PSCII28 - Counseling

Counselling is a scientific process of assistance extended by an expert in an individual situation to a needy person. Counselling involves relationship between two persons in which one of them (counsellor) attempts to assists the other (counselee or client) in so organising himself as to attain a particular form of happiness, adjusting to a life situation, or in short ,self actualisation. Shortly, it is a personal and dynamic relationship between two individuals in which the more experienced person helps the less experienced person to find self determined solution for his problem.

Counselling helps the client make his own decision during the process of counseling. The counsellor is not supposed to make decision for the client. Counsellor may provide various types of information so that the client could get insight to take a decision.

Directive Counseling (Clinical counselling) - Counsellor –centred: the counsellor direct the client to take steps in order to resolve his conflicts. It is based on assumption that the client cannot solve his own problems for lack of information. The counsellor plays an important role; he tries to direct the thinking of counselee by informing , explaining, interpreting and advising. It gives more importance to intellectual aspect than emotional aspects.

Merits - This approach save time. This method can be adopted when an early solution is required. It lays more emphasis on the intellectual rather than the emotional aspects of an individual’s personality. This is best method at lower levels where the client is not in a position to analyse his own problem. The methods used in directive counselling are direct, persuasive & explanatory.

Demerits - It makes the counselee over dependent on the counsellor. The personal autonomy and integrity of the client is not respected, it leads to new adjustment problems. It will not help the individual to develop any attitudes through his own experiences. It does not guarantee that the counselee will able to solve the same problem on his own in future.

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• Non-directive counselling - This school of thought is just reverse to that of directive counseling. It is a client-centred process. In this, the counselee is the pivot of the whole counselling process. The main function of the counsellor is to create an atmosphere in which the client can work out his problem. It is also known as permissive counselling. In this type of counselling, emotional elements rather than intellectual element are stressed.

Merits - It helps the counselee to become independent and self-reliant and to attain the ability for self-direction. It helps the client to attain emotional integrity; and helps to reach his full growth. It helps to attain more sustainable adjustment to his situation. This type of counselling leaves it’s impressions for a longer period.

Demerits - It is usually more time-consuming. It is not suitable for a less matured and less intelligent counselee. The counsellor’s passive attitude might irritate the counselee so much that he might hesitate to express his feelings. It is not possible in schools because the counsellor has to attend many pupils.

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• Eclectic Counselling - Eclectic counselling is a type of counselling which is neither counsellor-centred nor client centred; but a combination of both. Here the counsellor is neither too active as in directive counselling nor too passive as in non-directive counselling, but follows a middle course.

Counselling to relieve acute distress: In this situation there is emphasis on emotional release and ways of coping with the immediate problem. Where the method is nondirective, unstructured and involves the recall of distressing events, it may be inappropriate for those surviving traumatic experience and may lead to worse outcomes than where the patient receives no counselling. Cognitive methods may be of some help but timing is important.

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• Counselling for late effects of trauma, including post-traumatic stress disorder: As above, it is inappropriate to use  nondirective and unstructured approaches since they may result in recreating the emotionality of the experience without offering ways to deal with it. Cognitive and psychodynamic approaches may be more useful.

Counselling for relationship problems: It may be helpful for a counsellor to encourage couples to talk constructively about their relationship so that they come to appreciate their thoughts and feelings for each other.

Risk counselling: It may be helpful for those who may be facing the risk of developing an hereditary disease or acquiring a sexually transmitted disease to discuss with a counsellor the nature of the risks and the possible responses to the various outcomes.

Bereavement counselling: Counselling in this situation focuses on giving information about the normal stages of grieving, working through the normal stages of grief and giving advice on coping without the deceased.

Mild-to-moderate depression: The National Institute for Health and Care Excellence (NICE) questions the efficacy of this compared with other therapies and has downgraded it to second-line therapy in its latest guidance.

Generalised anxietyand panic disorder.

Obsessive-compulsive disorder.

Psychosomatic conditions - chronic pain, chronic fatigue, and gastrointestinal disorders such as irritable bowel.[3]Also, some gynaecological syndromes such as premenstrual syndrome and chronic pelvic pain.

Health promotion: Counselling can also play an important role in health promotion for some patients, including smoking cessation.

Chronic or terminal disease: Counselling may help some patients to come to terms with chronic or terminal disease. One study advocated the use of group psychotherapy for this indication.

• The evidence base regarding primary care counselling is confusing and controversial. A Cochrane review of counselling in primary care concluded -
• - Counselling is associated with significantly greater clinical effectiveness in short-term mental health outcomes compared to usual GP care in the UK, but provides no additional advantages in the long term.
• - Participants were satisfied with counselling.
• - Although some types of healthcare utilisation may be reduced, counselling does not seem to reduce overall healthcare costs.

NICE recommends that if counselling is offered it should be for 6-10 sessions over a period of 8-12 weeks.

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• - help the patient amplify the vision of the specific situation
• - discover the proper potential in dealing with the conditions of disease, in order to promote a better quality of life.
• - improved communication and interpersonal skills
• - greater self-acceptance and self-esteem
• - ability to change self-defeating behaviors/habits
• - better expression and management of emotions, including anger
• - relief from depression, anxiety or other mental health conditions
• - increased confidence and decision-making skills
• - ability to manage stress effectively
• - improved problem-solving and conflict resolution abilities
• - greater sense of self and purpose
• - recognition of distorted thinking

• The GATHER approach
• G Greet the client respectfully.
• A Ask them about their family planning needs.
• T Tell them about different contraceptive options and methods.
• H Help them to make decisions about choices of methods.
• E Explain and demonstrate how to use the methods.
• R Return/refer; schedule and carry out a return visit and follow up.