COUNSELING

Introduction

Beginning in the year 1970 most people agreed that counseling is beneficial and should made more widely available (Tyler, 1969, cit. Hershenson, Power & Waldo, 1996). Not only people in the mental health area use counseling, but also other areas, including general health areas. Doctors, nurses, midwives and other health providers start learning and implementing counseling in the last three decades. As the development of customer oriented climate and patient right, it is important for doctors to enhance their counseling skills, not only their medical skills.


What is counseling?

The central purpose of counseling is to facilitate wise choice and decisions. However, some professionals also give other definition, ‘counseling can be used to promote adjustment or mental health’. To give more understanding on the definition, counseling is meant by assisting an individual, family or group through the client counselor relationship:
 To develop understanding of intrapersonal and interpersonal problems
 To define goals
 To make decisions
 To plan a course of action reflecting the needs, interests and abilities of the individual, family or group
 To use informational and community resources, as these procedures are related to personal, social, emotional, educational and vocational development and adjustment


What is the difference between counseling and psychotherapy?

Psychotherapy implies adherence to a medical model, which views the person seeking help (the patient) as ill and the goal of intervention as curing that illness. Counseling, while it can have therapeutic effects, focuses instead on promoting healthy development by assisting the person seeking help (the client) to learn to cope effectively with problems of living. Thus, the goal of psychotherapy is the elimination of psychopathology (phobia, severe depression or anxiety), whereas the goal of counseling is to empower the client to achieve healthy growth (Hershenson, Power & Waldo, 1996, page 4)


Counseling process

As written in the skills laboratory manual, a counseling process may summarized as GATHER:

G – greet, give warm greeting to client
A – ask, ask client what happens to them
T – tell, tell client alternative
H – help, help client in choosing
E – explain, explain the client about the chosen alternative
R – return, return for follow up

Besides GATHER, two things that facilitate the counseling process should be considered:

CLEAR:
C – clarifying, clarify the client’ problem
L – listening, always perform as a good listener
 Concentrate
 Keep eye contact
 Show interest body language
 Encourage client to talk
 Ask client to explain
 Re check use paraphrase
 Leave your opinion
 Stay calm
E – encouraging, encourage clients to express their emotion and explain their
problem
A – asking for feedback, after you gave your interpretation and alternatives, ask
clients for their opinion about your interpretation or alternatives
R – repeating, encourage clients to apply the alternatives they choose and ask
them to return

ROLES:
R – relaxing, maintain a relax situation when conducting a counseling
O – opening up to client, disclosure your self as counselor and show your honest
acceptance of the diversity
L – leaning toward client, always see to the client’ problem and show your
“interest and motivated” body language
E – eye contact, establish eye contact during the counseling process
S – smiling and sitting squarely





Counseling principles

The process of counseling should follow principles below:

 Acceptance
Counselor should accept clients as they are, and understand the diversity
 Individual
Except for the group counseling, individual counseling should implemented individually and the client should be seen as an unique
person.
 Confidentiality
The confidentiality of client’ problem should be kept
 The client is the decision maker
Counselor should let the clients to make their own decision
 Emotion control
What ever the reaction or behavior of clients, counselor should stay calm
 Avoid judgment
Although client has “un manner” behavior, counselor should stay in the neutral way and avoid to judge the client

Communication skills that should be mastered in counseling process

Relating
Maintain a good and relax relationship between counselor and counselee
Observing
During the counseling process, counselor should observe the clients’ body language or non verbal language
Listening
As noted previously, counselor should maintain its listening behavior
Questioning
The way for asking client should perform adequately. It is suggested that counselor should use open question
Attending behavior
Acceptance of client is important. Counselors should show their non verbal language that show an acceptance and readiness to help
Talking
Use appropriate language and stay calm, avoid of giving judgment or blaming the client
Summarizing & paraphrasing
Sometimes counselor need to make summary or paraphrase (repeat the client’ talk with your own language)

Interpreting
Counselors also needs to make their own interpretation of the problem or emotion of the clients
Giving interpretation
The interpretation of the main problem and its emotion should be given to the clients.


Researches regarding counseling – a smoking cessation case

Several researches have been conducted for helping the smokers to quit. Some of them use the behavioral treatment, whereas the others use NRT (Nicotine Replacement Therapy) (Tang, Law & Wald, 1994; Fowler, 1994) and combining of behavioral treatment (counseling) and NRT (Gourlay, Forbes, Marriner, Pethica & Mc Neil, 1995).

Considering that stop smoking needs hardly effort, even though innovation strategies have been conducted, some studies involving medications or combining medications and behavioral treatments are still implemented. Fowler (1994) conducted randomized trial using nicotine patch to help the people stop smoking. His study showed that 19.4% out of 842 subjects who used patches were quit at 12 weeks, compare to 11.8 % out of 844 in the placebo patch group. The number of people who were quit decreased after 12-52 weeks, 10.8 % out of 842 in the patch group and 7.7% out of 844 in the placebo group.

Gourlay and his colleagues (1994) added brief counseling at monthly visits besides giving twelve transdermal nicotine for relapsed smokers. This study indicated that 6.7% (21 out of 315 subjects) had stopped smoking compared with 1.9% (6 out of 314) allocated in placebo. After 26 weeks the percentage of people who had stopped smoking were 6.4% (20 out of 315), whereas in the placebo only 2.6% (8 out of 314).


Brief counseling for helping patients stop smoking – an example

A brief counseling for assisting patients stop smoking has been developed in the USA. The process of brief counseling as below:

 ASK
o Take the tobacco use as ”vital sign” (always ask smoking behavior)
o Place smoking status in chart
o Enter smoking status in problem list (if yes)

 ADVISE
o Praise patient for trying or planning to stop smoking
o Link smoking to present symptoms/visit
o Discuss health, short-term benefits
o Give clear cessation message
o Ask all tobacco user “if we give you some help, are you willing to try to stop?”
 ASSIST
Who say YES:
Ready to stop now:
o Provide motivational and self-jelp
o Map out plan with patient
o Set date for stopping
Who say NO:
Not ready to stop
o Provide motivational literature
o Ask about barriers to stop
o Encourage – reconsideration in future; offer ongoing support
 ARRANGE FOLLOW UP
o Mention that you will follow up at next visit
o Arrange follow-up date for those ready now as appropriate
o Telephone/personal contact on quit date


Final remark

Counseling is one of communication skills. For mastering this counseling skill, students should practice and practice. Use your day life social interaction as a field for practicing. Helping friends’ problem is one example to practice your counseling skill. Enjoy your practice, good luck!


Reference

1) American Medical Association. 1992 How to Help Stop Smoking. USA: National Cancer Institute, Centers for Disease Control and Prevention, American Society of Addiction Medicine

2) Fowler, G. (1994) Randomised trial of nicotine patches in general practice: results at one year. BMJ COM, 308:1476-1477, dowload 12/26/01

3) Gourlay, S.G., Forbes, A., Marriner, T., Pethica, D., & McNeil, J.J. (1995) Double blind trial of repeated treatment with transdermal nicotine for relapsed smokers. BMJ COM, 311:363-366, download 12/26/01

4) Herhshenson, DB., Power, PW., & Waldo, M. 1996 Community Counseling – Contemporary Theory and Practice. Boston: Allyn and Bacon

5) Tang, J.L, Law, M., & Wald, N. (1994) How effective is nicotine replacement therapy in helping people to stop smoking. BMJ COM, 308: 21-26, download 26/12/01