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Counselling Skills

Case Study

By Karyn Krawford 04/2011

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Introduction

There are a number of important micro skills a counsellor uses to help clients and this

case study sheds light on how a client can benefit from the appropriate use of them

and what negative outcome can arise from not using them.

This case study examines a counsellor and clients first session. In the beginning the

counsellor positively uses counselling skills to both enhance the counsellor-client

relationship and to prompt the client to tell her story. In proceeding transactions the

counsellor fails to use skills that are identified as essential to use in this context and

instead makes inaccurate judgements on the client with a false diagnosis bringing the

relationship to a negative end.

Egan (2010), provides a well referenced framework of using counselling skills from a

micro perspective that focuses on the importance of communication skills, while Carl

Rodgers (1985) uses a person centred approach to counselling that is widely accepted

and used in the counselling field, that makes clear the importance of putting the client

first and a focus on the growing relationship essential for a client to grow and heal.

Together with the insight provided by these theories and the results of the examination

of the counselling session called Helping Rose, this case study brings to light

strengths and weaknesses within the counselling session and possible suggestions for

how this might be improved.

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Counselling Session Overview

Rose is a first time mother with a five year old daughter who has been unable to sleep

alone in her bed without crying and insisting on sleeping with Rose. At first Rose

allowed her daughter to sleep with her to stop her crying, however she has recently

decided this must stop and has become increasingly frustrated in using various

behavioural strategies to try changing her daughters behaviour. After five years of

this, Rose is almost desperate for help in resolving the problem when she comes to her

first session with counsellor Dr Berenson (DB).

As DB listens to Rose she talks more about her problem. Not long after the session

has begun, DB stops listening and puts forward an idea that he explains is

spontaneous. The idea consists of his perception of how the problem lies within Rose

and not her daughter. Further attempts by Rose to talk about her problem are

interrupted by DB at which point Rose speaks less and less as DB increases his

talking. DB leads the session to a conclusion that Rose needs to form a closer,

spontaneous partnership with her daughter and to use her own internal signals from

her heart rather than her head. After failing to be heard, Rose seems to give up and

ends up agreeing with DB.

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Counselling Skills Application

One of the leading writers on counselling skills is Professor Gerard Egan from

Chicago, an organisational consultant and lecturer who has produced nine editions on

his problem management and opportunity development framework (Egan, 2010). He

believes there are logical developmental stages a counsellor and client must go

through in order to solve any problem. The first of these stages is called The current

picture, Egan, 2010 (chapter 4), (pg 93), where the counsellor aims to find out what

is going on with this person, what are their key issues, resources and opportunities,

resulting in the development of a mutually trusting relationship and clear picture for

the counsellor and client to work on collaboratively.

Developing this working partnership which helps a client tell their story requires the

effective use of counselling skills that include the following;

Listening

Egan (2010) describes active listening as the foundation of understanding and is of

such importance he has dedicated a whole chapter on the subject. Effective

listening.....is not something that just happens. Its an activity. In other words,

effective listening requires work. McLeod (2007), explains it conveys to the client

the counsellor wants to know more, is curious, patient and they are of great

importance. Furthermore, it is not just listening for what is being said but how it is

being said, Armstrong (2006).

In this counselling session DB was clearly showing he was actively listening by

giving indicators of hmmm and ummm at the beginning. According to Egan

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(2010) and Armstrong (2006), using small indicators like this conveys the message

that the counsellor is interested, keeps the client focused on their issue and prompts

the client to talk more. Similarly Hackney & Cormier (2009), explain these short

verbal encouragers as having a powerful effect in communicating interest and

encouraging expression.

As DB listens, Rose talks more. However DB stops listening after a short time and

proceeds to explain his ideas spontaneously when he says I have an impulse to be

very initiative with you right now, he then proceeds to tell Rose what might be called

his diagnosis of her and her problems. Egan (2010) provides a possible explanation

for the type of listening DB used called evaluative listening. This type of listening is

judgemental on what the other person is saying to be good/bad/wrong/right. It also

gives way to advice giving which is exactly what DB proceeds to do next in the next

sentences. Egan (2010) explains this will put people off and judgements should be

put aside until understanding of clients stories, worlds and viewpoints has been

established.

Similarly, DB interrupts Rose a few times which effectively means according to Egan

(2010) the person has stopped listening and often means they say things they have

been rehearsing.

The highest level of listening according to Egan (2010) is called empathic listening,

when the counsellor puts aside their own experiencing of reality and sense the

experiencing of the client as if it were their own (Mearns & Thorne, 2007, Hackney &

Cormier, 2009).

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Empathy

Mearns & Thorne (2007) describe the most advanced level of empathic responding is

to show an understanding beyond the clients immediate awareness by communicating

not just the surface feelings but the underlying feelings.

DB effectively responded empathically with Rose a few times during the session.

One response was very accurate when he said it leaves you feeling kind of helpless

which Rose responded Right. Thats exactly what it was. Hackney & Cormier

(2009) explain expressions such as yes thats it or thats exactly how I feel are

acknowledging an accurate understanding of both their meaning and content.

Genuineness

Carl Rogers created a Humanistic approach called the person-centred approach which

focuses on putting first both the client and the relationship between the counsellor and

client. One of the necessary elements of this approach is the counsellors ability to be

real and genuine with the client. This means being congruent and sharing openly,

feelings and attitudes in the moment which can be communicated if appropriate.

Furthermore, Hackney & Cormier (2009) state the genuine counsellor is open to the

experience, comfortable with themself and those behaviours that help clients. They

note spontaneity is used in reference to genuineness but doesnt include verbalising

passing thoughts and ideas that come into the mind.

While DB was being open and spontaneous with his thoughts and his shared feelings

of uncertainty by saying he wasnt sure he was doing the right thing by sharing this

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information because he didnt know how it would impact the counselling session, he

wouldnt be helping Rose because he is taking the focus off her and her problems and

focusing on his ideas. It was clear from Roses response of Ah, um? that she didnt

agree with this idea and possibly didnt understand what he meant. DB proceeded to

elaborate further without recognising her responses.

Similarly, caring is a fundamental aspect of the counsellor/client relationship and the

counsellor should be communicating this in terms of paying attention, being patient,

anticipating needs, putting own needs aside for the other person and displaying

genuine curiosity about the clients views and experiences (McLeod, 2007).

Moreover, acceptance is crucial to forming any trusting relationship especially in the

initial stages and this is done by eliminating any judgemental verbal or non verbal

responses (Hackney & Cormier, 2009). Clearly this didnt happen in this session.

Checking out

At this point DB might have asked Rose what she thought of his idea or waited for her

response. Checking out conveys to the client that they are important, listened to and

the counsellor is focused completely on them and what they have to say. It is a time

that a counsellor pauses in the conversation to find out or enquire about assumptions

or experience at that moment that the client may have (McLeod, 2007). The

counsellor could have asked her if they could stop as he had some questions about

what she had said so far.

At numerous times in this counselling session DB had opportunities to pause and

check the accuracy of his understanding of where Rose was at and her problems. For

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example DB used a potentially good reflection that Rose wanted her daughter to

control her but didnt want to lose control at the same time and Rose responded

yeah, I guess that is true. An improvement DB could have made is to say have I got

this right?...you sound a bit uncertain. This would allow DB to check the accuracy of

his understanding of the message and Rose to feel acknowledged in her response.

Another way to check accuracy according to Egan (2010) is for the counsellor to give

a summary. Summarising is particularly helpful at the beginning of new sessions to

help explore and clarify, moving the discussion forward.

DB would have benefited from summarising with Rose to check his understanding of

what she had said and where they were up to in the session. This may also prompt

Rose to bring up other important areas in her story rather than going over the same

problem repeatedly.

Some clients may require reassurance of the relationship before they can rely on it

which is why counselling often takes time and the importance of building a strong

relationship requires the counsellor to reflect on the impact of what is happening as it

progresses (McLeod, 2007). DB might have used a question such as would it be ok

to pause here so that I can share an important idea that we might be able to explore

together, and then listen to her feedback. By using this approach Rose would

understand they were both in the discussion and more likely to respect what the

counsellor is saying. However at the time of DBs intervention, it was inappropriate

as the session had just begun and DB did not know enough about Rose or her

situation.

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Asking Questions

It is unclear what lead DB to conclude he knew the cause of Roses problems and how

to fix them as he didnt do any basic fact finding. There was alot of information that

would be required before the problem can be clarified such as Roses living

conditions, medical history, social resources, to name a few.

While asking questions needs to be kept to a minimum (Egan, 2010) and done

appropriate to the session and issue at hand (Armstrong, 2006), it might prove

effective for DB to ask some open questions such as you said your daughter was very

ill, what was the problem? and you said we are working on the problem, how does

the other person perceive the problem?

This information will help define the problem which is necessary according to Welfel

& Patterson (2005), who provide a five component process before a hypothesis testing

process of assessment can begin.

DB had been leading this session to a conclusion with Rose reluctantly following

which is contradictory behaviour to what Egan (2010), McLeod (2007), Armstrong

(006), Rogers (1995) and Welfel & Patterson (2005) suggest. They recommend the

counsellor follows the client and is directed by the client. This is based on the

philosophy that humans have an actualising tendency, that have the internal resources

and self directed behaviour given the right conditions of which are explained above

(Rogers, 1995, McLeod, 2007, Welfel & Patterson, 2005).

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Conclusion

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In summary Rose didnt get help from DB, instead she had to struggle to get her story

out, most of what she repeated when DB stopped listening. DB failed in using the

most basic fundamental counselling skills of listening, acceptance, questioning,

accuracy and positive regard for his client. He was instead set on leading Rose down

a path to diagnosis and advice giving.

Thus DB could have continued doing what he was doing well at the beginning which

was to give verbal encourages that allowed Rose to tell her story. That story would

be different and more information would be obtained in order to know how to proceed

next.

The Person-centred Humanistic approach and Egans Counselling Framework are

both effective methods that a counsellor can follow to ensure a collaborative, trusting

partnership is formed first, allowing the client to lead the journey to self discovery

while the counsellor partners with the client on this path.

Many recommendations were made for improvements to this counselling session,

however these suggestions are limited because there was a lack of other important

information such as ethnicity, non verbal communication between the counsellor and

client, what information had already been obtained by DB prior to the session and if a

contract had been established.

Finally there was insufficient space to include other suggestions for improvement

such as challenging and paraphrasing which were not mentioned.

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Reference List

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Armstrong, P. (2006). The practice of counselling. Melbourne: Thomson Higher

Education

Egan, G. (2010). The Skilled Helper. 9th Ed. Brooks/Cole, Cengage Learning.

Belmont, CA

Hackney, H.L., & Cormier, L.S. (2009). The professional counsellor. 6th ed. Sydney:

Pearson Education

McLeod, J. (2007). Counselling Skills. Maidenhead, UK: Open University Press

Mearns, D., & Thorne, B. (2007). Person-centred counselling in action. 3rd Ed.

London: Sage Publications.

Rogers, C. (1995). A way of being. New York: Houghton Mifflin.

Welfel, E.R., & Patterson, L. E. (2005). The counselling process: A multitheoretical

integrative approach. 6th ed. Pacific Grove, CA: Brooks/Cole