COUN110 Lecture Notes - Lecture 11: Therapeutic Relationship, Rationality, Professional Code Of Quebec
!!
Intake
• Intake is the initial contact the client has with the counsellor or counselling service
(agency) !
• This may involve initial screening over the phone when the client rings to make an
appointment:
– Identifies if the client is suitable for counselling • Is there a problem?
• Can this problem be addressed through counselling?
• Is the context one in which the counsellor has sufficient experience?
– Develops an understanding of the problem – Develops an understanding of the
client !
• The nature of intake processes depends on the counsellor’s/agency’s philosophical
and theoretical framework !
• Building therapeutic relationship is the most important component !
!!
Examples of different approaches
• Psychodynamic Psychotherapy(PPT) !
– Exploring possible relationship patterns from early childhood that relate to
current problem !
• Person-Centred Therapy(PCT)!
– Exploring present experiencing!
– Looking for conditions of worth, locus of evaluation !
• Cognitive Behaviour Therapy(CBT)!
– Looking for evidence of dysfunctional thoughts or illogical patterns of thinking!
• Solution Focused Therapy(SFT) !
– No intake process !
!!
Intake
• Intake may be formal or informal !
– Formal approaches often involve intake form(s) and/or an intake interview !
• an assessment tool!
• task of establishing a therapeutic alliance is an integral element !
– Be aware that these can be influenced by:!
• client’s temperament or feelings regarding the intake or counsellor !
• the intake’s setting!
• the counsellor’s own feelings !
• Less formal intake approaches identify and explore the client’s presenting concern: !
– Determine the client’s primary reason for coming to therapy !
– Emphasis on understanding the client’s experience !
– Often follows a particular framework !
• For example (5 Ps model) !
– Presenting concerns!
– Predisposing factors!
– Precipitating factors !
– Perpetuating factors !
– Protective factors !
Common areas explored during intake
• personal history and info(particularly relevant to PPT) !
–!!including family dynamics !
!family history with similar complaints !
–!!health !
–!!substance abuse, and anything else that might be impacting the client’s
presenting issue. !
• review current functioning:!
– client’s current level of functioning
– strengths
– coping skills
– adaptive self-care !
!!
Setting up safety for the client
• Holding environment !
–!!substitute holding environment based on the mother/infant bond !
–!!Winnicott wrote: “A correct and well-timed interpretation in an analytic
treatment gives a sense of being held physically that is more real...than if a real
holding or nursing had taken place. Understanding goes deeper” !
• Going at client’s pace !
Intake Skills
• The intake session is also the first counselling session and like any other session
requires the therapist to: !
– Use active listening skills (i.e., foundation skills) !
• Minimal encouragers !
• Restatements/Paraphrasing !
• Reflecting feeling!
• Summarising !
– Establish rapport / build therapeutic alliance (bond, goals, tasks) !
• In addition, the session involves assessment (formal or informal) !
!!
Case Formulation
• Information gathered during intake is used to develop an initial formulation (after the
counselling session) !
–!!Formulation depends on theoretical approach !
–!!Formulation is tentative !
–!!Formulation may be shared with client (e.g., CBT) in following session !
–!!Formulation is updated/revised as new information comes to light !
–!!Formulation identifies!
• Therapist’s ideas about goals for therapy
• How the client’s problem has developed
• The therapeutic interventions the counsellor may use !
!!
Situations
• Singh (2007) proposes five situations in which a therapist needs to refer: !
–!!Therapist uncovers issues or concerns that are beyond their capacity (i.e. their
limits of proficiency) !
–!!Therapist feels their personality and the clients are not compatible and this is
interfering with the counselling process !
–!!Potential clients who are relatives or personal friends !
–!!Client is hesitant of sharing their issues with the counsellor for
whatever reason !
–!!Following several counselling sessions, the counsellor feels that the therapy has
not shown any signs of being effective !
!!
Referral
• Referral can be perceived by the client as – a form of rejection
– an indication that they can’t be helped – or a betrayal of trust. !
• Essential to refers ensitively !
• Mutual trust and respect !
• Offer alternatives to the client !
• Ensure client confidentiality is upheld !
• Maintain therapeutic support until alternative therapy is established !
!!
Termination
The Termination Stage is the final stage of counselling, but is just as important as the
initial phase of counselling.
How you close your counselling relationship can have a significant impact on your client’s
view of his or her experience in counselling and the likelihood of their practicing what
has been learned in counselling after sessions have concluded.
The longer the treatment, the more time that needs to be given to the process of
termination.
!!
Reasons for Termination
• Break in treatment !
• Therapist leaving permanently !
– Ethics involved !
• Client leaving permanently !
– Dissatisfied with treatment
– Not ready for treatment !
– Money
– Time
– Impasse
– Grudge
– Resistance
– Cut and run- Sometimes we don’t know why !
– Boundary violations !
• Client cured! !
When?
• After months or years of hardwork !
• After !
–!!good rapport !
