COUNSELING
Summarized and written by Warsinah
Pharmacy Department – Medical Faculty
-UNSOED
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:
ü To develop understanding of
intrapersonal and interpersonal problems
ü To define goals
ü To make decisions
ü To plan a course of action reflecting
the needs, interests and abilities of the individual, family or group
ü 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
w Concentrate
w Keep eye contact
w Show interest body language
w Encourage client to talk
w Ask client to explain
w Re check use paraphrase
w Leave your opinion
w 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:
v Acceptance
Counselor
should accept clients as they are, and understand the diversity
v Individual
Except
for the group counseling, individual counseling should implemented individually
and the client should be seen as an unique
person.
v Confidentiality
The
confidentiality of client’ problem should be kept
v The client is the decision maker
Counselor
should let the clients to make their own decision
v Emotion control
What
ever the reaction or behavior of clients, counselor should stay calm
v 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:
Ø 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)
Ø 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?”
Ø 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
Ø 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
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