In some settings, the authorities may demarcate certain areas for PFA. In
other settings, PFA providers may need to circulate around the facility to
identify those to be approached for assistance. The PFA provider should
concentrate on how people reaction to or interact with in any setting. Those
showing signs of acute distress such as disorientation, confusion, panic,
extreme withdrawal, apathy, hypersensitivity, high irritability, extreme
anger, and worry are the ones who need assistance. Identify those you can
help and refer the others to a specialist. Plan and arrange for regular
meetings, referrals and follow-ups within the time and constraints of the
setting.
3. Maintain a Calm Presence
It is very important for the PFA provider to maintain a calm presence. This
has a calming effect on the victims. This demonstration of calmness and
clear thinking helps the individuals feel that they can rely on you. This also
helps them remain focused even if they do not feel calm, safe, effective, or
even hopeful. PFA providers often model the sense of hope that affected
persons cannot always feel while they are still attempting to deal with what
happened and current pressing concerns.
4. Be Sensitive to Culture and Diversity
This aspect cannot be stressed enough. Sensitivity to culture and ethnic,
religious, racial, and language diversity is central to providing PFA. As dealt
with clearly in an earlier chapter, it helps to be aware of their own values
and prejudices, and how these may coincide or differ with those of the
community being served. The victims may need to be helped to maintain or
reestablish customs, traditions, rituals, family structure, gender roles, and
social bonds. It helps to gather information about the community being
served, including how emotions and other psychological reactions are
expressed, attitudes toward governmental agencies, and receptivity to
counseling beforehand. This can be done with the assistance of community
cultural leaders who represent and best understand local cultural groups.
5. Be Aware of At-Risk Populations
Individuals who are at special risk after a disaster include the following:
 Children (especially those whose parents have died or are missing)
 Those that have had multiple relocations and displacements
  Medically frail adults
 The elderly
 Those with serious mental illness
 Those with physical disabilities or illness
 Adolescents who may be risk-takers
 Adolescents and adults with substance abuse problems
 Pregnant women
 Mothers with babies and small children
 Professionals or volunteers who participated in disaster response and
recovery efforts
 Those that have experienced significant loss
 Those exposed first hand to grotesque scenes or extreme life threats
SOME

GUIDELINES FOR PFA ADMINISTRATION

 First and foremost, it is important for the PFA provider to keep in mind that
the goal of Psychological First Aid is to reduce distress, assist with current
needs, and promote adaptive functioning, not to elicit details of traumatic
experiences and losses. which can be handled at a later stage.
 Politely observe first, don’t intrude. Let the victim guide the conversation.
The victim will talk about what is bothering him or her the most at that time.
This gives the care provider an idea of where to start focusing. Then it helps
to ask simple respectful questions, either about what the victim is talking, or
how to provide assistance.
 It is important to get a feel of the situation, person or family before
embarking on full-fledged intervention to determine that contact is not likely
to be an intrusion or disruptive. Initiate contact only after that.
 Different people react differently. Either they rush to seek help or avoid
getting help. The professional needs to be prepared for either situation. Any
aggressive move to either make contact with the person who is avoiding or
providing help to those who seek help can prove to be ending in frustration
for the professional. Thus, one can make brief but respectful contact with
each person who approaches and wait to see if those who avoided come
forward.
  As in all counseling situations this too calls for one to speak calmly, speak
slow (if necessary), simple and concrete terms, listen patiently and focus on
learning what they want to tell you and how you can be of help––be
responsive and sensitive.
 People need to know what they are doing right, and how they are helping
themselves. This instills a sense of hope and confidence in their otherwise
shattered mind. The professional can help this only by acknowledging the
positive features of what the person has done in order to be safe and reach
the current setting by positively reacting.
 Confusion and panic render the person oblivious of even what is in front of
their eyes. They find it difficult to think and assimilate even simple
information. Thus, it becomes the job of the care provider to simplify the
necessary information, adapt to directly address the person’s immediate
goals and clarify answers repeatedly as needed.
 The professional needs to be careful to give information that is accurate and
age-appropriate, and correct inaccurate beliefs and myths that float around
aplenty in crisis situations. There is no harm in acknowledging that you
don’t know and offer to find out.
 When communicating through a translator, look at and talk to the person you
are addressing, not at the translator. This helps create personal rapport and
make use of nonverbal communication like holding hand, or giving a hug,
more effective.
The Core Actions of Psychological First Aid
PFA is the effort to provide basic needs while providing stabilization of the lives of
the individuals who have been affected. It is made of eight core components.
Reference to the development of PFA can be found in the Field Operations Guide
for Psychological First Aid published by the National Center for Child Traumatic
Stress Network and National Center for PTSD (2006).
Psychological First Aid includes a set of eight interventions that can be used to
support survivors after a disaster or traumatizing event. These eight core actions
and focus goals include: -
1. Contact and engagement
 Goal:
To respond to contacts initiated by affected persons, or initiate contacts in
a non-intrusive, compassionate, and helpful manner. Respect the
 confidentiality of the individual. Make prudent decisions to divulge
information.

2. Safety and comfort

 Goal:
To enhance immediate and ongoing safety, and provide physical and
emotional comfort. This is about how to make people feel safe, de-arouse
people and make them feel calm. It helps to:-
a) Ensure immediate physical safety
b) Provide information about disaster response activities and services
c) Attend to physical comfort
d) Promote social engagement
e) Attend to children who are separated from their parents/caregivers
f) Protect from additional traumatic experiences and trauma
reminders
g) Help survivors who have a missing family member
h) Help survivors when a family member or close friend has died
i) Attend to grief and spiritual issues
j) Provide information about casket and funeral issues
k) Attend to issues related to traumatic grief
l) Support survivors who receive a death notification
m) Support survivors involved in body identification
n) Help caregivers confirm body identification to a child or
adolescent

3. Stabilization (if needed)

 Goal:
To calm and orient emotionally-overwhelmed/distraught survivors.
a) Stabilize emotionally overwhelmed survivors
b) Orient emotionally overwhelmed survivors
c) The role of medications in stabilization
4. Information gathering: Current needs and concerns
 Goal: To identify immediate needs and concerns, gather additional
information, and tailor PFA interventions.
a) Nature and severity of experiences during the disaster
b) Death of a loved one
 c) Concerns about immediate post-disaster circumstances and
ongoing threat
d) Separations from or concern about the safety of loved ones
e) Physical illness, mental health conditions, and need for medication
f) Losses (home, school, neighborhood, business, personal property,
and pets)
g) Extreme feelings of guilt or shame
h) Thoughts about causing harm to self or others
i) Availability of social support
j) Prior alcohol or drug use
k) Prior exposure to trauma and death of loved ones
l) Specific youth, adult, and family concerns over developmental
impact
5. Practical assistance
 Goal: To offer practical help to the survivor in addressing immediate
needs and concerns.
a) Offering practical assistance to children and adolescents
b) Identify the most immediate needs
c) Clarify the need
d) Discuss an action plan
e) Act to address the need

6. Connection with social supports

 Goal: To help establish brief or ongoing contacts with primary support
persons or other sources of support, including family members, friends,
and community helping resources.
a) Enhance access to primary support persons (family and significant
others)
b) Encourage use of immediately available support persons
c) Discuss support-seeking and giving special considerations for
children and adolescents
d) Modeling support
7. Information on coping
 Goal: To provide information (about stress reactions and coping) to
reduce distress and promote adaptive functioning.
a) Provide basic information about stress reactions
 b) Review common psychological reactions to traumatic experiences and
losses
 Intrusive reactions
 Avoidance and withdrawal reactions
 Physical arousal reactions
 Trauma reminders
 Loss reminders
 Change reminders
 Hardships
 Grief reactions––traumatic and otherwise
 Depression
 Physical reactions
c) Talking with children about physical and emotional reactions
d) Provide basic information on ways of coping
e) Teach simple relaxation techniques
f) Coping for families
g) Assist with developmental issues
h) Assist with anger management
i) Address highly negative emotions
j) Help with sleep problems
k) Address alcohol and substance use
8. Linkage with collaborative services
 Goal: To link survivors with needed services, and inform them about
available services that may be needed in future.
a) Provide direct link to additional needed services
b) Referrals for children and adolescents
c) Referrals for older adults
d) Promote continuity in helping relationships
These core goals of PFA constitute the basic objectives of providing early
assistance (e.g., within days or weeks following an event). These objectives
will need to be addressed in a flexible way, using strategies that meet the
specific needs of children, families and adults. The amount of time spent on
each goal will vary from person to person, and with different circumstances
according to need.
Not much research has been done on the above model. However, slowly
researchers are starting to focus on PFA. Ruzek (2007) says, “There is a
 great need for both program evaluation and RCTs that will evaluate the
effectiveness of Psychological First Aid principles in a number of contexts”
(p. 5). He maintains that the basic premise of PFA is to support individual
and community resiliency, to reduce acute distress following disaster, and
encourage short- and long-term adaptive functioning. Napoli (2007),
outlines the characteristics of resiliency to include “inquisitiveness, optimal
optimism, active coping and problem-solving, effectiveness despite being
fearful, emotional self-regulation, bonding for a common mission, positive
self-concept, internal control, desire to improve oneself, altruism, social
support, the ability to turn traumatic helplessness into learned helpfulness,
humor and meaning” (p. 2).
PFA aims to promote resilience in the victims. For disaster responders, the
principles of PFA honor the adage of Primum non nocere or ‘First Do No
Harm’ as an appropriate initial guide for the application of PFA (Uhernik,
J.A. and. Husson, M. A., 2009).
APPLICATIONS OF PFA
PFA has evolved such that it has been made applicable for working with specific
subgroups of individuals, such as children and adolescents, first responders, groups
of survivors, military, and those who may require further assistance or who may
have special needs during a disaster.
Working with children and adolescents—National Child Traumatic Stress
Network
Preschool Through Second Grade (Adapted from: Pynoos RS, Nader K: 1988)

Response to Trauma
1. Helplessness and passivity
2. Generalized fear
3. Cognitive confusion (e.g., do not understand that the danger is over)
4. Difficulty identifying what is bothering them
5. Lack of verbalization––selective mutism, repetitive nonverbal traumatic
play, unvoiced questions
6. Attributing magical qualities to traumatic reminders
 7. Sleep disturbances (night terrors and nightmares, fear of going to sleep, fear
of being alone, especially at night)
8. Anxious attachment (clinging, not wanting to be away from parent,
worrying about when parent is coming back, etc.)
9. Cognitive confusion (e.g., do not understand that the danger is over)
10. Anxieties related to incomplete understanding about death: fantasies of
“fixing up” the dead: expectations that a dead person will return, e.g., an
assailant
First Aid
1. Provide support, rest, comfort, food, opportunity to play or draw
2. Reestablish the adult protective shield
3. Give repeated concrete clarifications for anticipated confusions
4. Provide emotional labels for common reactions
5. Help to verbalize general feelings and complaints (so they will not feel
alone with their feelings)
6. Separate what happened from physical reminders (e.g., a house, monkey
bars, parking lot)
7. Encourage them to let their parents and teachers know
8. Provide consistent caretaking (e.g., assurance of being picked up from
school, knowledge of caretaker’s whereabouts)
9. Tolerate regressive symptoms in a time-limited manner
10. Give explanations about the physical reality of death
Third Through Fifth Grade
Response to Trauma
1. Preoccupation with their own actions during the event: issues of
responsibility and guilt
2. Specific fears, triggered by traumatic reminders
3. Retelling and replaying of the event (traumatic play)
4. Fear of being overwhelmed by their feelings (of crying, of being angry)
5. Impaired concentration and learning
6. Sleep disturbances (bad dreams, fear of sleeping alone)
7. Concerns about their own and other’s safety
8. Altered and inconsistent behavior (e.g., unusually aggressive or reckless
behavior, inhibitions)
9. Somatic complaints
 10.Hesitation to disturb parent with own anxieties
11.Concern for other victims and their families
12.Feeling disturbed, confused, and frightened by their grief responses, fear of
ghosts
First Aid
1. Help to express their secretive imaginings about the event
2. Help to identify and articulate traumatic reminders and anxieties; encourage
them not to generalize
3. Permit them to talk and act it out; address distortions, and acknowledge
normality of feelings and reactions
4. Encourage expression of fear, anger, sadness, in your supportive presence
5. Encourage to let teachers know when thoughts and feeling interfere with
learning
6. Support them in reporting dreams, provide information about why we have
bad dreams
7. Help to share worries; reassurance with realistic information
8. Help to cope with the challenge to their own impulse control (e.g.,
acknowledge “It must be hard to feel so angry”)
9. Somatic complaints
10.Offer to meet with children and parent(s) to help children let parents know
how they are feeling
11.Encourage constructive activities on behalf of the injured or deceased.
12.Help to retain positive memories as they work through the more intrusive
traumatic memories
Adolescents (Sixth Grade and Up)
Response to Trauma
1. Detachment, shame, and guilt (similar to adult response)
2. Self-consciousness about their fears, sense of vulnerability, and other
emotional responses; fear of being labeled abnormal
3. Post-traumatic acting out behavior, e.g., drug use, delinquent behavior,
sexual acting out
4. Life threatening reenactment; self-destructive or accident-prone behavior
5. Abrupt shifts in interpersonal relationships
6. Desires and plans to take revenge
7. Radical changes in life attitudes, which influence identity formations
 8. Premature entrance into adulthood (e.g., leaving school or getting married),
or reluctance to leave home
First Aid
1. Encourage discussion of the event, feelings about it, and realistic
expectations of what could have been done
2. Help them understand the adult nature of these feelings; encourage peer
understanding and support
3. Help to understand the acting out behavior as an effort to numb their
responses to, or to voice their anger over, the event
4. Address the impulse toward reckless behavior in the acute aftermath; link it
to the challenge to impulse control associated with violence
5. Discuss the expectable strain on relationships with family and peers
6. Elicit their actual plans of revenge; address the realistic consequences of
these actions; encourage constructive alternatives that lessen the traumatic
sense of helplessness
7. Link attitude changes to the event’s impact
8. Encourage postponing radical decisions in order to allow time to work
through their responses to the event and to grieve
Counselor Skills (NCTSN Manual)
 When making contact with children or adolescents, it is good practice to
make a connection with a parent or accompanying adult to explain
counselor’s role and seek permission.
 When speaking with a child in distress when no adult is present, it is
important to find a parent or caregiver to let them know about the
conversation.
 Sit or crouch at a child’s eye level.
 Help children verbalize their feelings, concerns, and questions; provide
simple labels for common emotional reactions (e.g., mad, sad, scared,
worried).
 Match the children’s language to help you connect with them, and to help
them to feel understood and to understand themselves. Do not increase
their distress by using extreme words like “terrified” or “horrified.”
 Match your language to the child’s developmental level. Children 12
years and under typically have much less understanding of abstract
 concepts and metaphors compared to adults. Use direct and simple
language as much as possible.
 Adolescents often appreciate having their feelings, concerns and
questions addressed as adult-like, rather than child-like responses.

Counseling process
1. Identification of the Need for Counseling
It is important first step to identify the need for counseling. Whether the
person concerned requires counseling at all and if so, what is the reason for
the same. Sometimes counseling may be needed for a child in the school
who is unable to benefit from the teaching learning process that goes on in
the school. In yet another case an adolescent facing self-esteem problems or
 showing aggression to Counselling or extreme anger at minor things may
need counseling to overcome the anger and aggression and restore the self-
esteem. In certain other cases an adult who has gone through a financial
crisis in business may need counseling to overcome the depression that the
person is facing. In yet other cases, there may be a marital problem or
divorce situation which needs to be handled through counseling. In
organizations and industries, counseling may be required to motivate the
employees to work better and to their full potential or in some cases to
overcome the workplace violence etc. Counselling for better interpersonal
relationship is very much needed in an organization where the work and
performance of employees are affected due to lack of positive interpersonal
relationship amongst various levels of staff.
2. Preparation for Counselling
Successful counseling requires preparation. To prepare for counseling, the
following needs to be done:
 Select a suitable place
 Schedule the time.
 Notify the person or the client well in advance.
 Organize information.
 Outline the counseling session components.
 Plan the counseling strategy.
 Establish the right atmosphere.
As for selecting a suitable place, counseling should be carried out in an
environment that minimizes interruptions and is free from distracting
sights and sounds. Regarding the scheduling the time, when possible, the
client should be counseled after deciding upon a mutually convenient
timing.
The length of time required for counseling depends on the complexity of
the issue. Generally, a counseling session should last less than an hour. If
the client needs more time, a second session may be scheduled. Also, the
counsellor should select a time free from competition with other activities
and consider what has been planned after the counseling session.
Important events can distract a client from concentrating on the
counseling. For a counseling session to be client centered, the client must
have time to prepare for it. The client should know why, where, and
when the counseling will take place. Counseling following a specific
event should happen as close to the event as possible. However, for
performance or professional development counseling, clients may need a
week or more to prepare or review specific products, such as support
forms or counseling records. Solid preparation is essential to effective
counseling. The counsellor should review all pertinent information. This
includes the purpose of the counseling, facts and observations about the
client, identification of possible problems, main points of discussion, and
the development of a plan of action. Focus on specific and objective
behaviors that the client must maintain or improve as well as a plan of
action with clear, obtainable goals.
It is important to outline the components of the counseling session. For
this, using the information obtained, the counsellor should determine
what to discuss during the counseling session. He must note what
prompted the counseling, what the counsellor aims to achieve, and what
the role of the counselor is. It is important to identify possible comments
or questions to help the counsellor keep the counseling session client
centered and help the client progress through its stages. Although the
counsellor never knows what a client will say or do during counseling, a
written outline helps organize the session and enhances the chance of
positive results.
Many approaches to counseling exist, such as directive, nondirective, and
combined approaches to counseling. The counsellor should use a strategy
that suits the clients and the situation. The counsellor must establish the
right atmosphere which promotes two-way communication between a
counsellor and a client. Some situations make an informal atmosphere
inappropriate. For example, during counseling to correct substandard
performance of a subordinate, the manager who functions also as a
counsellor, may direct the client subordinate to remain standing while he
remains seated behind a desk. This formal atmosphere, normally used to
give specific guidance, reinforces the manager’s rank, position in the
chain of command, and authority. But in general counseling session this
is not advocated. The counsellor should sit in such a manner that he is
able to observe every emotion of the client and note every gesture verbal
and nonverbal that the client makes so that the same could be used in
counseling and problem-solving sessions.
Counselor attitudes
Understanding the clients’ expectations and hopes and by showing concern for the
client instills the confidence and encourage him to pay an active role in the
counselling process
Do’s
 Show interest
 Do not Judge
 Pay Attention
 Indicate agreement with the client’s views and feelings
 Show empathy
 Think about the client
 Ask questions
 Summarize
 Ask for modifications
Don’ts
 Argue
 Belittle the client’s concern
 Solve the problem for the client
 Give advice
 Avoid painful areas causing distress
Counseller’s Skills
To be successful, a counsellor has to be skillful in his approach. Important skills
essential for any counsellor are as follows: -
1. Social Skills
2. Learning skills
3. Communication skills
4. Empathy
5. Probing Skills
6. Deeper Exploration skills
7. Problem Solving skills

Social Skills
  For establishing working relationship between client & Counsellor
1. Credibility :- enhancing expertise by study and practice , creating trust by
maintaining integrity in the relationship with the client
2. Confidentiality: -fully discussed before first session.
3. Attention: -verbal messages and non-verbal messages.
Learning skills
 Counselling is about learning about client and extending help
1. Sensory skills:- sensitivity with which one has to grasp information
2. Perceptual skills:- need to avoid forming quick impression, stereotyping
3. Cognitive skills:- why, what, where , who, when and how….(analytical
thinking process-for logical understanding)
4. Suspension : develop the skills of suspending own judgment
5. Observation : client’s body language
Communication skills
 Attention
 Non-verbal signals – posture, eye contact, facial expression etc
 Encourager/ continuers– Can be verbal or non verbal ( smiles, nodding the
head)
Empathy skills
 Empathy involves perceiving and Communication
Skills associated with Empathy
1. Attending, acknowledging
2. Re-stating, paraphrasing
3. Reflecting
4. Interpreting
5. Summarizing
Probing Skills
 Probing involves deep exploration to know extensively as well as intensively
the problems and related aspects.

 Inquiry process –methods:–

A. Questioning techniques
 B. Statements
C. Reflective methods

A. Questioning techniques:
 Open questions, Hypothetical questions, Why questions, Closed
questions, Multiple questions

Hypothetical questions: if you leave the company what will

happen?
Why questions: • why do you hate your boss?
Closed questions: Did you inform your boss?
Either /or questions: • is it your boss or the nature of work that is
causing dissatisfaction in your present job?
Multiple questions: • Did you talk to your boss? Did you notify
your employer that you are quitting the job? Did you collect your
papers from the new employer?
Leading questions: • Are you going to say that you feel like
leaving the company?

B. Statements: • Gentle form of inquiry but not in the form of questions/

interrogation
C. Reflective methods:
 Ability to communicate with the client’s internal frame of
reference
 Echoing, key word repetition, paraphrasing, summarizing.

Deeper Exploration skills

 Deeper exploration aims at helping clients discover their true self
 Hidden areas:
A client may not want to disclose some of his thoughts and feelings or even
certain incidents of the past.
 Blind spot:
 A client may not know his or her inner feelings.
 He is either dimly aware of them or totally unaware of certain
dimensions of his personality and orientations.
  Challenging:
 Challenging is a powerful approach to shift the client from one
perspective to another
 Helps to discover the unknown weakness and strengths of clients
Types of challenges
 Confrontation- makes them aware of faulty feelings or views
 Self-confrontation
 Additional information
 Counsellor self disclosure

Problem Solving Skills

 Refers to set of skills that helps to see the problem, and search for a solution

__________________________________________________________________
Stage One: The Beginning of Counselling- Getting Started
The counselling actually begins with the vital first impressions that a client gets
when arriving for his initial counselling session. The beginning stage includes
many vital tasks such as establishing rapport, gaining trust, defining needs,
deciding roles and limits etc.
An overview of the different steps involved in the first stage of counselling is
given below:-
1. Establishing Rapport : The term 'rapport' refers to a relationship of
confidence, trust and mutual appreciation between the counsellor and
counselee in a counselling situation. It is a harmonious and sympathetic
relationship that is easy, comfortable and free where the client and counselor
can be honest. In counselling, the term rapport is used to denote the feelings
of friendliness, security and mutual confidence between the counsellor and
counselee which helps the latter to express himself without inhibitions and
resistance. It is a unique bilateral relationship of mutual confidence and trust
between the counsellor and the counselee to have a meaningful exchange of
ideas in a personal situation.

Techniques to establish rapport: Establishment of rapport is essential for

successful counselling; and the building of this relationship is helped by the
atmosphere of the counsellor's room, his attitude and the initial reception he
gives to the counselee. The room should be attractive and pleasing. The
general atmosphere should convey an impression of friendliness and
informality.

The following techniques are usually used to increase rapport:

a) Sympathy: The counsellor expresses sympathy for the counselee.

b) Assurance: The counsellor will try to ease the counselee's fear by
encouraging him that his problem will be solved.
c) Approval: The counsellor expresses his approval with something that the
counselee has said or done.
d) Humor: The counsellor attempts to ease tension in the mind of the
counselee with humorous remarks.
 e) Personal reference: The counsellor tells about some of his own
experience to illustrate his point by saying: I would do this.
f) Non personal reference: The counsellor cites an example of the
experience of another person.
2. Establishing Confidentiality and Gaining Trust : During the first stage of the
counselling relationship, it is important to establish confidentiality with one's
client. This helps in developing trust. All that transpires in an interview is
private, and counselors are obligated not to discuss client's relationship with
outside parties unless the client has given permission to the counselor. The
counselor should let the client know that whatever he wants to share with the
counselor will remain confidential, and the counselor is not going to harm
the client or someone else in any way. As the client becomes confident that
the counselor respects the privacy of the relationship, trust in the counselor
grows.
3. Deciding plan of action: next step is to decide a plan of action which will
lead the counselee to the solution of his problem.
It involves
a) Defining Needs and Setting Goals : The primary purpose of this phase is
to have the client articulate his goals. These goals are essential to the
development of a treatment plan. The counseling needs are identified and
discussed between the counselor and the client. They need to decide what
they want to change, and they need to consider what can be solved and
what can only be managed differently. The client now chooses and
prioritizes his goals. Firstly, the general goals are determined and then
broken down into workable objectives.
b) Deciding Roles and Limits: The different roles to be played by the client
and counselor in the counseling process are discussed and defined at this
segment. Occasionally roles are also assigned to other significant persons
in the life of the client too. The client is also made aware of the limits of
the counselling outcome.

Stage Three: The End /Termination of the Counseling Relationship

The last stage involves ending the counseling program with the client and
empowering him with the tools needed to lead a successful life. Ideally,
termination occurs when the goals that are mutually agreed upon by the counselor
and client have been achieved.
To increase the likelihood of successful termination with your clients, take note of
the following suggestions:
a) Discuss termination with the client early on in the counseling process
b) Establish clear goals with the client so that progress toward those goals can
be recognized and completion of those goals is apparent.
c) Respect the client's desire to terminate if it is client-initiated but be confident
in expressing concerns if the counselor feel termination may be premature.
d) Keep your relationship professional and do not let it stray into the realm of
friendship.
e) Communicate to the client that he can return if needed.
f) Help the client to review the success he has had in counseling.
g) Allow the client to discuss feelings of loss surrounding termination and
process counsellor’s own feelings surrounding the process, as well.

COUNSELLING SKILLS
Counselor’s skills are very important factor for an effective counseling. The
important skills are the following:
1. Attending skills- It includes attending physically, observing and listening.
Attentiveness is one of the important skills of the counselor. To understand the
essence of the content and feeling expressed by the counselee, the counselor
should be attentive while listening and observing. Attending physically means
attending contextually and personally to the client. The counselor by his very
posture must let the client know that he is with him and he is completely
available to him. For e.g. We communicate attentiveness when we maintain eye
contact with the client or often look at his face.
The skill of observing means the counselors ability to see and understand the
client’s nonverbal behaviors. The client gives the counselor may clues to the
way he experiences the world in his physical appearance and behavior. The skill
of listening means the counselor’s ability to listen and recall all the verbal data
presented by the counselee. The counselor must listen to both verbal and non-
 verbal massages of the client. It helps in establishing a rapport and get insight in
to physiological world of the client.
The skill of listening involves
i. listen to confirm the hypothesis counselor made from his observation
with client’s words
ii. listen the specific content i.e., the who, what, where, when, why and
how of the situation
iii. resist distracting thoughts and imagination
iv. recall counselee’s voice tone, words they use, specific feeling, way of
expression etc.
2. Responding skills This involves the skill of reacting appropriately to the
problem narrated by the client. The counselor should respond with empathy.
The purpose of responding is to enter in to the counselee’s frame of reference
(the way he sees himself in relation to the world around him). It involves
reflecting the content, reflecting the feeling, dealing with strong negative
feeling, responding to silence, asking facilitative questions, skill of spacing
responses, giving information etc.
The counselor should ask probing and reflecting questions. Probing questions
refers to going deep in to the client’s response by asking a serious a subsequent
question. Empathetic approach is very important skill of a counselor. The skill
of responding involves the counselor’s ability to communicate to the client his
feelings and his ability to capture the experience of the client. He must respond
not only to what the client has said, but also to how it is said.
3. Initiating skills
This involves the ability of the counsellor to initiate the client to act. This
involves skill to change what can be changed, skill in defining the goals, skill in
helping client to accept the change gracefully, skill in preparing the client to
happy. It is the skill of the establishing rapport. Rapport is a warm, friendly and
understanding condition which for an effective relationship between the
counselor and counselee. Rapport is not one sided. It is mutual and grows out of
the cooperative effort. It helps the counselor to facilitate the development of the
client by motivating him to take decisions.
4. Skill of personalizing
Personalizing is an attempt on the part of the counsellor to make the client
realize his personal deficits that contributed to the problem. This involves skill
of making client to internalizing the experience (personalizing the meaning),
skill of preparing the client to take decision and execute it (personalizing the
 problem), skill of making client to rectify the deficiencies of his role in the
problem (personalizing the goal).

QUALITIES OF A COUNSELOR
Counsellor is the centre of counseling process. Success or failure of counselling
depends on his personal qualities and competencies of counsellor.
Some of the qualities that a counsellor should possess are
a. Well Adjusted Personality- Counsellor should have pleasing and well-
adjusted personality. He should possess maturity, emotional stability, sense
of worth, confidence, self-reliance, flexibility and adaptability. He should be
well aware of his strength and limitations. He should be a person of high
social interest, professional aptitude, respect, good judgment etc.
b. Sincere Interest- Counsellor should be interested in helping others. He
should possess sincere interest in client, his environment, social life,
activities etc.
c. Knowledge- Counsellor should be a knowledgeable person, knowledgeable
about range of psychological disorders the individual experiences and
knowledgeable about the different techniques in counselling.
d. Personal Competence- Counsellor should know his job well, possess wide
knowledge of world, should be well versed with different techniques in
counselling. He should keep abreast with the latest trends in his field. He
should be a person of self-understanding, sense of mission, loyalty,
enthusiasm, dedication and professional ethics.
e. Availability- Counsellor should be available to the client at all the time, even
at odd hours if needed.
f. Confidentiality- means keeping secrecy of the information disclosed. It can
be Absolute confidentiality (under no circumstance the information is
disclosed) or Relative confidentiality (in exceptional circumstance the
information is disclosed). Confidentiality facilitates client to disclose,
safeguards him from harmful effects, prevents others from misusing etc.
g. Empathy- Empathy means ‘feeling into’ and has a significant role in the
counseling situation. Empathy is referred to as the apprehension rather than
the mere comprehension of the emotions of another person without feeling
 completely what he feels. It is “the ability to feel and describe the thought
and feelings of others” (Dymond, 1949). She further describes empathy as
“the imaginative transposing of oneself into the thinking, feeling and acting
of another and so structuring the world as he does”. It is recognizing and
acknowledging feelings of client without experiencing those emotions.
General characteristics of a good Counselor
1. A good counsellor must be fluent in the language of his client in order to
guess what is unsaid, and to correctly interpret nuances in communication.
2. A good counselor must understand the culture to which the client belongs.
Without such an understanding, the counselor may misinterpret various
behaviors that the client shows.
3. A good counselor should have charisma and personality. He should inspire
confidence and respect in his client.
4. A good counsellor must have much experience of life.
5. A good counsellor must be reasonably mature and intelligent to understand
the client’s problems, formulate an appropriate plan of management, and
carry it through.
6. During therapy, the counsellor’s values invariably percolate down to the
client. Therefore, a good counsellor must have a healthy set of values.
7. A good counsellor should be psychological minded; that is, he should
understand the intricacies and the workings of the human mind.
8. A good counsellor should be knowledgeable about the range of
psychological disorder that individuals experience.
9. A good counsellor should be knowledgeable about the client’s problem field.
10.A good counsellor should have few emotional problems. This is because a
counsellor who is unhappy may not be able to give the client his undivided
attention. Furthermore, his judgment may be clouded by his personal
problems.
11.A good counsellor must be well trained.
12.A good counselor should have good communication skills; he must know
what to say, how to say it, and when to say it.
13.A good counsellor should be genuinely motivated to help persons in distress.
He should not counsel merely out of a feeling of duty.
While counselors can be of any age or sex, most clients tend to prefer their
counselor to be older than they are. Some clients may find it easier to confide of
a particular gender, In Nepal many clients (particularly females) prefer same-
gender counsellors.

ESSENTIAL COMMUNICATION SKILLS

The following skills must be developed by the counselor for effective
communication.
1. NON-VERBAL COMMUNICATION
If the counsellor is sensitive to the non – verbal language of the counselee,
the entire communication process will be much more effective. A speaker’s
voice, body position and gestures transmit message that may alter the
meaning of what is said. This is especially important in effective counseling.

In the development of human personality, non- verbal communication

precedes the development of the capacity to communicate verbally.
Scientists have estimated that 70% of our communication is non- verbal.
Hence, it is important to pay attention to body, facial expression, tone of
voice etc.

Some important non- verbal communication forms are: -

- Eye contact
One of the most important forms of nonverbal communication is eye
contact. It is used to obtain genuine feedback, to indicate receptiveness to
feedback, to seek recognition and to hide feelings (by means of avoiding
eye contact). While eye contact from a counselee is usually a positive
sign, the reverse is not always true. Sometimes, lack of eye contact may
signal the counselee’s negative self-image rather than poor
communication.
- Gestures
Smiles, head nods, and other gestures convey information about a
counselee’s emotional states, and this information should be absorbed
and utilized. Restricted hand movements and exaggerated trunk and leg
movement, for e.g., may indicate stress. Gestural behavior has special
 significance for the counselor who must consider the counselee’s
problems and their effect body language.
- Distance
Distance is the space that separates two speakers. Cultural norms dictate
acceptable distance, but generally, the closer the participants are, the
more positive is their communication. The following factors are
responsible for the effective communication in counseling process.
a) Relaxed body posture.
b) Slight forward lean.
c) Good eye contact.
d) Appropriate facial expression.
e) Use of Head nods.

2. SELECTIVE PERCEPTION
Perception is the process of categorizing and interpreting sensory
information in a meaningful manner. Perception helps us to attain an
awareness or understanding of the sensory information we experience every
day. Selective perception is the process by which we focus our activity to
needed sensory stimuli, neglecting what is not required. Understanding is
essentially the perception of another’s attitudes, meanings and feelings. In a
counseling situation, understanding has two connotations. First, it refers to
the client’s understanding of himself and his situation or environment and,
second to the understanding of the counselor about the client’s position or
situation. The counselor should be able to select the information that can
help the client and discard the unwanted ones.

Selective perception has become crucial in counseling because of the

following reasons: -

a) Selective perception will help the counselor to focus keenly on relevant

information by neglecting what is irrelevant.
b) Selective perception is important as counsellor cannot absorb everything
that he observes about the counselee.
c) It helps to save time and effort and also to reduce monotony in the
counseling sessions.
3. ASKING EFFECTIVE QUESTIONS:
 Effective questioning is the process of asking relevant questions to the client
in such a manner that the very process of questioning encourages and
motivate the respondent to reveal more and more information.
Effective questions are those questions which are powerful and thought
provoking. It helps the counselor to understand client’s problem better. It
helps the client to disclose his inner personality. Effective questioning will
help to reduce mistakes and defuse volatile situations.
For effective questioning, the counselor should ask probing and reflecting
questions. Probing questions refers to going deep into the client’s response
by asking a series of subsequent questions. Reflective questions enable the
counselee to reflect on the information he/she has shared.

4. ACTIVE LISTENING:
Real listening is an active process that has three basic steps.
a) Hearing: Hearing just means listening enough to catch what the speaker
is saying
b) Understanding: The next part of listening happens when you take what
you have heard and understand it in your own way.
c) Judging: After you are sure you understand what the speaker has said,
think about whether it makes sense
Active listening involves the following four skills.
i. Listening to and understanding the client’s verbal messages - usually
in counselling, the client shares mixture of experiences (what
happened to him), behaviors (what he did or failed to do) and affect
(the feelings and emotions associated). The counsellor has to listen to
all of these, also what he is not saying
ii. Listening to and interpreting the client’s non-verbal messages-
counsellor should learn to listen clients’ non-verbal messages such as
bodily behavior, facial expressions, voice related expressions (tone,
intensity, spacing between words, silence, fluency etc.), physiological
expression (quickened breathing, paleness, blushing etc.), physical
appearance etc.
iii. Listening to and understanding the client in context- The counsellor
should listen to the whole person in the context of his/her social
settings.
 iv. Listening with empathy- to listen with empathy means that the
counsellor must temporarily forget about his or her own frame of
reference and try to see the client’s world and the way the client sees
him or herself.
Steps to be followed for effective listening
a) Face the speaker and maintain eye contact,
b) Be attentive yet relaxed,
c) Keep an open mind,
d) Listen to the words and try to picture what the speaker is saying,
e) Don’t interrupt and don’t impose your “solutions”.
f) Wait for the speaker to pause to ask clarifying questions,
g) Ask questions only to ensure understanding of something that has
been said (avoid questions that disrupt the speaker’s strain of
thought),
h) Try to feel what the speaker’s is feeling.
i) Give the speaker regular feedback, eg: summarize, reflect feelings,
or simply say” uh, huh”.
j) Pay attention to what isn’t said – to feelings, facial expressions,
gestures, posture, and other nonverbal cues.
Listening is a precious gift. It helps build relationships, solve
problems, ensure understanding, resolve conflicts, and improve
accuracy. At work, effective listening means fewer errors and less
wasted time. At home, it helps develop resourceful, self-reliant kind
who can solve their own problem. Listening builds friendships,
careers.
5. REFLECTING FEELINGS
The term ‘reflection of feelings’ refers to listening accurately to the client;
identify the feeling component of the communication and reflecting the
emotional element of the communication to the client in counsellor’s own
words.
That is, the process of reflecting feelings involves two steps-
- identifying client’s feeling and
- mirroring the client’s feeling.

Identifying client’s feeling:

The skillful use of reflective feelings depends on the counsellor’s ability to
identify feelings. Some feelings are more subtle than others. Counsellor
should look for the hidden feelings by paying attention to client’s physical
signs such as energy, body, facial expression etc. and verbal signs such as
tone, volume, words etc.
Mirroring the client’s feeling:
After identifying the client’s feelings, the counsellor articulates the feeling in
own words. When counsellor understand the connection between feeling and
content, he can then utilize the combined form to convey deeper
understanding of the reasons for the client’s feelings.