CLINICAL COUNSELING

MRS TAFADZWA
 COUNSELING
• Counseling: is a method of relieving distress undertaken
by means of a dialogue between two people.
• The aim is to help the client find their own solutions to
problems, while being supported and being guided by
appropriate advice.
 PRINCIPLES OF COUNSELLING
The following are the principles of counseling:
• Uniqueness
• Neutrality
• Acceptance
• Flexibility
• Realism
• Empowerment
• Autonomy
• Mutuality
 UNIQUENESS

• This involves treating each client and

the problem that they present as
being different.
• It entails refraining from comparing
clients and how they respond and
adapt to different situations
 NEUTRALITY

• The counselor has to maintain a non-

judgmental attitude.
• She/he does not play the role of a
judge but helper.
• This will encourage the client to
freely express himself/herself freely.
 ACCEPTANCE
• The relationship between the
counselor and the client should be
empathic. The client should be
regarded as a worthy person and
treated with dignity.
• The counselor should continually
emphasize an attitude of positive
regard for the client.
 FLEXIBILITY
• When dealing with the client,
handle him/her and proceed as
though he/she is right the way
he/she comes out, presents
his/her story and how he/she
intends to sort out his/her
problems.
 REALISM
• Be objective as you help out
the client set his goals. Be
mindful of his/her of his
capacity and identify his/her
limitation and work within this
context.
 EMPOWERMENT

• The counseling session should be

structured in such a way that it
equips the client with skills to handle
his/her problems competently.
• The client should come out of the
session with confidence to handle
future problems independently.
 AUTONOMY
• During the counseling session, show
that you believe in the client as
someone who is independent and has
the capacity to handle and fix his/her
problems.
• The client should be treated as
someone with the ability to take
responsibilities for his choices,
decisions and actions.
 MUTUALITY

• Counseling is a shared and sharing

responsibility.
• Demonstrate that both the
counselor and the client have a
role to play in sorting out the
problem at hand.
 BASIC COUNSELING SKILLS
The following are the counseling skills:
• Attending skills
• Listening skills
• Probing/Questioning skills
• Empathy skills
• Challenging skills
• Paraphrasing skills
• Reflecting skill
 ATTENDING SKILLS
• These involve such elements as
friendliness, courtesy, eye contact, relaxed
postures, body language and vocal tones.
• Attending skills also encompasses
commitment to time and contractual
obligations, and how the counseling room
is arranged.
• These skills are helpful in making the client
feel at easy and relaxed.
 ATTENDING SKILLS
• Attending involves “SOLER” behaviours:
S-Sitting squarely: face the patient
O-Open position: Open your posture
L-Leaning forward: Lean towards the
patient
E-Eye contact: Maintaining eye contact
with patient.
R-Relaxing: Relax while attending to the
client.
 LISTENING SKILLS
• Listening is used to gather
information about the client.
• It is a tool that involves getting the
actual words of the client and also
involves listening to the mood, the
feelings and the underlying
messages that are conveyed through
the actual words that the client uses.
 PROBING/QUESTIONING SKILLS
• This skill involves coming up with the
right questions in order to elicit and
capture as much information as possible.
• Open ended questions will be more
useful because they will permit the
client to express himself fully.
• If the questioning skills are poor, the
counselor will fail to establish the
 EMPATHY SKILLS
• Empathy is a form of communication
which involves listening to the client,
clarifying his concerns and
communicating this understanding
to the client.
• This helps the client to discover new
meaning and perception in relation
to his situation.
 EMPATHY SKILLS
• A great deal of the discussion in
empathy centers on the kind of
observing and listening needed to
develop an understanding of the
client and his world.
• It involves entering another person’s
perceptual world.
 CHALLENGING SKILLS
• A challenge is an invitation to examine internal
and external behaviour that seem to be self-
defeating, harmful to others or both.
• It is aimed at helping the client develop new
perspectives to his situation.
 PARAPHRASING SKILLS
• A paraphrase is a verbal statement that is
interchangeable with the client’s
statements.
• The words may be different but the
meaning is retained.
• In other words the counselor repeats
back the essence of the client’s main
words and thoughts.
 REFLECTING SKILLS
• Reflecting refers to the counselor’s
ability to communicate his/her
understanding of the client’s
concerns and perspective at an
emotional level.
• It demonstrates that the counselor
is able to follow through what the
client is saying and feeling.
 TYPES OF COUNSELING
1. Client centered
2. Directive counseling
3. Problem solving
4. Cognitive behavioral counseling
5. Psychodynamic counseling
6. Crisis counseling
 CLIENT CENTERED COUNSELING

• This approach is widely used.

• It was first used by Carl Rodgers in 1951.
• Carl Rodgers noted that the client
him/herself is better placed to decide to
find solutions for him/herself.
• The client centered approach presumes
that a client in need goes to the
counselor to be helped.
 CLIENT CENTERED COUNSELING
• In order to be helped, the client needs to
know that he/she has been understood
of how he/she feels and thinks.
• The client must know that whatever the
counselor’s own feelings about him/her,
the counselor must accept as he/she is.
• The counselor accepts the client’s right
to his/her own life.
 DIRECTIVE COUNSELING
• It involves making decisions,
suggestions or offering advice to the
client.
• This is no longer a popular approach to
counseling.
• However, it can be used in limited
number of situations e.g. newly
diagnosed diabetics.
 PROBLEM SOLVING
• It operates on the premise that the client’s
problems is caused by everyday problems.
• If problems are resolved, symptoms will
disappear.
• Problems are solved using problem solving
techniques.
• The stages of problem solving are listed
below:
 PROBLEM SOLVING

1. Explanation of therapy and formulation of the

problem list.
2. Clarification and definition of problem.
 PROBLEM SOLVING
3. Setting achievable goals
4. Generating solutions
5. Choice of preferred solutions
6. Implementing of preferred solutions
7. Evaluation.
 COGNITIVE BEHAVIORAL COUNSELING

• It is aimed at changing the thoughts, beliefs and

behaviors of a client.
• It is highly structured looking at specific
problems and aims to enable a client learn skills
to help him/her deal with present and future
problems.
 PSYCHODYNAMIC COUNSELING
• It emphasizes social development
associated with individuation and the
family life cycle.
• The task of the counselor in this
approach is to encourage the client to
talk about his difficulties and reflect on
them as they may have come from
childhood traumatic experiences.
 PSYCHODYNAMIC COUNSELING
• Psychodynamic counseling may also in cooperate
problem solving and behavioral experiments.
 CRISIS COUNSELING
• This is a short and active intervention.
• It is based on sound assessment of the
situation which include family, patient,
social network, nature of the stressor,
severity of the response of risk and
available coping resources including
external support.
 CRISIS COUNSELING

• The task is directed at helping the client redefine

the challenges and mobilize resources for its
resolution.
 THE COUNSELING PROCESS
Stage 1 Create a rapport
•Greet the client.
•Establish a relation and structure.
•Find out their name, what they do, and where they come
from.
• Initiate a conversation on neutral topics before asking
them to tell you why they have come to see you
Introduce your service e.g. tell them you are a clinical
counselor/ HIV counselor
 THE COUNSELLING PROCESS
Stage 2. Problem Assesment
•Gather data about client and identify their
problems – what is the client’s problem of concern
and what is his strength and weakness.
 THE COUNSELING PROCESS
Stage 3 Goal setting
•Determine outcome (what do we want to happen)
•Generate solutions (what shall we do to bring an
end to the presenting problems?)
 THE COUNSELING PROCESS
• The outcome of this stage is aimed at allowing the
client to identify as many solutions as possible,
protect the consequences of each solution and
finally set priorities of these solutions.
 THE COUNSELING PROCESS

Stage 4 Counselling Intervention

• In this stage, the client has the responsibility
for applying the determined solution.
• The counselor must encourage the client to
implement the agreed solution to the problem.
• While the client is actively engaged in applying
the problem solution, the counselor will often
maintain contact as a source of follow up
support encouragement.
 THE COUNSELLING PROCESS
Stage 5. Evaluation, termination or referral
•Prepare the client for termination
•Counsellor should avoid fostering dependency
•Termination is done also even for unhelpful counselling process
or referring
•Termination is a way of empowering the client
•Open door / plan for possibility of future need
 QUALITIES OF A GOOD COUNSELOR

1. Responsibility
• Counseling is an enormous task.
• For a counselor to function well and effectively, a
high sense of commitment and responsibility is
essential.
 QUALITIES OF A GOOD COUNSELOR
2. Reliability
• A counselor must be truthful and honest. She should be
able to hold reasonable control over her emotions.
• She should be someone who is dependable and be
considered as such by the client and the community at
large.
 QUALITIES OF A GOOD COUNSELOR

3.Humility
• The counselor must be in a position to
acknowledge her own limitations. It is
not possible for a counselor to handle
competently all the problems that may
be presented to her. She should be ready
and willing to handle over the clients that
she cannot competently handle.
QUALITIES OF A GOOD COUNSELOR
4. competence
• A good counselor uses her intellectual
capacity to the fullest.
• The counselor must be eager to learn
and acquire different skills.
• This will enable her to see problems in
their right perspective and help out to
give appropriate advice.
 QUALITIES OF A GOOD COUNSELOR
5. Confidentiality
• The counselor should not divulge
information about the client without
permission.
• Information should be kept strictly
confidential.
• This will help the client to have trust in the
counselor and be ready to share sensitive
information that may be helpful in solving
the client’s problems.
QUALITIES OF A GOOD COUNSELOR
6. Professionalism
• Counseling carries with it professional
responsibilities.
• Good conduct and appearance is
important for the counselor’s own
physical and mental health. This will
cause the counselor to be respected and
valued by the clients.
 SUPPORT GROUPS
• Support groups: refer to groupings that
are formed by people undergoing
similar problems with a view to sharing
ideas of how to overcome the
challenges that they face.
• Support groups are beneficial because
the members have a sense of belonging.
 SUPPORT GROUPS
• The members feel free to share their
problems and coping strategies with people
in similar situations.
 SUPPORT GROUPS
• The help from support groups is meaningful
because it comes from people who have gone
through a certain problem.
• The solutions are based on practical experience.
 SUPPORT GROUPS
• The counselor can provide technical support and
guidance to the group.
• The counselor will help out in the initial
organization of the support group.
 COGNITIVE ASSESSMENT
• A cognitive assessment is an examination
conducted to determine someone's level
of cognitive function.
• One reason to perform
a cognitive assessment is if a medical
professional is concerned that someone
may be experiencing a cognitive
impairment.
• This may be the result of
a brain injury or stroke, or it may be
congenital in nature, as in a child
with suspected intellectual
disabilities.
 HOW TO CONDUCT COGNITIVE
ASSESSMENT
• In cognitive assessment, the subject will
be asked to complete a series of tasks
that require cognitive skills.
• Exams may be broken up into several
different components to test things like
concentration, reasoning, understanding
language, orientation and so forth.
• Each section is scored separately, and
the results can be compared with those
of other people who have taken the test
to see where someone falls on a scale
of cognitive performance.
 ORIENTATION
• Orientation is conventionally described in
three spheres: person, place, and time.
• Orientation to person reflects an
understanding of who one is and one's
relationship to others.
• Orientation to time and place exists in
multiple dimensions.
• If a patient is disoriented it is important to
establish the degree.
• Is a patient aware of being in a hospital
but not know which hospital?
• Does the patient believe it is a hotel
instead of a hospital? Does the patient
know the city in which the interview is
being conducted?
• The date, day of the week, and time of
day?
 CONCENTRATION
• Concentration describes the ability to sustain attention over
time.
• Concentration is one of the cognitive functions most easily
assessed simply by talking with a patient.
• Patients who forget the examiner's question, are distracted by
extraneous stimuli, or lose track of what they are saying have
impaired concentration.
• Concentration may be more formally
tested in several ways. One of the most
commonly taught and frequently misused
tests is “serial sevens” in which a patient is
asked to count backward from 100 by 7s.
• This is a valid test of concentration only if
the person can comfortably perform the
mental subtractions and if it is carried out
for a substantial period of time