3 Counseling Skills3-010915
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Transcript of 3 Counseling Skills3-010915
Counseling Skills
Prof. Datuk Dr. D.M.Thuraiappah
MAHSA University College
http://www.patient.co.uk/improveddoctor/Counselling-in-Primary-Care.htm
Counseling
Consent
Agreement
Management plan
Confidentiality
Agreement to follow up
Family
Employers
Consent
Assumed consent
Virtual consent
Oral/Verbal consent
Limited consent
Written consent
Court order
Third party/proxy consent
Types of counselling
Problem-solving counselling
Interpersonal counselling
Psychodynamic counselling
Problem-solving counselling
This is a structured and systematic approach to resolving problems that are due to stressful circumstances.
First listen to the patient and analyze the problem with the patient step by step. Usually the problem is solved by the patient
If the patient cannot see the solution, then offer different solutions for the patient to identify the best fit.
This method has been shown to be useful in treating mild mood disorders.
Steps in Problem Solving
1.Problem Orientation
2. Identify the root cause
3.Select & Define
4.Generate Solutions
5.Decision Making
6.SMARTAction
7.Review Progress
Interpersonal Relationship Counselling
This is to problem-solving with the focus on breakdown of relationships in the home, work and in social
network
Problems like loss, interpersonal disputes, role transitions and interpersonal deficits.
A problem-solving approach is suggested to encourage the patient to try out different ways of coping.
This has been effectively used for patients with minor mood disorders
Psychodynamic counselling
In this technique emphasises on past experience and unconscious processes as the mainspring of current behaviour.
The patient's emotional reactions to the counsellor and situation are an
indicator of the nature of problems in other relationships.
This approach has not been as thoroughly evaluated as those above.
FRAMES• The principles underlying most approaches to brief interventions were
systemized by Hester and Miller in what is called the FRAMES model:[1]• Feedback: Give feedback on the risks and negative consequences of
substance use. Seek the client's reaction and listen.• Responsibility: Emphasize that the individual is responsible for making
his or her own decision about his/her drug use.• Advice: Give straightforward advice on modifying drug use.• Menu of options: Give menus of options to choose from, fostering the
client’s involvement in decision-making.• Empathy: Be empathic, respectful, and non-judgmental.• Self-efficacy: Express optimism that the individual can modify his or her
substance use if they choose. Self-efficacy is one's ability to produce a desired result or effect.
CLINICAL RECOMMENDATIONEVIDENCE RATING REF: COMMENTS
Primary care counselling leads to short-term benefits for psychiatric symptoms.
B 45, 46 Most studies involved a mental health counsellor in a primary care practice; heterogeneous counselling models were used.
Brief alcohol intervention is associated with reduced alcohol use over time.
B 47, 48 Systematic review and meta-analysis; benefit may be more enduring for men; counselling methods included the FRAMES technique.
The five A’s technique is effective for smoking cessation.
B 12, 13 Most studies in the systematic review evaluated pregnant women.
Stages of change (transtheoretical model), using individualized patient feedback, is associated with improved adherence to a hypertensive regimen at 12 and 18 months.
B 24 Study relied solely on patient self-report of adherence behaviour.
Brief motivational interviewing provided by non-specialists for substance abuse reduces alcohol and marijuana use.
B 32 Follow-up periods were variable; there was a limited number of marijuana studies.
SORT: KEY RECOMMENDATIONS FOR PRACTICEFive A’s = ask, advise, assess, assist, arrange; FRAMES = feedback about personal risk, responsibility of patient, advice to change, menu of strategies, empathetic style, promote self-efficacy.A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.xml.
Developed Specifically for Family Physicians Approaches to Counselling in the Primary Care Setting
• BATHE = background, affect, troubles, handling, empathy;
• Five A’s = ask, advise, assess, assist, arrange; FRAMES = feedback about personal risk, responsibility of patient, advice to change, menu of strategies, empathetic style, promote self-efficacy.
Specific uses of counselling
Counselling to relieve acute distress
Counselling for late effects of trauma
Counselling for relationship problems
Risk counselling
Grief counselling
Mild-to-moderate depression
Chronic or terminal disease
Counseling to relieve acute distress
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, direct counselling may be inappropriate for those surviving traumatic
experience and may lead to worse outcomes than where the patient receives no counselling.
Well-timed Cognitive methods recommended
Counselling for late effects of trauma
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
• to discuss with a counsellor the nature of the risks and
• the possible responses to the various outcomes.
1.Risk of developing
an hereditary
disease 2.Acquiring a sexually
transmitted disease
Mild-to-moderate depression
The National Institute for Health and Clinical Excellence (NICE) questions the efficacy of this
compared with other therapies and has downgraded it to
second-line therapy in its latest guidance
Mild to moderate DepressionGeneral Anxiety and panic disorder
Obsessive-compulsive disorder
Psychosomatic conditions - chronic pain, chronic fatigue, gastrointestinal disorders such as irritable
bowel[5] and 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.[6]
Techniques of Counselling Nondirective counselling
Problem-solving therapy
Cognitive techniques
Behavioural therapy:
Cognitive behavioural therapy
Interpersonal therapy
Psychodynamic counselling:
Nondirective counselling:
Encourages the patient to share his or her problems with the counselor.
Through listening, the counselor affirms the patient's worth and allows him or her to take
the time to express his or her thoughts.
Problem-solving therapy:
Systematically teaches generic skills in active problem-solving,
helping individuals to clarify and formulate their life difficulties and apply principles of problem-solving to reduce stress and enhance self-
efficacy.
Cognitive techniques
Such as challenging negative automatic thoughts) and
behavioural techniques (such as activity scheduling and behavioural experiments): Are used to relieve
symptoms by changing maladaptive thoughts and beliefs.
Behavioural therapy:
Seeks to solve problems and relieve symptoms by changing behaviour and the
environmental factors which control behaviour.
Graded exposure to feared situations is one of the most common behavioural treatment
methods and is used in a range of anxiety disorders.
Cognitive behavioural therapy: Is a combination of the two techniques of cognitive and behavioural therapy.
It looks at how a person's self-perception can influence his or her behaviour.
It addresses some of the underlying issues and how these can give rise to destructive or damaging behaviour.
Can be useful in treating depression, anxiety and substance abuse. One study found it was beneficial in the management of elderly patients with depressive disorder.[7]
Access has always been the issue in primary care but one study found that online real time therapy delivered by a counselor over the internet was effective.[8]
NICE has reviewed the use of and access to cognitive behavioural therapy in general practice and has recommended:[9]
Beating the Blues - an internet-based cognitive behavioural therapy programme for the treatment of mild-to-moderate depression.[10]
Fear Fighter - a similar programme available for the treatment of panic and phobic anxiety.[11]
Interpersonal therapy
Structured, supportive therapy linking recent interpersonal events to mood or other problems, paying
systematic attention to current personal relationships, life
transitions, role conflicts and losses.
Psychodynamic counselling:
Based on the view that past and unresolved conflicts and events result in current emotional distress, a variety of
methods is used to help the client make sense of repressed or forgotten
experiences, allowing the client to move forward and resolve the conflict or
troubling behaviour.
Benefits of counselors in primary care
Effect is confusing
In some studies it has been shown that primary care counseling is more beneficial that psychiatric counseling
On-directive and CBT are the most useful
Is beneficial in mild-to-moderate MH problems in the short term(< 6 months)
In depression, anti-depressives act faster than generic counseling. Counselng should not exceed 12 weeks
Grief counseling
Counseling in this situation focuses on:
a. the normal stages of grieving,b. working through the normal stages of
grief and c. giving advice on coping without the
deceased
Grief in Bereavement
• What is bereavement?• Stages of bereavement• The importance of mourning• Coping with grief• How to tell if grief has become
depression• What is bereavement counseling?• Further help
What is bereavement?
Period of confusion after a sudden emotional and physical loss
Neurochemical changes-autonomic + endocrine
Manifests in physical signs and symptoms - fatigue
Non acceptance-denial syndrome
Period of irrational self-blame
Depression/anxiety
Stages of bereavement
• Not everyone experiences the same stages of bereavement at the same time or in the same order,
• accepting that your loss really happened• experiencing the pain that comes with grief• trying to adjust to life without the person who
died• putting less emotional energy into your grief and
finding a new place to put it i.e. moving on.
Accepting that your loss really happened
• Nothing prepares for the loss of a loved one. • Even when a person is ill & their death coming
for a long time.• When it comes there is disbelief,• Expect to see the person appear in a crowd,• Feeling of loss of appendage,• No grief
Experiencing the pain that comes with grief
• Grief is complex• sorrow• longing (to see them again)• guilt• numbness• anger• hopelessness• loneliness• despair.
Trying to adjust to life without them
• Adjustment to a new life. • Coping will depend on relationship with loss,• Change to life are bigger if contact is low• Feel like you are in a different dimension,
unreal.• Realise that everyday life has to go on,• With time of adjustment to life without them.
Moving on
• Life begins to take you on a new route,• Memory of loss is there,• Grieving is continuous,• Find alternate resources
The importance of mourning
• Mourning is an important part of bereavement. • Mourning involves rituals like funerals,
solicitations, and anniversary celebrations,• Mourning allows us to say goodbye. • Seeing the body, watching the burial, or scattering
the ashes or ways of where the remains are is a way of affirming what has happened.
• See evidence that a person really has died before we can truly enter into the grieving process.
What is bereavement counseling?
• Offer an understanding of the mourning process
• Explore areas that could potentially prevent you from moving on
• Help resolve areas of conflict still remaining• Help you to adjust to a new sense of self• Address possible issues of depression or
suicidal thoughts.
Assignment
• Name three techniques of counseling and discuss issues relating to such techniques.
• Total of 500 words• 1 ½ line spacing• Word format• Send to [email protected]
Thank you for your attention