COUNSELING

Counseling is a therapeutic dialogue intended to increase a person’s self-understanding and emotional independence. Sigmund Freud spoke of the “talking cure”.

It involves:

• Support and encouragement

• Non-possessive warmth

• Listening skills

• Ventilation of feelings

• Non-judgmental attitudes

At its simplest, counseling is help that anyone with warmth and common sense can give to help restore a person’s self-confidence. Counseling skills are now seen as important to many different professionals.

A trained and experienced counselor will have a repertoire of approaches and styles to draw upon. Unskilled counselors tend to overuse directive counseling and may dabble dangerously in confrontation and catharsis.

The counselor’s approach must fit the situation. For example, if a person has a short time to live then lengthy insight-orientated psychotherapy is inappropriate.

At a deeper level counseling can help a person make sense of conflicting thoughts and feelings which may be causing irrational (neurotic) behavior. This takes more time and skill and tends to be called psychotherapy. Counseling alone cannot help if there is total disruption of the personality as in a psychosis, or if a person does not want to be helped or changed.

The aims and expectations of the counselor need to be realistic and in agreement with the client or patient.

The effectiveness of counseling depends largely on the personality and skill of the counselor, who should ideally have:

• Genuine concern

• Little interest in status

• An understanding of his own emotional needs

• Support and supervision

Counseling involves a number of essential skills which can be listed as:

• Information-giving (see Explanation)

• Information-receiving

• Clarifying

• Probing

• Empathy

• Confronting (with reality)

• Sharing

• Reassurance (see Reassurance)

• Listening without speaking (see Listening)

• Giving alternative frames of reference

• Interpretation

• Reflection

• Acceptance, affirmation

• Noticing body language (see Non-verbal Communication)

• Giving feedback

• Supporting (see Support)

Problems arise if the counselor is trying to resolve his or her own un-met emotional needs. (Ventilating your own feelings and attitudes is not counseling.)

Skills are best acquired by the practice of counseling, while being supervised by an experienced counselor. Counseling is emotionally demanding and needs to be structured and supported to avoid exhaustion. (see Burn Out)

Short workshops to teach basic counseling techniques, using group work, video filming and feedback on performance, can effectively improve basic skills.

It is estimated that up to 50% of hospice patients and their families want counseling help in dealing with their emotional problems. The few studies that exist support the assumption that emotional support and improved communications reduce anxiety and depression, improve satisfaction and self-esteem, and have a positive effect on the family. More work is needed to measure the effectiveness of these interventions, to assess the different types of interventions, and to develop ways of targeting those patients and family members at high risk. (see Communication Problems, Listening, Talking with Families, Talking with Patients)

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.