Understanding the Counseling Process

Hello friends, today we are going to discuss about counselling. I am Dr. Suresh Badamat, Professor of Psychiatry, Head of Telemedicine Centre, Head of Forensic Psychiatry Unit working at NIMANS, Bangalore. Before I start my presentation, I would like to have a disclaimer. This presentation is for academic purpose only, not for legal opinion or a professional mental health opinion. Just by watching this video, you are not going to be a certified counsellor and this video is not for treatment purpose. If you want to have an opinion or a treatment, please do contact respective professional for help. The objective of this video is to define counseling, steps of counseling, skills required for counseling, when to refer and also ethics involved in counseling. Now, let's understand the counseling. Counseling is a skill and a process. the skills required is very essential these skills cannot be learned by just reading books articles or watching video watching this video is not going to certify that you are a counselor and definitely you are not going to learn counseling just by watching the video then what is the best way of learning counseling it is by std model the model was given by my friend dr manjunath yen who is working as associate professor of psychiatry in NIMANS. According to him, he said that the counseling can be learned by seeing a trained professional doing the counseling, that is by watching and trying to do counseling in the presence of a trained counselor. We call it as a master counselor. That means you'll try. The third one is by doing it. Unless you do it, you'll never learn counseling skills. and you should do counseling under the guidance of a professional counselor so with this background let's move into who are the people who should learn the counseling skills again counseling is not restricted to one profession counseling cuts across many professions so people who need to learn about counseling are doctors not only just allopathy, ayurveda homeopathy unani siddha so all doctors need to know how to do counseling all health care providers like nurses psychologist social worker physiotherapist name any person who is involved in providing care to patients they need to learn about counseling teachers especially in educational sector advocates in judiciary they are in contact with the clients who are in distress who are in litigation and when your time the litigation will be invariably with the family members they have emotional distress hence advocates need to learn about counseling skills human resource professionals in any corporate sector managers and project leaders who day in and day out deal with humans and their conflicts if let me tell you one important point here If you are leading a team which is highly productive, there will be conflict. Accept this conflict. Learn to deal with the conflict. Because across the world, high performing units or teams have conflicts. If your team doesn't have conflict, that means there is something wrong in the team. Hence, a good manager or a leader knows how to deal with the conflicts by counseling skills. and of course custodial care providers like prison juvenile homes home where we are going to provide care for the orphans so those people need to learn about counseling skills of course lay counselors religious leaders especially in a developing countries like india religious leaders do play a very important role in providing mental health counseling hence they need to undergo this training and finally parents so let's understand the definition of counseling as i said the counseling is not meant for only healthcare professionals it cut cut across various professions and various fields so let's define let's understand the definition there are various definitions of counseling has been given by various professionals various behavioral scientists psychiatrist and many other people. Now, understand the first definition. Counseling means it is a process of assisting and guiding the clients, especially by a trained person on a professional basis to resolve especially personal, social or psychological problems and difficulties. This is one definition. The NHS UK has defined counseling as a talkative therapy or a talking therapy that involves a trained therapist listening to you and helping you finding ways to deal with emotional issues. And this is very concrete or a specific way of telling. It's a talking therapy and the client will learn to deal with the emotions during the counseling process. The American Counseling Association gave a comprehensive definition. They defined counseling as a professional relationship that empowers diverse individuals, families and group to accomplish mental health, wellness, education and career goals. See here they have moved from individual counselling to group counselling. So this is a broader and a comprehensive definition. Further you can see one more definition. Counselling means a process that occurs when a client and counsellor set aside a time to explore. difficulties which may include the stressful or emotional feelings of the client. This is very specific and related to mental health counselling. Counselling also means process of helping the client to see things more clearly, possibly from a different viewpoint. This can enable the client to focus on feelings, experiences or behaviours with the goal of facilitating positive change. So this is a very precise way of telling that there is a biological basis for counseling. In a situation where a person is in a difficult or a stressful situation, in that process the emotions are very high. That basically amygdala is firing. The prefrontal cortex which is required for attention, concentrating, thinking and executive function gets hijacked. That means under the high emotion, the person loses thinking or judgment capacity and he will do certain wrong things. So if you are able to remove those emotional, heavy loaded emotional situation, or else if you are able to diffuse those emotional situation, that person starts thinking properly and he learns to handle his emotion. That is what is counseling means. Counseling also means a relationship of trust and confidentiality however counselors may be required by law to disclose information in certain situation or scenario whenever there is a conflict with law in such a scenario the counselor should inform the law agencies now let's understand counseling we know we discussed various definition of counseling but however the concept of counseling needs to be understood very well let me tell you counseling is not giving advice you are not a ready-made machine or a automatic human who will provide solution it is not giving a fish for a person who is hungry it is teaching how to fish it is a skills transference that is called as counseling you are not here to give a lecture or a teach when a client has approached for counseling that means counseling involves transferring skills not giving information not providing immediate solution it is a process of transferring skills to the client that is you have to understand so you don't provide any kind of materials here you are providing skills so that in near future whenever he has been faced with a similar situation He has been empowered with problem solving skills and he will solve his problem. That is what is counseling means. That means you are empowering the person. Let's give me one more example. In this scenario, you can see Arjuna is at the feet of Lord Krishna. See here in Kurukshetra, which lasted for 18 days during the battle of Kurukshetra. The Arjuna has a lot of conflicts. He has lot of issues. lot of problems. Here he has to fight with his own family members, own relatives, friends. He has to fight with his own teachers. He has too many problems. Either he has to fight now or else quit the battle. So in such a scenario, in the battle of Kurukshetra, the savior or what we call it as the person Lord Krishna comes here to guide him. So please understand, where the counselling started was Bhagavad Gita. 18 days battle and different counselling techniques was given here. So here in this, the Lord Krishna never fought a battle in Kurukshetra. But he guided Arjuna to win. Similarly in counselling, the counsellor or therapist is not going to fight your battle. They are going to guide you. The client needs to fight his own battle. That is what is counseling means. You are not going to fight the patient's battle or the client's battle. You are going to guide them. And the patient need to fight and learn the skills. That is called as empowering. That is called as teaching the skills which is required for life. And then the Arjuna fought the Kurukshetra and won the battle. That is all about counseling. counseling is not giving immediate solution counseling is not giving ready-made answers counseling is teaching skills to the client so that he learns how to deal the problems when he is alone so counseling in another way i can explain you is counseling is similar to any training program the trainer will train you for one hour per week and you should Again do practice at home the more you practice you become skilled just because you have been trained doesn't mean that you will not be Facing challenges just because you have learned counseling just you are a counselor doesn't mean that you will be not facing problems in life Will face the problem now because you are learnt counseling or you have undergone counseling now You have learned to deal the problems of life. That means you are learned the skills of life what we call it as life skills is what we have to teach to the clients that is life skills need to be taught here you are not going to solve the patient's problem or the client's problem you will enable them with the skills to solve their problems by giving your time see the counselor's time is limited and the counselor is giving his time to solve the emotional problems thinking problem behavioral problems relationship issue problems and he will guide you to solve the client's problem that is what is counseling means let's understand by summarizing counseling means enabling the client to find solution by himself by empowering through giving certain skills or teaching certain skills and making the client independent and autonomy where the whole counseling revolves around counseling is not giving lecture not giving solutions counseling is transferring skills to the clients what is not counseling means counseling is not advice giving machine or a human being or a instant solution providing person counseling is not just talking counseling is not having just friendly talk counseling is not being judgmental counseling is not a romantic relationship counseling is not making the client dependent on the counselor it is making independent making autonomy and empowering the client is very essential in counseling so when should a person should approach for counseling what are the situation how should a client come to know that he needs counseling because counseling means they feel that they are weak they have to be there is something wrong in them or they have mental illness no counseling is required in various situations like this whenever a person is unable to manage his emotions when he started excessively thinking about his problems or even normal issues is thinking more unable to handle stress or burnout at workplace unable to control certain behaviors baby gambling maybe excess pornography watching substance use alcohol use drug use non-substance use that is internet addiction social media addiction problems with self-esteem and self-confidence unable to do presentation relationship issues problem with parents problem with the girlfriend or boyfriend problem with spouse problem with any other person in the society may be problem at workplace trauma violence disaster situation if a person is finding it overwhelming that is unable to handle the situation then the counseling is required and certain life events death relationship breakage or it even during pregnancy or if the child the child dies and the mother needs counseling or even the the father also may have to undergo counseling to recover from the loss that is basically we do grief counseling so the grief has to be resolved so that they become empowered tomorrow to deal with any other loss so these are the situation where the counseling is required in a simple way i can tell you is whenever there is a person is unable to handle his emotion about his thoughts unable to handle his thoughts and his behavior then the counseling is required then how often the client needs appointment or counseling or how often the session should be done initially the sessions will be once a week sometimes if the client is very disturbed maybe two or three times a week and later it becomes monthly once and over a period of time it will become once in three months to six months that means booster sessions how long each session should last between 30 to 60 minutes each session will last how long the counseling should last it may be the counseling will be invariably period of maybe three months to nine months and the number of session would depend upon the individual cases the individual resources the progress and any comorbid illness imagine a person has mental illness and also physical illness at the same time when he is dealing with his depression he has a problem at workplace he has a problem at in the marriage so you may have to require counseling for long duration so briefly we call it as three months to nine months in a regular case but in a complicated case you may have to receive counseling for long duration of period now let's understand and deal how the counseling is done in various stages there are five stages of counseling first stage is intake session in the first stage you will do one to two sessions history taking one to two session goal setting two to three sessions intervention four to ten session winning and termination two to four sessions invariably it will be around 10 to 20 sessions are required sometimes if the person is able to deal even in four to five sessions is more than enough But generally the sessions last from 10 to 20 sessions and the frequency will depend upon various other factors. If there is a crisis, the sessions are done more frequently. If the person is becoming more empowered, the sessions are spaced. Initially it is once a week, later it will become once in three months. Now let's take each session, stage one, that is intake. the person has approached the counselor for help so once he comes rapport building ask the client to tell his story what is his problems what is the reason he has arrived for seeking help and at the same time you should know your limitation how much you can help assure confidentiality and also limits of confidentiality that means I will not discuss your problem with anybody. But however, if there is any legal issues involved by law, I need to tell somebody, maybe law implementing agencies. Clarifying the client's expectation is very essential. Because many a time, the client will say, I am coming for counseling, you solve my problem. I am not going to do anything. That is not counseling. The counseling is here, just like Arjuna, he has to fight his battle. And the counselor is here to guide him. So, it is a collaborative work and the Partha Sarathi, that means Krishna is a Partha Sarathi. The Partha has to fight his battle. that is what is counseling and the role of counselor what the counselor will do to guide him and what is the role of client has to be clearly told in the intake session the intake session may be one or two sessions and time duration and session frequency need to be discussed clearly so that the whole process of counseling for a period of maybe 10 to 20 sessions is well planned during which the skill transference occurs or where the client learns to deal with this problem by learning various set of skills. If there is a session is missed because of some urgency, how to deal that situation and how to contact the therapist. What are the phone numbers? Whether there will be tele-counseling is done? Those issues need to be discussed in the first intake. So once the clear do's and don'ts and the contract has been clearly mentioned. the counseling session starts that is stage two in stage two you are going to take the complete history of the patient what are his problems what are the main issues what are the conflict what are the stressors what was the precipitating factor which pushed him to take counseling and what are these stressors when did the stress started and what is the frequency of the stress or emotional problem, duration, any aggravating factor and relieving factor and also you need to assess multiple domains such as relationships, at home, at workplace, at the social place, sexual issues, academic failure or academic achievements, finances, health related issues etc. need to be probed at the same time family history and personal history need to be taken personality history and biological social occupational dysfunction if it is there clearly to be noted so stage two usually you will do for one to two sessions and during this not only you will talk to the client you will take consent from the client you will talk to other people it may be family members of the patient or also the friends but it has to be done with the consent of the patient or the client without that don't do it as much as information you are able to gather it is easy to help the person that needs to be conveyed to the client that means we are here to help you we are non-judgmental please be open and before i discuss with anybody else i will take concern from you without your knowledge it will not be revealed to anybody however the limitations if there is a law has been involved or there is a conflict of law i need to inform the police has to be communicated before in hand coming to stage three once you have taken the history now the goal setting starts each session before you start each session you should revise and recapitulate the previous session previous session what we did either the therapist will do or the client himself will be telling you have to ask him tell me what did we discuss in the previous session what was the homework given So that needs to be discussed before starting each session. Short term goals. What are the long term goals? Selecting the goal and trying out each goal should be the stage 3. And how to get this? What are the questions you should ask? You need to ask the client. What do you want to achieve in life? How are you going to achieve it? When do you want to achieve? Who will support you in this endeavor? What obstacles do you anticipate? How will you address these obstacles? How will you measure and monitor the progress to achieve that goal? Are your goals realistic? So these are the questions you will be asking and planning so that the patient knows if I go through this counseling process, I will be able to achieve certain goals. That is very essential. Long term goal and short term goal that has to be planned because the patient after some time he feels i'm coming and discussing here and i'm not gaining anything here you have to clearly say what is the short term goal that may be in another 10th session what you are going to achieve long term goal maybe after one or two years what you are going to achieve so that has to be clearly defined in goal setting coming to stage four this is where the intervention starts this is where the maximum interaction resistance, problems and also sometimes the patient starts avoiding the sessions because during intervention the counselor will challenge sometimes. or else he may ask about the stressors he may ask about conflicting situations and how he handled the problems previously what are his issues looking for solutions asking for alternatives at the same time if there is a problem he will be asked to tell me what are the different solutions you have now whom do you seek for help weighing each solution pros and cons of each solutions Implementing one possible solution which the patient has chosen by himself or the client has chosen by himself at the same time You will be providing emotional support Empathizing with the client is very essential at this point of time and also validating his emotions if he is going through a tough time By implementing a solution which he has dreaded a long time. For example, if the patient has difficulty in talking to Strangers or giving a lecture in public situation what we call it a social anxiety disorder or a social phobia and you have told him or given him a task of going and talking to stranger during that time emotional support is very essential and also if he says that i went and spoke to mr x or miss y i had a panic attacks you have to validate telling that of course any person who is going through this problem and when he is challenging his own belief or is challenging his own emotions he will go through similar panic attacks. By validating him these emotions, the patient or the client feels I am not alone. There are many people like me who is going through this situation. At the same time, you have to give homework assignments. This homework assignment is one of the indicator of how the patient's outcome or the counseling outcome will be. If the person is able to stick to 100% of the homework assignment, you will definitely improve by 100 percent if the homework assignment is 50 percent then the improvement will be 50 percent homework assignment is an indicator or a variable for outcome of counseling hence homework assignment is essential hence you may ask the client to keep a dairy daily on his emotions daily reporting about his behavior and about thoughts so that you know how the thoughts are progressing how is his emotions how is his behavior At the same time, you will be giving some homework which will be documented in the diary. So that over a process of 10 to 20 sessions, you can see how the person has progressed from A to B or maybe A to Z. So that the intervention is very essential to have homework assignments. Coming to the various intervention technique at stage 4. So what are those intervention? Lifestyle changes. Many times, most of our problems are because of lifestyle. Maybe having unhealthy food habits, getting up late, watching movies in the late night, having unhealthy habits. So the lifestyle change will solve half of the problems. Also seeking help from others, asking help from the colleagues, asking help from the family members. Sometimes person has self-esteem issues. So those self-esteem issues, if it is the main issue, then you have to address those self-esteem issues. Suppose the person has emotional issues, yoga, meditation, breathing exercise, those will help him to control his emotions, control his abnormal panic attacks, or maybe it may be phobias, fears, anxiety can be addressed. Hobbies. maybe dancing maybe singing spending time with the loved ones will make him relaxed spirituality skills training program you can say you have to undergo the skill training program if it is maybe very specific especially if it is related to english language undergoing english proficiency classes will be helping him sometimes other maybe communication skills training program assertive training program management training program so those can be advised facing and learning from the failures many a time people are so afraid they don't take up the task because they are afraid of failures and they don't since they don't have failures because they have not tried it that means they don't learn from the failures so you have to tell him there will be failure there will be setback learn to get over those setbacks, learn to get over those obstacles. Obstacles is the only way to get new opportunity. obstacles are there to grow without obstacles he will not learn that they have to learn and behind every obstacle there is an opportunity hidden so you have to overcome that obstacle to get those opportunity has to be conveyed and especially if there are failures multiple perseverance has to be thought especially if you look at the boxing there will be punches given by the life by the opponent. You may receive punches. That doesn't mean that you are a failure. You may be knocked down. Until you quit, the match is not over. You have to get up, bounce back. That is called as resilience and continue the fight. Until you give up, the match is not over. Similarly, you have to choose your battle. There are certain battles you have to lose to win the war. Here the war is very essential. The life is very essential. there will be small battles you should learn to choose the battle learn to ignore certain battles to win the war that is where the intervention technique starts playing very important i hear the wisdom of the counselor the way the counselor is going to guide the client how he will teach him various skills and also give suggestions so that the change starts occurring in the patient's mind or the client's mind here the intervention technique has to be as creative as possible because each individual or each client is different his lifestyle is different his background is different whatever he is coming with the baggage is different hence you cannot have one single tailor-made counseling it has to be different different that means you have to be creative you have to tailor the needs of the client and have to provide counseling sessions coming to the last stage 5 weaning and termination Here, now you have to focus on the skills he has gained and empowering the client to solve his own problem. Discuss now. You are at the end of the sessions. You have to tell, now we have to win the sessions. If the client is coming once a month, you will say, now I think you are doing well. We have to shift from once a month to we can meet once in two months. So, you are now spacing. that means you started winning the counseling sessions and sometimes you may have to have booster sessions once in three months or once in six months and finally the termination the termination occurs when the person is completely empowered here many a time the clients will refuse because they slowly feel that my problems are solved because of interaction between the counselor and the client yes of course but he doesn't even trust his own skills that's where the problem occurs then you have to point him out yes you have been empowered now you have to go and try it out in the real life best example is a master will teach a student the karate skills or martial art skills under the guidance of his master he will learn he will practice unless he goes into Fight or unless he faces a challenge. He will never be a winner Similarly if a ship is built and it has been trained it has been checked for the quality It is not made for to keep it in the harbor It has to set sail similarly here the counselor need to Allow the client after empowering him to set sail and he has to learn To face the problem and solve his problem. That is what about counseling is that is transferring skills now let's understand what are the different skills a counselor should have first and the foremost introduce yourself collect the demographic details of the client ask the client by name address him what is your name and talk to him by his name ask the reason for consultation what was the reason for seeking help ask open ended questions avoid closed ended Making eye contact is very very essential. Genuine care that I am here to help you. I am non-judgmental. That is very very essential. If you are able to communicate this much that genuineness and being non-judgmental plays a very essential role in counselling. Avoid asking why questions. Better you ask please explain to me. I would like to know about it. Please elaborate. Those are the important questions you should ask. Do not threaten him. do not belittle him give time many a time the clients takes three four five sessions to become comfortable with the counselor so giving time is very essential empathizing skills this i am going to make a separate video especially empathizing skills in counseling both verbal skills and non-verbal skills that you need to learn if you are going to be a counselor being reassuring and supportive that means you need to instill hope you if the patient is highly negativistic you can't also be along with him next to it negativistic you have to instill hope and be supportive what are the skills that need to be in a counselor the skills decoded to learn empathy is active listening you should make head nod not only by verbal skills by even non-verbal skills you have to say that i am listening not only listening i am understanding understanding your thoughts your emotions your behavior under what background it is occurring that that means listening and understanding not only listening and understanding communicating that i have understood is very essential that how you are going to communicate is a skill which i am going to discuss in empathy in a different video Coming to the qualities of the therapist, accepting the person, unconditional positive regard, respecting their views, confidentiality, empathetic listening, warm and genuine concern about the client's problem, listening without being non-judgmental, being sincere to patient, being resourceful, giving information, knowing the limitations of the therapist knows this is my limitation i can't handle family related issues i can't handle children related issues that limitation if the person knows he is a one good counselor one another tip a good pilot is one who knows when not fly fly his aircraft if he knows that he is the best pilot in the world when to refer that means the counselor knows when to intervene when to refer so what are the situation when the counselor need to refer whenever there is a deliberate self-harm or suicidal ideas that is dangerous to the client himself that is the situation you have to refer whenever the violence against others if your client is becoming violent towards others unable to take care of himself on day-to-day basis if that is the case you need to refer if there is a legal issues if the person who is undergoing counseling is getting into a legal issue you need to refer if the person or the client has mental health issues or he has mental illness then you need to refer if there are any organic issues like head injury seizures high fever or encephalitis meningitis whatever the brain illness especially neurological and neurosurgical illness is there please refer by counseling you are not going to cure neurological illness they need intervention that means organic issues and symptoms are not decreasing in spite of you providing counseling and you have done your best efforts there are certain clients which do not get benefit from counseling they need to be referred to the higher counselors or a master counselor or maybe even to a psychiatrist or to your professionals for help and if you feel that the domain what you are dealing is beyond your skills then you need to refer so refer referring means the counselors knows his limitation and he is one of the best because he is not going in the area where he is not comfortable he knows his skill sets so that's where you should know when to refer the last part of my presentation ethics in counseling autonomy the client needs to have autonomy during the counseling you are not going to dictate terms with the patient or the client confidentiality that is privacy of the information shared during the counseling need to be confidential you are not going to discuss with anybody else maximum is with your master trainer or maybe a master psychotherapist you are going to discuss with the consent of the client and also non-maleficiency you are not going to do any harm to the client if you feel that you are going to harm him better to refer You will work for the beneficency of the client. Justice. you are going to treat every client equally just because one client is filthy rich you are not going to treat him very high and the person who is coming from a poor area or a poverty stricken area you are not going to treat him very badly boundary violations that's very very essential crossing and getting involved with the client romantically or sexually or else using the client for your personal gain getting work done by the clients that is simply no even if the client wants to have a sexual relationship it is no because it is a fiduciary relationship here the client is at the lower pedestal you are at the higher pedestal never ever get involved with the client if you do it you are no more a counselor you have broken the ethics of counseling and never use the client for your benefit you are going to work for the benefit of the client Here the client is not working for your benefit. That's what is counseling is. You are going to transfer the skill to the client. You are not going to take anything especially which is agreed upon. If you are agreed upon for certain remuneration that will be the maximum, not more than that. So that needs to be the professional counseling ethics. To conclude my dear friends, the whole counseling revolves around listening skills, Empathizing skills, enabling the client with the skills. It may be problem solving skills, decision making skills, assertive training, communication skills, study skills, interpersonal skills. That means you are going to enable the client. You are not going to provide solutions. You will provide information and also telling where to search for more information. And also you will teach him certain simple techniques, maybe yoga, meditation. Progressive muscular relaxation, spirituality. If you don't know these techniques, you may refer them to go and find those. You may refer him to a yoga instructor. And please follow ethics. It is very essential in counseling. So, my final word, counseling means empowering the client so that he will deal his problems on his day-to-day basis. Not disabling him. You are enabling by skills. That is counseling. Thank you very much for your valuable time. Stay safe.

If you want to have an opinion or a treatment, please do contact respective professional for help. The objective of this video is to define counseling, steps of counseling, skills required for counseling, when to refer and also ethics involved in counseling. Now, let's understand the counseling.

Counseling is a skill and a process. the skills required is very essential these skills cannot be learned by just reading books articles or watching video watching this video is not going to certify that you are a counselor and definitely you are not going to learn counseling just by watching the video then what is the best way of learning counseling it is by std model the model was given by my friend dr manjunath yen who is working as associate professor of psychiatry in NIMANS. According to him, he said that the counseling can be learned by seeing a trained professional doing the counseling, that is by watching and trying to do counseling in the presence of a trained counselor. We call it as a master counselor. That means you'll try.

The third one is by doing it. Unless you do it, you'll never learn counseling skills. and you should do counseling under the guidance of a professional counselor so with this background let's move into who are the people who should learn the counseling skills again counseling is not restricted to one profession counseling cuts across many professions so people who need to learn about counseling are doctors not only just allopathy, ayurveda homeopathy unani siddha so all doctors need to know how to do counseling all health care providers like nurses psychologist social worker physiotherapist name any person who is involved in providing care to patients they need to learn about counseling teachers especially in educational sector advocates in judiciary they are in contact with the clients who are in distress who are in litigation and when your time the litigation will be invariably with the family members they have emotional distress hence advocates need to learn about counseling skills human resource professionals in any corporate sector managers and project leaders who day in and day out deal with humans and their conflicts if let me tell you one important point here If you are leading a team which is highly productive, there will be conflict. Accept this conflict.

Learn to deal with the conflict. Because across the world, high performing units or teams have conflicts. If your team doesn't have conflict, that means there is something wrong in the team.

Hence, a good manager or a leader knows how to deal with the conflicts by counseling skills. and of course custodial care providers like prison juvenile homes home where we are going to provide care for the orphans so those people need to learn about counseling skills of course lay counselors religious leaders especially in a developing countries like india religious leaders do play a very important role in providing mental health counseling hence they need to undergo this training and finally parents so let's understand the definition of counseling as i said the counseling is not meant for only healthcare professionals it cut cut across various professions and various fields so let's define let's understand the definition there are various definitions of counseling has been given by various professionals various behavioral scientists psychiatrist and many other people. Now, understand the first definition.

Counseling means it is a process of assisting and guiding the clients, especially by a trained person on a professional basis to resolve especially personal, social or psychological problems and difficulties. This is one definition. The NHS UK has defined counseling as a talkative therapy or a talking therapy that involves a trained therapist listening to you and helping you finding ways to deal with emotional issues. And this is very concrete or a specific way of telling.

It's a talking therapy and the client will learn to deal with the emotions during the counseling process. The American Counseling Association gave a comprehensive definition. They defined counseling as a professional relationship that empowers diverse individuals, families and group to accomplish mental health, wellness, education and career goals.

See here they have moved from individual counselling to group counselling. So this is a broader and a comprehensive definition. Further you can see one more definition.

Counselling means a process that occurs when a client and counsellor set aside a time to explore. difficulties which may include the stressful or emotional feelings of the client. This is very specific and related to mental health counselling. Counselling also means process of helping the client to see things more clearly, possibly from a different viewpoint. This can enable the client to focus on feelings, experiences or behaviours with the goal of facilitating positive change.

So this is a very precise way of telling that there is a biological basis for counseling. In a situation where a person is in a difficult or a stressful situation, in that process the emotions are very high. That basically amygdala is firing. The prefrontal cortex which is required for attention, concentrating, thinking and executive function gets hijacked.

That means under the high emotion, the person loses thinking or judgment capacity and he will do certain wrong things. So if you are able to remove those emotional, heavy loaded emotional situation, or else if you are able to diffuse those emotional situation, that person starts thinking properly and he learns to handle his emotion. That is what is counseling means.

Counseling also means a relationship of trust and confidentiality however counselors may be required by law to disclose information in certain situation or scenario whenever there is a conflict with law in such a scenario the counselor should inform the law agencies now let's understand counseling we know we discussed various definition of counseling but however the concept of counseling needs to be understood very well let me tell you counseling is not giving advice you are not a ready-made machine or a automatic human who will provide solution it is not giving a fish for a person who is hungry it is teaching how to fish it is a skills transference that is called as counseling you are not here to give a lecture or a teach when a client has approached for counseling that means counseling involves transferring skills not giving information not providing immediate solution it is a process of transferring skills to the client that is you have to understand so you don't provide any kind of materials here you are providing skills so that in near future whenever he has been faced with a similar situation He has been empowered with problem solving skills and he will solve his problem. That is what is counseling means. That means you are empowering the person. Let's give me one more example.

In this scenario, you can see Arjuna is at the feet of Lord Krishna. See here in Kurukshetra, which lasted for 18 days during the battle of Kurukshetra. The Arjuna has a lot of conflicts. He has lot of issues.

lot of problems. Here he has to fight with his own family members, own relatives, friends. He has to fight with his own teachers. He has too many problems.

Either he has to fight now or else quit the battle. So in such a scenario, in the battle of Kurukshetra, the savior or what we call it as the person Lord Krishna comes here to guide him. So please understand, where the counselling started was Bhagavad Gita. 18 days battle and different counselling techniques was given here.

So here in this, the Lord Krishna never fought a battle in Kurukshetra. But he guided Arjuna to win. Similarly in counselling, the counsellor or therapist is not going to fight your battle.

They are going to guide you. The client needs to fight his own battle. That is what is counseling means. You are not going to fight the patient's battle or the client's battle.

You are going to guide them. And the patient need to fight and learn the skills. That is called as empowering.

That is called as teaching the skills which is required for life. And then the Arjuna fought the Kurukshetra and won the battle. That is all about counseling.

counseling is not giving immediate solution counseling is not giving ready-made answers counseling is teaching skills to the client so that he learns how to deal the problems when he is alone so counseling in another way i can explain you is counseling is similar to any training program the trainer will train you for one hour per week and you should Again do practice at home the more you practice you become skilled just because you have been trained doesn't mean that you will not be Facing challenges just because you have learned counseling just you are a counselor doesn't mean that you will be not facing problems in life Will face the problem now because you are learnt counseling or you have undergone counseling now You have learned to deal the problems of life. That means you are learned the skills of life what we call it as life skills is what we have to teach to the clients that is life skills need to be taught here you are not going to solve the patient's problem or the client's problem you will enable them with the skills to solve their problems by giving your time see the counselor's time is limited and the counselor is giving his time to solve the emotional problems thinking problem behavioral problems relationship issue problems and he will guide you to solve the client's problem that is what is counseling means let's understand by summarizing counseling means enabling the client to find solution by himself by empowering through giving certain skills or teaching certain skills and making the client independent and autonomy where the whole counseling revolves around counseling is not giving lecture not giving solutions counseling is transferring skills to the clients what is not counseling means counseling is not advice giving machine or a human being or a instant solution providing person counseling is not just talking counseling is not having just friendly talk counseling is not being judgmental counseling is not a romantic relationship counseling is not making the client dependent on the counselor it is making independent making autonomy and empowering the client is very essential in counseling so when should a person should approach for counseling what are the situation how should a client come to know that he needs counseling because counseling means they feel that they are weak they have to be there is something wrong in them or they have mental illness no counseling is required in various situations like this whenever a person is unable to manage his emotions when he started excessively thinking about his problems or even normal issues is thinking more unable to handle stress or burnout at workplace unable to control certain behaviors baby gambling maybe excess pornography watching substance use alcohol use drug use non-substance use that is internet addiction social media addiction problems with self-esteem and self-confidence unable to do presentation relationship issues problem with parents problem with the girlfriend or boyfriend problem with spouse problem with any other person in the society may be problem at workplace trauma violence disaster situation if a person is finding it overwhelming that is unable to handle the situation then the counseling is required and certain life events death relationship breakage or it even during pregnancy or if the child the child dies and the mother needs counseling or even the the father also may have to undergo counseling to recover from the loss that is basically we do grief counseling so the grief has to be resolved so that they become empowered tomorrow to deal with any other loss so these are the situation where the counseling is required in a simple way i can tell you is whenever there is a person is unable to handle his emotion about his thoughts unable to handle his thoughts and his behavior then the counseling is required then how often the client needs appointment or counseling or how often the session should be done initially the sessions will be once a week sometimes if the client is very disturbed maybe two or three times a week and later it becomes monthly once and over a period of time it will become once in three months to six months that means booster sessions how long each session should last between 30 to 60 minutes each session will last how long the counseling should last it may be the counseling will be invariably period of maybe three months to nine months and the number of session would depend upon the individual cases the individual resources the progress and any comorbid illness imagine a person has mental illness and also physical illness at the same time when he is dealing with his depression he has a problem at workplace he has a problem at in the marriage so you may have to require counseling for long duration so briefly we call it as three months to nine months in a regular case but in a complicated case you may have to receive counseling for long duration of period now let's understand and deal how the counseling is done in various stages there are five stages of counseling first stage is intake session in the first stage you will do one to two sessions history taking one to two session goal setting two to three sessions intervention four to ten session winning and termination two to four sessions invariably it will be around 10 to 20 sessions are required sometimes if the person is able to deal even in four to five sessions is more than enough But generally the sessions last from 10 to 20 sessions and the frequency will depend upon various other factors. If there is a crisis, the sessions are done more frequently. If the person is becoming more empowered, the sessions are spaced.

Initially it is once a week, later it will become once in three months. Now let's take each session, stage one, that is intake. the person has approached the counselor for help so once he comes rapport building ask the client to tell his story what is his problems what is the reason he has arrived for seeking help and at the same time you should know your limitation how much you can help assure confidentiality and also limits of confidentiality that means I will not discuss your problem with anybody.

But however, if there is any legal issues involved by law, I need to tell somebody, maybe law implementing agencies. Clarifying the client's expectation is very essential. Because many a time, the client will say, I am coming for counseling, you solve my problem.

I am not going to do anything. That is not counseling. The counseling is here, just like Arjuna, he has to fight his battle.

And the counselor is here to guide him. So, it is a collaborative work and the Partha Sarathi, that means Krishna is a Partha Sarathi. The Partha has to fight his battle.

that is what is counseling and the role of counselor what the counselor will do to guide him and what is the role of client has to be clearly told in the intake session the intake session may be one or two sessions and time duration and session frequency need to be discussed clearly so that the whole process of counseling for a period of maybe 10 to 20 sessions is well planned during which the skill transference occurs or where the client learns to deal with this problem by learning various set of skills. If there is a session is missed because of some urgency, how to deal that situation and how to contact the therapist. What are the phone numbers? Whether there will be tele-counseling is done?

Those issues need to be discussed in the first intake. So once the clear do's and don'ts and the contract has been clearly mentioned. the counseling session starts that is stage two in stage two you are going to take the complete history of the patient what are his problems what are the main issues what are the conflict what are the stressors what was the precipitating factor which pushed him to take counseling and what are these stressors when did the stress started and what is the frequency of the stress or emotional problem, duration, any aggravating factor and relieving factor and also you need to assess multiple domains such as relationships, at home, at workplace, at the social place, sexual issues, academic failure or academic achievements, finances, health related issues etc. need to be probed at the same time family history and personal history need to be taken personality history and biological social occupational dysfunction if it is there clearly to be noted so stage two usually you will do for one to two sessions and during this not only you will talk to the client you will take consent from the client you will talk to other people it may be family members of the patient or also the friends but it has to be done with the consent of the patient or the client without that don't do it as much as information you are able to gather it is easy to help the person that needs to be conveyed to the client that means we are here to help you we are non-judgmental please be open and before i discuss with anybody else i will take concern from you without your knowledge it will not be revealed to anybody however the limitations if there is a law has been involved or there is a conflict of law i need to inform the police has to be communicated before in hand coming to stage three once you have taken the history now the goal setting starts each session before you start each session you should revise and recapitulate the previous session previous session what we did either the therapist will do or the client himself will be telling you have to ask him tell me what did we discuss in the previous session what was the homework given So that needs to be discussed before starting each session. Short term goals. What are the long term goals?

Selecting the goal and trying out each goal should be the stage 3. And how to get this? What are the questions you should ask? You need to ask the client. What do you want to achieve in life? How are you going to achieve it?

When do you want to achieve? Who will support you in this endeavor? What obstacles do you anticipate?

How will you address these obstacles? How will you measure and monitor the progress to achieve that goal? Are your goals realistic? So these are the questions you will be asking and planning so that the patient knows if I go through this counseling process, I will be able to achieve certain goals.

That is very essential. Long term goal and short term goal that has to be planned because the patient after some time he feels i'm coming and discussing here and i'm not gaining anything here you have to clearly say what is the short term goal that may be in another 10th session what you are going to achieve long term goal maybe after one or two years what you are going to achieve so that has to be clearly defined in goal setting coming to stage four this is where the intervention starts this is where the maximum interaction resistance, problems and also sometimes the patient starts avoiding the sessions because during intervention the counselor will challenge sometimes. or else he may ask about the stressors he may ask about conflicting situations and how he handled the problems previously what are his issues looking for solutions asking for alternatives at the same time if there is a problem he will be asked to tell me what are the different solutions you have now whom do you seek for help weighing each solution pros and cons of each solutions Implementing one possible solution which the patient has chosen by himself or the client has chosen by himself at the same time You will be providing emotional support Empathizing with the client is very essential at this point of time and also validating his emotions if he is going through a tough time By implementing a solution which he has dreaded a long time.

For example, if the patient has difficulty in talking to Strangers or giving a lecture in public situation what we call it a social anxiety disorder or a social phobia and you have told him or given him a task of going and talking to stranger during that time emotional support is very essential and also if he says that i went and spoke to mr x or miss y i had a panic attacks you have to validate telling that of course any person who is going through this problem and when he is challenging his own belief or is challenging his own emotions he will go through similar panic attacks. By validating him these emotions, the patient or the client feels I am not alone. There are many people like me who is going through this situation. At the same time, you have to give homework assignments. This homework assignment is one of the indicator of how the patient's outcome or the counseling outcome will be.

If the person is able to stick to 100% of the homework assignment, you will definitely improve by 100 percent if the homework assignment is 50 percent then the improvement will be 50 percent homework assignment is an indicator or a variable for outcome of counseling hence homework assignment is essential hence you may ask the client to keep a dairy daily on his emotions daily reporting about his behavior and about thoughts so that you know how the thoughts are progressing how is his emotions how is his behavior At the same time, you will be giving some homework which will be documented in the diary. So that over a process of 10 to 20 sessions, you can see how the person has progressed from A to B or maybe A to Z. So that the intervention is very essential to have homework assignments.

Coming to the various intervention technique at stage 4. So what are those intervention? Lifestyle changes. Many times, most of our problems are because of lifestyle. Maybe having unhealthy food habits, getting up late, watching movies in the late night, having unhealthy habits. So the lifestyle change will solve half of the problems.

Also seeking help from others, asking help from the colleagues, asking help from the family members. Sometimes person has self-esteem issues. So those self-esteem issues, if it is the main issue, then you have to address those self-esteem issues. Suppose the person has emotional issues, yoga, meditation, breathing exercise, those will help him to control his emotions, control his abnormal panic attacks, or maybe it may be phobias, fears, anxiety can be addressed. Hobbies.

maybe dancing maybe singing spending time with the loved ones will make him relaxed spirituality skills training program you can say you have to undergo the skill training program if it is maybe very specific especially if it is related to english language undergoing english proficiency classes will be helping him sometimes other maybe communication skills training program assertive training program management training program so those can be advised facing and learning from the failures many a time people are so afraid they don't take up the task because they are afraid of failures and they don't since they don't have failures because they have not tried it that means they don't learn from the failures so you have to tell him there will be failure there will be setback learn to get over those setbacks, learn to get over those obstacles. Obstacles is the only way to get new opportunity. obstacles are there to grow without obstacles he will not learn that they have to learn and behind every obstacle there is an opportunity hidden so you have to overcome that obstacle to get those opportunity has to be conveyed and especially if there are failures multiple perseverance has to be thought especially if you look at the boxing there will be punches given by the life by the opponent.

You may receive punches. That doesn't mean that you are a failure. You may be knocked down.

Until you quit, the match is not over. You have to get up, bounce back. That is called as resilience and continue the fight.

Until you give up, the match is not over. Similarly, you have to choose your battle. There are certain battles you have to lose to win the war. Here the war is very essential.

The life is very essential. there will be small battles you should learn to choose the battle learn to ignore certain battles to win the war that is where the intervention technique starts playing very important i hear the wisdom of the counselor the way the counselor is going to guide the client how he will teach him various skills and also give suggestions so that the change starts occurring in the patient's mind or the client's mind here the intervention technique has to be as creative as possible because each individual or each client is different his lifestyle is different his background is different whatever he is coming with the baggage is different hence you cannot have one single tailor-made counseling it has to be different different that means you have to be creative you have to tailor the needs of the client and have to provide counseling sessions coming to the last stage 5 weaning and termination Here, now you have to focus on the skills he has gained and empowering the client to solve his own problem. Discuss now. You are at the end of the sessions. You have to tell, now we have to win the sessions.

If the client is coming once a month, you will say, now I think you are doing well. We have to shift from once a month to we can meet once in two months. So, you are now spacing.

that means you started winning the counseling sessions and sometimes you may have to have booster sessions once in three months or once in six months and finally the termination the termination occurs when the person is completely empowered here many a time the clients will refuse because they slowly feel that my problems are solved because of interaction between the counselor and the client yes of course but he doesn't even trust his own skills that's where the problem occurs then you have to point him out yes you have been empowered now you have to go and try it out in the real life best example is a master will teach a student the karate skills or martial art skills under the guidance of his master he will learn he will practice unless he goes into Fight or unless he faces a challenge. He will never be a winner Similarly if a ship is built and it has been trained it has been checked for the quality It is not made for to keep it in the harbor It has to set sail similarly here the counselor need to Allow the client after empowering him to set sail and he has to learn To face the problem and solve his problem. That is what about counseling is that is transferring skills now let's understand what are the different skills a counselor should have first and the foremost introduce yourself collect the demographic details of the client ask the client by name address him what is your name and talk to him by his name ask the reason for consultation what was the reason for seeking help ask open ended questions avoid closed ended Making eye contact is very very essential. Genuine care that I am here to help you. I am non-judgmental.

That is very very essential. If you are able to communicate this much that genuineness and being non-judgmental plays a very essential role in counselling. Avoid asking why questions. Better you ask please explain to me.

I would like to know about it. Please elaborate. Those are the important questions you should ask.

Do not threaten him. do not belittle him give time many a time the clients takes three four five sessions to become comfortable with the counselor so giving time is very essential empathizing skills this i am going to make a separate video especially empathizing skills in counseling both verbal skills and non-verbal skills that you need to learn if you are going to be a counselor being reassuring and supportive that means you need to instill hope you if the patient is highly negativistic you can't also be along with him next to it negativistic you have to instill hope and be supportive what are the skills that need to be in a counselor the skills decoded to learn empathy is active listening you should make head nod not only by verbal skills by even non-verbal skills you have to say that i am listening not only listening i am understanding understanding your thoughts your emotions your behavior under what background it is occurring that that means listening and understanding not only listening and understanding communicating that i have understood is very essential that how you are going to communicate is a skill which i am going to discuss in empathy in a different video Coming to the qualities of the therapist, accepting the person, unconditional positive regard, respecting their views, confidentiality, empathetic listening, warm and genuine concern about the client's problem, listening without being non-judgmental, being sincere to patient, being resourceful, giving information, knowing the limitations of the therapist knows this is my limitation i can't handle family related issues i can't handle children related issues that limitation if the person knows he is a one good counselor one another tip a good pilot is one who knows when not fly fly his aircraft if he knows that he is the best pilot in the world when to refer that means the counselor knows when to intervene when to refer so what are the situation when the counselor need to refer whenever there is a deliberate self-harm or suicidal ideas that is dangerous to the client himself that is the situation you have to refer whenever the violence against others if your client is becoming violent towards others unable to take care of himself on day-to-day basis if that is the case you need to refer if there is a legal issues if the person who is undergoing counseling is getting into a legal issue you need to refer if the person or the client has mental health issues or he has mental illness then you need to refer if there are any organic issues like head injury seizures high fever or encephalitis meningitis whatever the brain illness especially neurological and neurosurgical illness is there please refer by counseling you are not going to cure neurological illness they need intervention that means organic issues and symptoms are not decreasing in spite of you providing counseling and you have done your best efforts there are certain clients which do not get benefit from counseling they need to be referred to the higher counselors or a master counselor or maybe even to a psychiatrist or to your professionals for help and if you feel that the domain what you are dealing is beyond your skills then you need to refer so refer referring means the counselors knows his limitation and he is one of the best because he is not going in the area where he is not comfortable he knows his skill sets so that's where you should know when to refer the last part of my presentation ethics in counseling autonomy the client needs to have autonomy during the counseling you are not going to dictate terms with the patient or the client confidentiality that is privacy of the information shared during the counseling need to be confidential you are not going to discuss with anybody else maximum is with your master trainer or maybe a master psychotherapist you are going to discuss with the consent of the client and also non-maleficiency you are not going to do any harm to the client if you feel that you are going to harm him better to refer You will work for the beneficency of the client. Justice.

you are going to treat every client equally just because one client is filthy rich you are not going to treat him very high and the person who is coming from a poor area or a poverty stricken area you are not going to treat him very badly boundary violations that's very very essential crossing and getting involved with the client romantically or sexually or else using the client for your personal gain getting work done by the clients that is simply no even if the client wants to have a sexual relationship it is no because it is a fiduciary relationship here the client is at the lower pedestal you are at the higher pedestal never ever get involved with the client if you do it you are no more a counselor you have broken the ethics of counseling and never use the client for your benefit you are going to work for the benefit of the client Here the client is not working for your benefit. That's what is counseling is. You are going to transfer the skill to the client.

You are not going to take anything especially which is agreed upon. If you are agreed upon for certain remuneration that will be the maximum, not more than that. So that needs to be the professional counseling ethics. To conclude my dear friends, the whole counseling revolves around listening skills, Empathizing skills, enabling the client with the skills. It may be problem solving skills, decision making skills, assertive training, communication skills, study skills, interpersonal skills.

That means you are going to enable the client. You are not going to provide solutions. You will provide information and also telling where to search for more information. And also you will teach him certain simple techniques, maybe yoga, meditation. Progressive muscular relaxation, spirituality.

If you don't know these techniques, you may refer them to go and find those. You may refer him to a yoga instructor. And please follow ethics. It is very essential in counseling. So, my final word, counseling means empowering the client so that he will deal his problems on his day-to-day basis.

Not disabling him. You are enabling by skills. That is counseling.

Thank you very much for your valuable time. Stay safe.

Transcript for:Understanding the Counseling Process

Transcript for:
Understanding the Counseling Process