Counseling

Theory, Skills and Practice

 Counseling
Theory, Skills and Practice

RADHIKA SOUNDARARAJAN
Practising Pediatric Counselor and Lecturer

Tata McGraw Hill Education Private Limited

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 To
all the philosophers and psychologists
who made today’s science of psychology what it is
 Preface

When I started writing this book, I realized that it was much easier to lecture/counsel
than to write. As a counselor and teacher, with over two decades of experience, I have
taught and learned a lot. I realized that to put it all in a book called for incremental
skills and determination.
This book has been written to fulfill the requirements of students and
practitioners in the field of psychology, counseling, education and social work. It
provides a clear and concise account of different facets of counseling study and
practice. Assuming that the reader has had little or no background in the counseling
theories or methodology, it will serve as a resource book for anyone in the helping
professions as it provides the readers with introductory knowledge about counseling,
theoretical orientations, methodologies, concepts, skills and processes that are of
critical importance. A significant aspect of the book is that it elucidates the present
day Indian scenario, and the subsequent need for counseling.
The book is organized into three parts. Part 1, consisting of four chapters, helps
readers understand the concepts concerning the field, its evolvement and relevance
today. Chapter 1 takes the reader through the journey of counseling psychology,
and fructifying into what it is now. Chapter 2 discusses important issues related to
the western approach to counseling and understanding counseling from the various
vantage points like the client, the medium and the major theoretical orientations.
Chapter 3 expounds the psycho-socio-emotional factors that contribute to the pain
experienced by the Indian psyche, the relevance of spirituality in the therapeutic
process, and the overall scope of the field in India. Chapter 4 provides an introduction
to various developmental theories that a counselor should be conversant with in
order to be effective.
Part 2, consisting of three chapters, turns its focus on the actual process of
counseling, to enable readers gain a practical overview of the counseling process.
Chapter 5 discusses important issues related to the counselor. These include the
educational requirements, and ethical and legal issues that a counselor must be
aware of. Chapter 6 elucidates the personal qualities and values of the counselor,
 viii Preface

and sets out the characteristics, expectations and goals of the person seeking help.
Chapter 7 details a general model of counseling, the role of communication skills,
the stages in and the evaluation of the counseling process.
Part 3 provides an overview of the scope of counseling. Chapters 9 through 13
discuss main areas where specialized counselors may be called upon to function—
like in the education institutions, rehabilitation centers, group settings, and
hospitals. The special areas are by no means exhaustive, but give the readers an idea
of where and how their services may prove useful. Present day trends in field are also
discussed.
Finally a few case studies are presented from my personal counseling
experience to help readers appreciate the application of theory in practice.
I have attempted to cover the field of counseling as broadly as possible, without
entering into in-depth explanations and detail. This is done to provide the readers
with an introductory knowledge of the field of counseling.
RADHIKA SOUNDARARAJAN
 Acknowledgments

Sri Rama Jayam! Sri Gurubhyo namah!

I may have all the six ingredients (effort, initiative, courage, intelligence,
resourcefulness and perseverance) for success, but still there may be something that
makes the difference between success and failure. By my prayer I invoke daivam, the
seventh factor, to take care of the unknown element.
Pranams to Pujya Swami Dayananda Saraswati who helped me understand the
meaning and purpose of this life. I am eternally grateful to Swami Paramarthananda
Saraswati for showing me how best to live. It is indeed the grace of Iswara to have
given me such dedicated and insightful teachers.
I wish to express my heartfelt gratitude to Dr Aruna Balachandra, for her
guidance and expertise. Without her continued assistance and incessant help, this
project would not have been possible. A more sincere and committed teacher I am
yet to find.
I am deeply thankful to my husband Soundararajan for his support and
encouragement. Thanks to my children Vaishnavi and Mathangi, and my pets
Ritwic and Meghna for providing me with the courage to persist and stay deeply
true to myself; regardless of obstacle, setback or naysayer.
I would not be where I am if my father Ranganathan have had any less faith in
me. I am also grateful to my mother Vasantha for her love and encouragement and
for having looked after my family whenever required.
RADHIKA SOUNDARARAJAN
 Contents

Preface vii
Acknowledgments ix

1. Introduction to Counseling 1
Chapter Overview 1
What is Counseling? 2
Definitions of Counseling 4
Common Problems for Which People Seek Counseling 7
Scope of Counseling Psychologists 7
Origin and History of Counseling 8
Spotlight on Need for Indigenous Models of Counseling 15
Summary 17
References 18

2. Approaches to Therapy 21
Chapter Overview 21
What is Psychotherapy? 22
The Counseling and Psychotherapy Divide 22
The Birth of Psychotherapy 27
Different Facets of Counseling and Psychotherapy 29
The Different Theoretical Orientations 40
Summary 45
References 46

3. Counseling in India 48
Chapter Overview 48
Mental Healthcare Movement in India 49
Counseling and the Indian Scenario 51
Culture and Counseling 55
 xii Contents

Transpersonal Psychology 56
Dimensions of Spiritual Approach to Therapy 60
Inappropriateness of Adhering to Western Approaches 62
Indigenous Models of Counseling 63
Eastern Approach to Counseling: A Combination of Therapy and
Life Coaching 65
Summary 68
References 69

4. Counseling through the Lifespan 72

Chapter Overview 72
Developmental Psychology 73
Counseling and Developmental Psychology 74
Theories of Human Development 76
Theories from Mechanistic Worldview Perspective 79
Jean Piaget’s Theory of Cognitive Development 90
Theories from the Organismic Worldview Perspective 93
Theories from the Contextualistic Worldview Perspective 100
The Indian Focus: Philosophy of Indian Counseling 104
Four Types of Human Goals 107
Summary 108
References 109

5. Preparing to be a Counselor 110

Chapter Overview 110
Education and Training for Careers in Counseling Psychology 112
Preparation of Counselors 113
Qualification of Counselors 115
Counselor Certification 118
Selection and Training of Professional Counselors 119
Counseling Supervision 122
Choosing a Graduate Program 134
Summary 140
References 143

6. The Counselor and the Counselee 145

Chapter Overview 145
The Counselor 145
Philosophy and Attitude of a Professional Counselor 146
Personality of Effective Counselors 150
Skills of a Counselor 151
 Contents xiii

Values in Counseling 161

Ethical Considerations for a Counselor 167
The Counselee 169
The Counselee Characteristics and Variables 169
Characteristics of a Successful Counselee 170
Counselee Expectations 171
Counselee Perceptions 172
Summary 174
References 175

7. Counselor Database 177

Chapter Overview 177
Role of Communication in the Process of Counseling 178
Stages in the Counseling Process (Radhika Soundararajan, 2010) 183
Evaluation of the Process (Swami Paramarthananda Saraswati) 186
An Indigenous Model of Counseling 187
Summary 199
References 200

8. Counseling in the Educational Setting and

Career Counseling 203
Chapter Overview 203
Counseling in an Educational Setting 203
Who is a School Counselor? 205
System of School Counseling—ASCA National Model 205
Counselor’s Role and Responsibilities in Schools 209
College Counseling 214
Career Counseling 216
Career Theories 219
Campus Recruitment Training Program 225
Summary 227
References 228

9. Workplace Counseling 229

Chapter Overview 229
Why Workplace Counseling? 230
Models of Workplace Counseling 234
Theoretical Models of Stress 236
Workplace Counseling in India 240
Summary 241
References 243
 xiv Contents

10. Hospital Counseling 244

Chapter Overview 244
Grief Counseling 247
Counseling the Terminally Ill 259
Pain Management Counseling 265
Rehabilitation Counseling in the Hospital 275
Summary 281
References 281

11. Trauma Counseling: Psychological First Aid 284

Chapter Overview 284
What is Psychological First Aid? 284
Delivering PFA: Professional Behavior 292
Some Guidelines for PFA Administration 295
Applications of PFA 300
PFA for Students and Teachers 303
Summary 305
References 305

12. Counseling in Special Situations 307

Chapter Overview 307
Relationship Counseling 308
Rehabilitation Counseling 315
Issues Relevant to the Mental and Physical Well-being of Women 321
Social Injustice Issue Counseling 326
Addiction Counseling 327
Counseling Juvenile Delinquents 330
Suicide Counseling 333
Fatigue and Taking Care of Oneself 337
Spirituality and Wellness 348
Summary 350
References 353

13. Modern Trends in the Field of Counseling 357

Chapter Overview 357
Life Coaching 357
Mentoring 363
Consulting 367
Training 369
 Contents xv

Convergence of Approaches and Thinking 372

Stress Release Scenario in India Today 375
Summary 378
References 379

Case Studies 383

Index 399
 1
Introduction to Counseling

Chapter Overview
What is counseling?
Definitions of counseling
Common problems for which people seek counseling
Scope of counseling psychologists
Origin and history of counseling
Spotlight on need for indigenous models of counseling

T
he quest for happiness and avoidance of pain has been on from time
immemorial. Mankind, in this quest, has been facing a multitude of
obstacles. Seeking help to overcome them thus, is not new. This help
used to be sought from the learned, the clerics, or the old and wise. With people’s
domains widening, work and social milieu expanding, secrecy and privacy issues
gaining importance, people started looking towards professionals to help resolve
their problems. Commonly, practitioners counseled people about their anxieties,
marriages, careers, raising children, as well as advised people how to run their
companies, how to boost the morale of their workers, etc. In addition, spiritual
gurus sought to make people aware of the meaning of life, goals of an actualized
person, and showed the path and practice to achieve spiritual goals.
The concept of counseling (spelt ‘counselling’ in UK English) has actually been
around for ages, and it reflects the need for one person of seeking help or advice
from another professionally qualified person.
The counseling profession evolved from psychology and psychotherapy to
help those with normal developmental issues and everyday stress rather than
psychopathology. The counselor, through direct advice or non-directive guidance,
helps the counselee or client to overcome emotional distress by making rational
 2 Counseling: Theory, Skills and Practice

decisions. Counseling psychology is a sub-discipline of psychology that facilitates

personal and interpersonal functioning across a person’s lifespan with focus on
emotional, social, vocational, educational, health-related, developmental, and
organizational concerns.
Psychology as a profession was practiced for a long time before the science of
psychology was developed. Even before the term psychologist came into public use
there were people seeking as well as providing psychological help.
Today’s world is changing so fast that past “truths’’ often mislead us instead
of providing help. No longer is it easy to apply past truths to the problems of the
present and the future. Today’s world “calls for new approaches to experience, both
in acquiring it and in using what we already have’’ (Stevens, 1963, p. 56). Modern
society is characterized by rapid change and technological advancement. Perhaps
never in the history of humankind have so many changes occurred simultaneously
and with such acceleration over so broad a spectrum of man’s affairs. Changes
witnessed during the recent past are seen to represent and even took place at
accelerated speed compared to those of previous decades (Raina, 1989, p.43).
Mitchell (1993) explains the major global changes that have continued into the
21st century. He describes the “accelerating rate of change on a global scale,” pointing
to the rate of change of human invention, the speed of generation of new knowledge,
human population growth, and the evolution and speed of human transportation.
He maintains that information explosion is taking place at an unimaginable speed
and that most of the things that the young children are currently learning will be
obsolete by the time they grow up. This puts a lot of pressure on them to keep
themselves updated continuously and consistently.
While a very strong case is being made in the scientific community about the past
being obsolete, an equally strong, perhaps even stronger argument is being placed
about the importance of not breaking the string, which links us to our past. This
string provides us with the sanity associated with continuity and peace related to
history.

WHAT IS COUNSELING?

Life is fraught with stress, anxiety, and challenges. When one feels uncomfortable or
overwhelmed with these challenges, he/she can talk to a professional in a completely
confidential setting. This process is called counseling. Counseling results are more
favorable when clients understand what to expect from the process. This book will
provide some information to assist students of counseling in helping the clients to
understand the broad field of counseling and the intricacies of its process.
 Introduction to Counseling 3

Living is a process of continuously adjusting ourselves to the environment as well

as making necessary and possible modifications in our lifestyle so as to suit our needs
and requirements. These processes consume our physical and mental energies to a
significant extent. As the civilization becomes more and more complex, the process
of living becomes more knotty. Though scientific and technological advances make
our lives more comfortable, they also make it more complicated. Conflicts have
multiplied and as a result, decision-making needs have risen exponentially.
Many of our problems stem from what we want and what we think we should
want—a tug of war between the priorities of the head and the heart. The task
then would be to get our priorities right and synchronized—to want what is right.
Maintaining this consistently throughout our lives is most difficult. Thus, all our
problems originate in our mind. Yet, this is the glory of the human mind: its unique
capacity to inquire into the nature and meaning of things, to reason out, to analyze,
to appreciate subtleties, to imagine, to conceptualize, to come to conclusions, and
to make choices.
Ironically, we yearn for the simple living of the yesteryears, while holding on to
the comforts of the present world. All around, we see people struggling to make
progress. Paradoxically, we tend to glorify the uncomplicated existence of our
forefathers. Innumerable debates center on this issue. In such a conflicting situation,
the need for counseling is now felt like never before.
Counseling describes how a person functions effectively or ineffectively in
one or more of the following dimensions of life: need satisfaction, stress and the
coping processes, developmental task attainment, social contact and interpersonal
relationship skills, and other personal or characteristic attributes. It then discusses the
major problems that can impede the effective functioning of individuals. Counseling
also illustrates at length that individuals who are functioning effectively usually (1)
satisfy their needs in appropriate ways, (2) deal with pressure efficiently, (3) handle
their emotions as well as emotional reactions effectively, (4) learn tasks that are
appropriate to their developmental stage, (5) have meaningful social interactions
and interpersonal relationships, and (6) display other positive attributes.
Here are some general characteristics of counseling:
It is concerned with “normal” problems rather than mental health
problems.
It is more concerned with present events than with those of the past.
It is more concerned with conscious, rational thinking than with
unconscious functioning
It is concerned with the individual’s role function in different settings
wherein choices are to be made and actions are to be taken.
Counselors also assist their clients in areas of academic achievement, emotional/
psychological and physical health, career involvement, and responsible decision
making. The process of counseling empowers the clients to meet these needs. The
 4 Counseling: Theory, Skills and Practice

clients need to understand that seeking counseling is not a sign of weakness. On

the contrary, an individual needs courage to explore sensitive feelings and painful
experiences. Those who take the first step in resolving problems by seeking counseling
display their insight and inner strength. Counseling is more productive if the clients
are very clear about the process of counseling. It should be understood that counseling
is not a quick fix, and the counselor will not tell you what you should do. Rather,
he/she will let the client have the opportunity to explore feelings, values, thoughts,
concerns, and develop goals and steps leading to those goals. The client then makes
choices and decisions. The counselor just helps free the intellectual functioning of
the individual, which is hidden behind his/her emotional distress. Counseling is an
opportunity for an individual to talk over with a trained and objective person from
whom a new perspective on the situation can be gained. It also helps the individual
learn new skills to help resolve current concern and become more capable of solving
new problems on their own in the future.
In short, counseling promotes growth and helps to
express feelings in a safe, supportive and non-judgmental atmosphere,
identify and sort out problems,
identify longstanding patterns of behavior that keep one from solving
problems and developing new ways to look at them,
improve coping skills,
identify and achieve goals, and
help recognize internal worth and examine the way one sees oneself.

DEFINITIONS OF COUNSELING

The word “counseling” derives from the Middle English counseil, Old French conseil,
Latin cõnsilium, akin to cõnsulere, meaning to take counsel, consult. Counseling
can be defined as a relatively short-term, interpersonal, theory-based process of
helping persons who are fundamentally psychologically healthy to help resolve their
developmental and situational issues (add.about.com).
There are probably as many definitions of counseling as there are practitioners to
describe it. The term was originally used by Frank Parsons in 1908. Later on there
was a widespread prejudice in the United States against lay therapists. In response
and also because he was not permitted by the psychiatry professionals to call himself
a psychotherapist then Carl Rogers adopted the term (babylon.com).
Counseling is an interactive process of bringing together the counselee who needs
assistance and the counselor who is trained and educated to provide assistance to
the counselee (Perez, 1965). The counselor can initiate, facilitate, and maintain the
interactive process if he or she communicates feelings of spontaneity and warmth,
tolerance, respect, and sincerity.
 Introduction to Counseling 5

Smith (1955) defines counseling as “a process in which the counselor assists the
counselee to make interpretations of facts relating to a choice, plan or adjustments
which he needs to make.” Blocher (1966) described it as “helping an individual
become aware of himself and the ways in which he is reacting to the influence of
his environment. It further helps him to establish some personal meaning for his
behavior; and to develop and clarify a set of goals and value for future behavior.”
Rogers (1952) describes counseling as the process by which “the structure of
the self is relaxed in the safety of the client’s relationship with the therapist, and
previously denied experiences are perceived and then integrated into an altered
self.”
There are many more definitions and their explanations are almost the same.
Counseling helps people to examine and deal effectively with life issues. Some
situations faced by people require the need to seek assistance from a mental health
professional. It is an excellent way to examine and solve problems and a healthy way
to deal with the often stressful and discouraging issues that accompany a chronic
illness. Seeking counseling is also a responsible way to take care of oneself, especially
if the issues are beyond the normal problems encountered in daily life.
A self-conscious and self-aware person is appreciative of something that is lacking
in himself/herself. His mind, being an instrument of reason, searches for means
to overcome this deficiency and the person has a constant tendency to desire and,
according to his knowledge and values, tries to achieve it. Being acutely aware of
his/her anxieties and lack of peace within, she/he tries to overcome it through the
resources available to him/her. This awareness has three dimensions:
Awareness of the intensity of the problem depending on how unpleasant it
makes one feel.
Awareness of the consequences of the problem: how bad they are.
Awareness of the depth of the urge to come out of the problem.
When one recognizes his helplessness, uncertainty, and incapacity to accomplish
what she/he wants; that there is uncertainty with reference to the fulfillment of
wishes and desires; that there are limitations of strength in terms of will and the
capacity to make the necessary effort; that there are also limitations in terms of
knowledge and resources; that there is an absence of freedom mentally, that there is
the acknowledgment of one’s helplessness.
This helplessness takes on the following thought patterns:
“I can’t do it alone!”
“I feel trapped and there’s nowhere to turn!”
“There is no solution in sight!”
“I’ve tried to change, but things aren’t getting better!”
“My feelings are affecting my sleep, food habits, job and relationships!”
“I am always worried and I don’t like myself!”
“Even small issues daunt me!”
 6 Counseling: Theory, Skills and Practice

In these circumstances when one is overwhelmed by helplessness, she/he seeks

the help of a counselor.
A counselor or a therapist is someone who can remain objective about the client’s
situation. This means that outside of counseling, she/he is not a part of their daily
life and can therefore, view things from a different, often clearer, perspective than
a family member or close friend who is very emotionally involved with them.
Additionally, one can talk to the counselor openly without feeling judged.
Counseling psychology through the integration of theory, research and practice,
and with sensitivity to multicultural issue, facilitates personal and interpersonal
functioning across the lifespan focusing on emotional, social, vocational, educational,
health-related, developmental, and organizational concerns. Through this specialty
it encompasses a broad range of practices that help people improve their well-being,
alleviate distress and maladjustment, resolve crises, and increase their ability to live
more highly functioning lives.
Although counseling psychology and clinical psychology are closely related, they
differ in several very subtle ways. First, while counseling psychologists typically
focus on less severe psychopathology (e.g., depression and anxiety), and everyday
trials and tribulations, clinical psychologists take care of individuals with serious
emotional and cognitive disturbances (e.g., schizophrenia or personality disorders).
Second, counseling psychologists are more likely than clinical psychologists to
assume a client-centered or humanistic theoretical approach. Finally, counseling
psychology is unique in its attention both to normal developmental issues as well
as the problems associated with physical, emotional, and mental disorders. Despite
these differences, counseling and clinical psychology are becoming increasingly
indistinguishable, leading some to suggest that these fields should be combined.
It is helpful to understand the titles and functions of different professionals.
A psychiatrist is a medical doctor who specializes in treating persons with mental
disorders or those experiencing difficulties in their lives. Psychiatrists can prescribe
medications; however, it is important to remember that one can seek help from a
psychiatrist without having a mental disorder or needing medication. There are
many psychiatrists who are excellent therapists in addition to their knowledge
of medication. A psychologist is a professional trained to provide counseling and
therapy. Many psychologists are qualified to administer psychological testing. There
is often confusion about psychiatrists and psychologists. Unlike a psychiatrist, a
psychologist is not a medical doctor and cannot write prescriptions for medication.
A social worker is a professional who is trained to provide counseling and therapy.
Additionally, social workers often provide community resource and advocacy
services.
Counseling distinguishes itself from other mental health disciplines, such as
psychiatry, social work and clinical psychology by both history and emphasis. While
psychiatry and clinical psychology concentrate primarily on the treatment of severe
 Introduction to Counseling 7

emotional disorders, social work deals basically with the social and legal aspects of
assisting others in need, whereas counseling mainly focuses on development and
the prevention of serious mental health problems through education and short-
term treatment. It emphasizes growth as well as remediation. Counselors work with
persons, groups, families, and systems that are experiencing situational and long-
term problems. This stress of counseling on development, prevention, and treatment
make it attractive to those seeking healthy life-stage transitions and productive lives
(Cole & Sarnoff, 1980; Romano, 1992).

COMMON PROBLEMS FOR WHICH PEOPLE SEEK

COUNSELING
Anxiety and depression
Family and relationship issues
Substance abuse and other addictions
Sexual abuse, rape, and domestic violence
Eating disorders
Career changes and job stress
Social and emotional issues related to illness and disability
Adaptation to life changes
Grief and bereavement
Problems with shame
Problems dealing with anger
Self-injurious behavior

SCOPE OF COUNSELING PSYCHOLOGISTS

Counseling psychologists perform so many different functions that it is hard to give
a synopsis of their role. Generally speaking, a counseling psychologist can consult
with a variety of agencies (e.g., schools, government, private organizations), teach at
the college level (undergraduate and graduate levels), do research, administer therapy
(e.g., group, individual, family), hold academic administrative positions (e.g., dean
of a college), among others.
Counseling psychologists study and work in a variety of settings. Some areas that
counseling psychologists work in and study are as follows:
Vocational psychology
Child development
Adolescent development
Adult development/aging
 8 Counseling: Theory, Skills and Practice

Health psychology (e.g., including long-term care, AIDS, cancer, etc.)

Mental illness (e.g., anxiety disorders)
Forensic psychology
Sport psychology
Neuropsychology
Aggression/anger control
Anxiety disorders
Interpersonal relationships
Assessment
Rehabilitation
Community psychology
Counseling process/outcome
Group processes
Crisis intervention
Developmental disabilities
Eating disorders
Substance abuse
Suicidal and homicidal tendencies
Supervision
Multiculturalism

ORIGIN AND HISTORY OF COUNSELING

Emergence of Counseling as a Profession

The quest for the objective truth has always weighed the intelligent man down.
The many religions and philosophical orientations hold testimony for this quest.
Psychology, which emerged from both religion and philosophy, has been evolving
along a similar path. It is only recently that psychologists have shelved the idea of
“new theory” and concentrated on “new techniques” using the knowledge uncovered
by others before them. This practice has led techniques to become gimmicks!
Psychologists claim to have developed techniques through experience, observation
and reasoning. Though it is commendable that many “objective truths” have been
uncovered, the credibility of the field suffers from various differences of opinions,
foolhardy steadfastness, and unhealthy critiques.
Professional psychotherapy had its beginning with the work of Dr Sigmund
Freud at the turn of the twentieth century. Psychoanalysis made fascinating inroads
into the science of human behavior. A number of eager disciples were attracted to
it, but Freud was unable to hold them. Noting discrepancies and exaggerations
in the system, they branched off and proceeded to launch their own schools of
psychotherapy. After the founding of Freudian psychoanalysis, and the various
 Introduction to Counseling 9

subsequent neo-Freudian spin-offs, the field witnessed a proliferation of theoretical

approaches to psychotherapy.
The branching off of various ideological adherents in so dogmatic a manner
exhibited a total failure to acknowledge that human being is a total entity. Each
new system of therapy faulted, to some degree, all of its predecessors and claimed a
status superior to them on one ground or another. Like the story of the nine blind
men sizing up the elephant, each segment claimed superiority over the others to the
extent that some of them even refused to acknowledge the contribution of others.
Thus, after chancing upon one “truth,” they disqualified themselves from the arena
of integrity in their profession, objectivity in their mission, and humility in their
attitude, which determine success in their quest.
In this rat race for attention and superiority, psychologists have denied the “whole”
character of man, and focused instead on what they considered to be predominant
features in his making and breaking. They made pieces out of his personality, spread
them out, and concentrated deeply on each of the personality traits so much that
they have lost the total picture altogether. They claimed that “the theory was bigger
than any one individual, and exceptions proved the rule!”. Empathy lost out to
statistics; respect lost out to labels; compassion lost out to arrogance; and integrity
lost out to zeal.
Thus, by and large, the divisions in psychology have failed humankind. It is very
healthy to have a different point of view, to do an in-depth analysis on it, and to
bring out its merits. But holding on steadfastly to them, without also pointing out to
where that point is less than complete, without recognizing the pluses of the efforts
of others, is sad and, more importantly, not objective. Objectivity only lends any
stream of study its credibility. Only then it can boast of a wholesome view as well as
giving credit to other possibilities. Recognizing the strength of the self is alright, but
this should not distance one from recognizing the contribution of others.
Every theoretical orientation has merits and demerits; adhering steadfastly to
one particular theory is not the preserve of an intelligent and wise psychologist. It
is unprofitable to say the least, and at the most, that it is dangerous. No theory has
proven to be the best in terms of its application in therapy. The various schools of
psychotherapy have basic commonalities, which transcend the disparate teaching
and treatment approaches. The only way to rise above professional dogmatism and
bigotry is to realize this fact and steadfastly apply the principles of humanity in the
helping profession.
Counseling as a profession has evolved over the years. Nevertheless, many people,
even now, associate all counseling with schools or equate the word guidance with
counseling. C.H. Patterson, a pioneer in counseling, once observed that some writers
in counseling journals seem “ignorant of the history of the counseling profession…
(and thus) go over the same ground covered in the publications of the 1950s and
1960s” (Goodyear & Watkins, 1983, p. 594 from counseling.org ). Therefore, it is
 10 Counseling: Theory, Skills and Practice

important to examine the history of counseling because a counselor who is informed

about the evolution of the profession is more likely to make real contributions to
the field.
The emergence of counseling as a profession occurred in two stages over the
course of the 20th century, with roughly the first 50 years being a role development
stage and the last 50 years a profession development stage. History traces the roots of
the profession to educational and vocational guidance, mental health movement, and
the emergence of psychotherapy. Counseling has originated from many sources.

Evolution from the Guidance Movement

(Adapted from en.wikipedia.org).
At the beginning of the 20th century in the United States, Jesse B. Davis, a principal
in the Grand Rapids, Michigan, and known as the Father of School Counseling,
instituted weekly guidance lessons in English classes in the school system with the
goal of building characters and preventing problems. This marked the beginning of
the vocational guidance movement. Counseling then emerged from this educational
guidance movement.
In 1907, he encouraged the school English teachers to use compositions and
lessons to relate career interests, develop character, and avoid behavioral problems.
In 1908, Frank Parsons (Father of Guidance) established the Bureau of Vocational
Guidance in Boston to assist young people in making the transition from school to
work. Parson’s framework for vocational guidance was as follows:
Clear understanding of self, aptitudes, abilities, interests, resources,
limitations, etc.
Knowledge of requirements and conditions for success: pros and cons;
compensations, opportunities, prospects in a given line of work.
Apply “true reasoning” to realistically assess likelihood of successful match.
Progressive education which emphasized personal, social, moral development in
schools saw the growth of school guidance and counseling from the 1920s to the
1930s. Many schools reacted to this movement saying that it was anti educational
and demanded that schools only teach the fundamentals of education. This was also
the time which saw the economic hardship of the Great Depression. A combination
of all this led to a decline in school counseling and guidance.
In the 1940s, psychologists and counselors in the United States were called upon
to select, recruit, and train military personnel. The move resulted in development of
psychometric tests which helped understand the students, their needs, capabilities
and personalities better, which could be used to provide better education and
personalized service. Schools too accepted these military tests openly. Also, Carl
Rogers’ emphasis on the helping relationships during this time influenced the
profession of school counseling.
 Introduction to Counseling 11

In the 1950s, the US government established the Guidance and Personnel

Services Section in the Division of State and Local School Systems. In 1957, the
space race between the United States and the Russians commenced with the Soviet
Union launching Sputnik I. The American government reacted with nervousness
and anxiety, which had military implications. The American government, which
became concerned that there were not enough scientists and mathematicians,
established the National Education Act, which spurred a huge growth in vocational
guidance through large amounts of funding.
Since the 1960s, the profession of school counseling has continued to grow as new
legislation and new professional developments were established to refine and further
the profession and improve education (Schmidt, 2003). The growth of what is now
known Counselor Education Programs was initiated then, with school counseling
beginning to depart from focusing exclusively on career development to student
personal and social issues. Thanks to Norm Gysbers, school counselors developed
into more strategic and dynamic partners in the school system, responsible for the
systemic goal of having a comprehensive developmental school counseling program
for all students K-12 (ASCA, 2005)
However, this enthusiasm in school counseling saw a decline in the 1980s and
early 1990s, as the standards-based educational movement gained strength. The
systemic role of the school counselor reduced in value. This saw the birth of the ASCA
National Standards for School Counseling with three core domains (Academic,
Career, Personal/Social), nine standards, and specific competencies and indicators
for K-12 students (ASCA, 2005). In 1997 the ASCA standards were published,
which ushered in a unique period of professionalization and strengthening of school
counseling identity, roles, and programs.

Evolution from the Mental Health Movement

(Adapted from extramile.us)
In 1909, Clifford W. Beers founded the National Mental Health Association.
This association strove to improve mental health care and fight discrimination
against people with mental illness. This marked the beginning of the mental health
movement which had a favorable effect on guidance and counseling. Thus Beers has
often been called the founder of the modern mental health movement.
He recorded his memoirs in his autobiography A Mind that found itself for which
the Foreword was written by famed philosopher Dr William James who had been so
moved by early drafts of the book that he wrote the Preface. Through this he shared
his own experience with mental illness and the deplorable treatment he received
from the care givers. This book had an immediate impact which helped spread
Beers’ vision of a massive mental health reform movement. It was later translated
into several foreign languages and was well received across the globe. Beers then duly
 12 Counseling: Theory, Skills and Practice

devoted his life to create awareness about mental illness and its care in the United
States and throughout the world. His goal was to improve mental health care and
fight discrimination against people with mental illness. To this end he founded the
National Mental Health Association in 1909. This led to the creation of the modern
mental health movement.

A pen rather than a lance has been my weapon of offence and defence; with its point I
should prick the civic conscience and bring into a neglected field men and women who
should act as champions for those afflicted thousands least able to fight for themselves.
—Clifford W. Beers

In 1908, Beers helped launch the Connecticut Society for Mental Hygiene which
became the first of several state societies that would work to improve mental health
care and reduce stigma, and in 1909, in order to have nationwide reach they created
the National Committee for Mental Hygiene, the precursor to today’s National
Mental Health Association. Their vision was an ambitious plan…preservation of
mental health, prevention of psychiatric disorders, and improvement of care, among
others, to achieve which they set forth the following goals:
To improve attitudes toward mental illness and the mentally ill
To improve services for the mentally ill
To work for the prevention of mental illness and promote mental health.
In an attempt to fulfill its mission of change immediately, the National
Committee began to initiate successful reforms in several states producing a set of
model commitment laws. These were subsequently incorporated into the statutes of
several states. However, real changes in the mental health care system were prompted
by the conducting of many influential studies on mental health, mental illness, and
treatment by the Committee.
The “child guidance” movement started in 1921 which involved the Child
Guidance Clinics in the lives of the youth to prevent juvenile delinquency. These
clinics cooperated with juvenile judges, schools, and the like. The juveniles who
were engaging in asocial or antisocial activities were not seen as evil to be punished;
rather they were considered as psychiatric patients to be cared for. The movement
took a humane turn with this medicalization or a “medical view of crime,” wherein
asocial or antisocial behavior were considered as psychiatric disorders implying that
individuals exhibiting these behaviors are not evil, but ill, and should be treated
accordingly without punishment. This went a long way to help the parents and
major caregivers of children and adolescents, who saw hope in correcting their
wards.
From the state to national level, the success of the movement prompted Beers
to go global and attempt to make it a worldwide movement by organizing the First
International Congress for Mental Hygiene in 1930. More than 3,000 individuals
 Introduction to Counseling 13

from 41 countries were convened by the Congress for constructive dialogue about
fulfilling the mission of the mental health movement. The following year Beers
established the International Committee for Mental Hygiene, which is now known
as the World Federation for Mental Health. Thus under his stewardship, the mental
health care movement came to benefit the emotionally disturbed people all over the
world. They started to receive the humane care they needed.
In 1947, the WHO defined health as follows: “A state of complete physical,
mental, and social well-being and not merely the absence of disease and infirmity.”
The mental health movement grew directly out of community psychiatry
intended for psychiatric assistance, consultation, and prevention. The Community
Mental Health Centers (CMHCs) which emerged created a platform for not only
treating patients but carrying on the larger objective of initiating constructive social
change
The movement resulted in the growth and empowerment of the mental health
consumer movement with more people becoming aware of their right to treatment
and humane care. Thus mental health care for the benefit of past, current and future
generations of people in the United States and throughout the world was changed
forever by Clifford Beers. He did all this while suffering from periods of depression
and elation, unswervingly pushing the movement forward.
The work of a number of clinics led to the recognition of the importance of
emotional needs in the process of growth as well as of learning and adjustment. The
advent of psychoanalysis had a tremendous impact on psychotherapy. About this
time, sociologists were studying different societies and cultures, and had begun to
realize the need for understanding the social milieu in explaining human behavior.
Thus from the middle of the 19th century to the present, counseling has evolved
through various viewpoints and theories and their respective therapies. At present,
we are at a point where the ancient and the recent methodologies are being combined
to give a holistic approach to counseling.

Evolution from Psychotherapy

(Adapted from counsellingresource.com)
Counseling owes its existence to the work of Sigmund Freud in Vienna (hailed as
the Father of Modern Psychotherapy) in the 1880s. Initially trained as a neurologist,
Freud entered private practice in 1886 and by 1896 had developed a method of
working with hysterical patients, which he called “psychoanalysis. He also trained
others such as Adler, Snador Ferenczi, Karl Abraham, and Otto Rank in the
‘treatment-cum-training method, to becoming psychoanalysts in their own right.
Not to be left behind in this significant happenings, in the early 1900s, Ernest
Jones and A. A. Bril, from the United Kingdom and United States, respectively,
visited Freud in Vienna and returned to their own countries to promote his method.
 14 Counseling: Theory, Skills and Practice

Freud himself began his own lecture tour of North America in 1909. This began
a movement which had its followers as well as dissentors. Many developed their
own theories and practices which were offshoots of Psychoanalysis, There were also
those who were very critical of it, picked on its limitations, and went on to make a
name for themselves. Carl Jung, who was actually groomed as Freud’s intellectual
successor, eventually split from him and pursued his own school of analytical
psychology drawing heavily on both Freud and Adler’s ideas.
The 1940s saw the rise of another eminent psychologist, B.F. Skinner. Opposing
Freud and his concentration on internal processes which cannot be empirically
verified (such as the unconscious) vehemently, he developed a separate strand of
psychological therapy based upon the idea that learning is a function of change in
overt behavior. He contended that changes in behavior are the result of an individual’s
response to events (stimuli) that occur in the environment. Therapy, he maintained,
should concentrate on dealing with the observed behavioral anomalies through the
process of operant conditioning and reinforcement schedules. Focusing on providing
behavioral explanations for a broad range of cognitive phenomena, and dealing with
the issue of free-will and social control, he authored and co-authored many books, the
most well known being Beyond Freedom and Dignity and Walden Two.
While the two traditions were sparring with each other, Carl Rogers pioneered
the ‘third way’, the way which focused on the client––the person seeking help. Until
now the focus was on the process of therapy and the therapist. The Humanistic
approach to psychology saw the clients as whole human beings, who could not be
broken down into the pieces of stimulus and response (behaviorist position). Nor
could they be seen as a bunch of emotions and motives (the psychoanalyst position).
They had to be seen as active partners in the process of their own change. They had
to be attributed the respect and dignity of a fully functioning person who needed
just a little help to cope with their maladjustments. This marked the beginning of
modern counseling.
This was the first time psychotherapy concentrated on not only interventive but
also preventive processes by facilitating personal development. This brought about
the extension of counseling beyond the arenas of vocation and psychotherapy into
other aspects of human development was given a major boost with the publication
of Counseling and Psychotherapy by Rogers in 1942. His theory was based directly
on the “phenomenal field” personality theory of Combs and Snygg. He maintained
that problems of adjustment in one aspect of living had a profound effect on other
aspects as well. He also challenged the long years and rigid standards of training
required by psychoanalytic theory to become an agent for therapeutic change.
Originally called client-centered, and later person centered, his approach focused on
the experience of the person, neither adopting elaborate and empirically untestable
theoretical constructs, nor neglecting the internal world of the client in the way of
early behaviorists. His theory of Self, the role of Self Concept in the development of
 Introduction to Counseling 15

personality and the idea of a Fully Functioning Person found many takers and led
to a major shift from guidance to counseling as the primary function of counselors.
Later on approaches included Gestalt therapy (Fredrick Perls), transaction analysis
(Eric Berne) and the psychodrama of J. L. Moreno. Transpersonal Psychology and
Psychosynthesis (influenced by Abraham Maslow’s Self Actualized Person), and
Existential Therapy (based on the theories of 19th and 20th century influential
philosophers, such as Soren Kierkegaard and Friedrich Nietzsche) came under the
umbrella of the Humanistc therapies.

SPOTLIGHT ON NEED FOR INDIGENOUS MODELS OF

COUNSELING

Multicultural Counseling
Multicultural counseling started gaining increasing importance in the past few
decades in the United States. Psychologists started realizing that the population
of the United States was becoming more and more diverse and all of the major
theoretical approaches to counseling were developed by Europeans (Freud, Jung,
Adler, and Pearls) or Americans of European descent (Rogers, Skinner, Ellis, etc.).
This diversity created three major difficulties for multicultural counseling: the
counselor’s own culture, attitudes, and theoretical perspective; the client’s culture;
and the multiplicity of variables comprising an individual’s identity (Pedersen,
1986). Also, there was the growing acknowledgement that individual clients are
influenced by race, ethnicity, national origin, life stage, educational level, social class,
and sex roles (Ibrahim, 1985). Thus, the counselors’ acknowledgement of their own
basic tendencies, the way they comprehended other cultures, their understanding
of their own cultural heritage and world view, awareness of their own philosophies
of life and capabilities, recognition of different structures of reasoning, and the
understanding of their effects on one’s communication and helping style began to
be regarded as vital to successful counseling. Lack of such understanding was seen to
hinder effective intervention (Ibrahim, 1985; Lauver, 1986; McKenzie, 1986).
With the world shrinking in terms of convenient transportation and
communication, migrations becoming more common, and traveling back and forth
becoming the order of the day, it has led to dramatic increases of culturally diverse
individuals in various parts of the world, indigenous perspectives of healing must be
understood in the context of interdependent cultural practices.
Competence in multicultural counseling is understanding the different
cultures—the structure its expression, the effect of that on its people’s thinking
and functioning, and an insight into the stereotypes and idiosyncracies. The client’s
behavior needs to be compared to the typical behaviors of others in his or her group,
 16 Counseling: Theory, Skills and Practice

as in society or culture. The counselor needs to understand that the same behavior
that is considered abnormal in certain cultures can very well be adaptive in another.
There is no ‘one size fits all’ solution in counseling and psychotherapy. If therapy
has to be individualized, the counselor must understand acutely the language,
customs, values, beliefs, spirituality, religion, roles of men and women in society,
and sociopolitical history of the cultures whose people she/he is working with.
In the mental health professions, a growing awareness that all counseling is,
to some extent, multicultural contributed to the emergence and refinement of
numerous models of cultural identity development, frameworks for multicultural
counseling and training, and instruments to assess multicultural constructs (Kiselica
& Ramsey, 2001). Consequently since 1995, pluralistic counselors gained intensive
multicultural and diversity training which then spread widely throughout industry
and every level of the education system in the United States (Kiselica & Ramsey,
2001). The counseling literature which provides clinicians with a strong scholarly
foundation has failed historically to capture the profound human experiences that
occur in counseling, particularly those associated with crossing cultural boundaries
(Kiselica, 1999c). Derald Wing Sue (1992) noted that fully comprehending
complex concepts, such as racism requires an affective, as well as an intellectual,
understanding on the part of counselors.
Competency in multicultural counseling refers to counselors’ attitudes/beliefs,
knowledge, and skills in working with individuals from various cultural groups (Sue,
Arredondo, & McDavis, 1992). The multicultural counselor needs to conceptualize
clients from a multicultural perspective. The counselor trainees then should be aware
of, identify, and be able to integrate cultural factors into etiology and treatment
of the presenting concerns. These processes may become increasingly complex as
counselor trainees make associations between and among hypothesized etiologies
of presenting concerns and, accordingly, integrate these data into treatment plans
(Constantine & Gushue, in press). There are important implications for Counselor
trainees’ ability to perceive and conceptualize cultural information in a complex and
sophisticated manner and reflects on their ability to work effectively with culturally
diverse students. Hence, receiving multicultural supervision needs to become part
of the counselor training programs.
Three major dimensions in multicultural counseling are the counselor’s
own culture, attitudes, and theoretical perspective; the client’s culture; and the
multiplicity of variables comprising an individual’s identity (Pedersen, 1986).
Counselors of today are becoming more and more eclectic realizing that adherence
to a specific counseling theory or method may also limit the success of counseling.
Also many cultural groups do not share the values implied by the methods nor share
the counselor’s expectations for the conduct or outcome of the counseling session.
Consequently, effective counseling must investigate the clients’ cultural background
 Introduction to Counseling 17

and counselors need to be open to flexible definitions of “appropriate” or “correct”

behavior (LaFromboise, 1985).
Perhaps the most important stumbling block to effective multicultural counseling
and assessment would be language (Romero, 1985). Counseling process is grossly
impeded when clients cannot express the complexity of their thoughts and feelings
or resist discussing affectively charged issues. Counselors too may become frustrated
by their lack of bilingual ability. At the worst, language barriers may lead to
misdiagnosis and inappropriate placement (Romero, 1985).
Counselors must be aware of the dangers of stereotyping clients and of confusing
other influences, especially race and socioeconomic status, with cultural influences.
In addition to incorporating a greater awareness of their clients’ culture into their
theory and practice, they must acknowledge cultural diversity and appreciate the
value of different cultures. Finally they must use all of it to aid the client. While
universal categories are necessary to understand human experience, losing sight
of specific individual factors would lead to ethical violations (Ibrahim, 1985).
Multicultural counselors must learn to distinguish between race and culture. They
must view the identity and development of culturally diverse people in terms of
multiple, interactive factors, rather than a strictly cultural framework (Romero,
1985). A pluralistic counselor considers all facets of the client’s personal history,
family history, and social and cultural orientation (Arcinega & Newlou, 1981).
Pluralistic counselors need to become more sensitive to their own and their clients’
biases. This way they can avoid the problems of stereotyping and false expectations.
It is very important to examine their own values and norms, researching their clients’
backgrounds, and finding intervention methods to suit the clients’ needs. Clinical
sensitivity toward client expectation, attributions, values, roles, beliefs, and themes
of coping and vulnerability is always necessary for effective outcomes (LaFromboise,
1985). Three questions that counselors might use in assessing their approach are as
follows (Jereb, 1982): (1) Within what framework or context can I understand this
client (assessment)? (2) Within what context do client and counselor determine
what change in functioning is desirable (goal)? (3) What techniques can be used to
effect the desired change (intervention)?
Thus, the development of a client-centered, balanced counseling method can be
achieved through examination of the counselor’s own assumptions, acceptance of
the multiplicity of variables that constitute an individual’s identity. This in turn will
aid the multicultural counselor in providing effective help.

v Summary v
Counseling has become more relevant in today’s context than it was a few
years ago. People are experiencing more discomfort and anxiety. The ways
 18 Counseling: Theory, Skills and Practice

and ethics of family, society, community, and work are changing drastically.
Today’s adjustment needs to be redefined tomorrow. Such a situation has,
to say the least, spread panic among people. People are scrambling to seek
all sorts of help, from the age-old wisdom of the scriptures to modern-day
counseling.
Counseling catalyzes personal and interpersonal functioning across the
lifespan. It deals with the whole gamut of emotional, social, vocational,
educational, health-related, developmental, and organizational concerns,
encompassing a broad range of practices that help people improve their
wellness, assuage distress and alleviate maladjustment, resolve crises,
and augment one’s ability to live effectively functioning lives. Through
the integration of theory, research and practice, and with sensitivity to
multicultural issues, counseling successfully helps one to understand and
solve a life problem.
The evolution of counseling can be seen from three perspectives:
1. As descended from psychotherapy.
2. As descended from the guidance movement.
3. As descended from the mental health movement.
The discussion of counseling cannot be complete without alerting
the students to the fact that cultural and social backgrounds of both the
counselor and the counselee have a profound effect on the counseling
process. The counselor must be sensitive to the individual differences as
well as be aware of his or her own affiliations and attitudes. Thus, in the
multicultural, multiracial, multiethnic world, multicultural competency is a
must for any counselor.

References
Arcinega, M., and B.J. Newlou. 1981. “A Theoretical Rationale for Cross-Cultural Family
Counseling.” The School Counselor 28, pp. 89–96.
Cole, M. et al., 2005. The Development of Children. New York: Worth Publishers Company, New
York.
Constantine, M. G., and Gushue, G. V. (in Press). School Counselors’ Ethnic Tolerance Attitudes
and Racism Attitudes as Predictors of Their Multicultural Case Conceptualization of an
Immigrant Student. Journal of Counseling and Development.
Gainor, Kathy. A and Constantine, Madonna. G. 2002. Multicultural Group Supervision: A
Comparison of In-Person Versus Web-Based Formats. Professional School Counseling.
Ibrahim, F. 1991. Contribution of Cultural World View To Generic Counseling And
Development. Journal Of Counseling And Development, 70, pp. 13–19.
Ibrahim, F. A. 1985. “Effective Cross-Cultural Counseling and Psychotherapy.” The Counseling
Psychologist 13, pp. 625–638.
Jereb, R., 1982. “Assessing The Adequacy of Counseling Theories for Use With Black Clients.”
Counseling And Values 27, pp. 17–26.
 Introduction to Counseling 19

Kiselica, Mark S. 2005. Matters of The Heart And Matters of The Mind: Exploring The
History, Theories, Research, And Practice of Multicultural Counseling. A Review Of
The Handbook Of Multicultural Counseling.(Book Review). Journal of Multicultural
Counseling And Development.
Kiselica, M. S., and Ramsey, M. L. 2001. Multicultural counselor education. In D. C. Locke,
J. E. Myers, & E. L. Herr (Eds.), The handbook of counseling, pp. 433–451).Thousand
Oaks, CA: Sage.
Kiselica, MS. 1999c. Confronting prejudice: converging themes and future directions. In M.S.
Kiselica (Ed.) Confronting prejudice and racism during multicultural training (pp. 187-
198). Alexandria, VA: American Counseling Association.
Lafromboise, T. D. 1985. “The Role of Cultural Diversity In Counseling Psychology.” The
Counseling Psychologist 13: pp. 649–655.
Lauver, P. J. “Extending Counseling Cross-Culturally: Invisible Barriers.” Paper Presented at The
Annual Meeting of The California Association For Counseling And Development, San
Francisco, Ca. Ed 274 937.
Mckenzie, V. M. 1986. “Ethnographic Findings on West Indian-American Clients.” Journal of
Counseling And Development 65, pp. 40–44.
Mcleod, John, 2003. An Introduction to Counselling: Third Edition. Open University Press:
Berkshire, UK.
Pedersen, P. 1987. Ten Frequent Assumptions of Cultural Bias in Counseling. Journal of
Multicultural Counseling and Development, 15, pp. 16–22.
Pederson, P. 1986. “The Cultural Role of Conceptual and Contextual Support Systems in
Counseling.” American Mental Health Counselors Association Journal 8, pp. 35–42.
Raina, M. K. 1989. Social Change & Changes in Creative Functioning. New Delhi: National
Council of Educational Research And Training, pp. 8–9, 25–29, 100–122, 131–138.
Romano, G. 1992. The Power and Pain Of Professionalization. American Counselor, 1,
pp. 17–23.
Romero, D. 1985. “Cross-Cultural Counseling: Brief Reactions for the Practitioner.” The
Counseling Psychologist 13, pp. 665–671.
Schmidt, J.J. 2003. Counseling in Schools: Essential Services and Comprehensive Programs. 4th Ed.
Boston: Allyn and Bacon
Seto, Atsuko; Young, Suzanne; Becker, Kent W.; Kiselica, Mark S. 2006. Application of The
Triad Training Model in a Multicultural Counseling Course. Counselor Education and
Supervision.
Stevens, L.A. 1963. Experience Is Not The Best Teacher. Pageant, 19, pp. 54–60.
Sue, D.W., Arredondo, P., & Mcdavis, R. J. 1992. Multicultural Counseling Competencies
and Standards: A Call To The Profession. Journal of Multicultural Counseling and
Development, 20, pp. 64–68.
Adapted from the following websites:
http://add.about.com/od/treatmentoptions/a/Counseling.htm
http://ASCA.org
http://counsellingresource.com/types/history/index.html)
http://en.wikibooks.org/wiki/Introduction_to_Psychology/Clinical_Psychology
http://en.wikipedia.org/wiki/History_of_school_counseling
http://psychology.wikia.com/wiki/Counseling
http://wapedia.mobi/en/Subfields_of_psychology
http://wikipedia/ Counseling_Psychology
http://www.babylon.com/definition/counseling/English
 20 Counseling: Theory, Skills and Practice

http://www.counseling.org – ACA resources

http://www.counseling.org/Resources/ConsumersMedia.aspx?AGuid=8fa66290-45d6-4239-
97aa-4a30b2f0ec62
http://www.div17.org/students_defining.html
http://www.extramile.us/honorees/beers.cfm)
http://www.schoolcounselor.org
http://www.extramile.us/honorees/beers.cfm
http://counsellingresource.com/types/history/index.html
 2
Approaches to Therapy

Chapter Overview
What is psychotherapy?
The counseling and psychotherapy divide
The birth of psychotherapy
Different facets of counseling and psychotherapy
The different theoretical orientations

T
wo of the largest and most popular fields in psychology are clinical psychology
and counseling psychology. Both the fields are involved in psychological testing,
therapy, teaching and research. Both are also trained to understand and work
with psychopathology. Both the fields deal with the causes, prevention, diagnosis, and
treatment of individuals with psychological problems. Although the role of clinical
and counseling psychologists is very similar, their approach differs with respect to
the disorders of the patients they treat. Typically, clinical psychologists treat more
severe mental disorders, such as phobias, bipolar disorder, and schizophrenia. On the
other hand, counseling psychologists work with normal or moderately maladjusted
individuals suffering from everyday stresses, including career planning, academic
performance, and marriage and family difficulties.
Clinical and counseling psychologists are employed in a variety of settings,
including universities, hospitals, schools, governmental organizations, businesses,
private practice, and community mental health centers. Every practitioner
adopts a method of therapy according to the theoretical orientation she/he was
provided with and each of them gives a different explanation for the etiology of
the psychological disorders and their appropriate treatments. Although some
orientations are more popular than others because of their ease, time, and cost
effectiveness, most psychologists integrate two or more orientations into their
therapy. Furthermore, some theoretical orientations are better at explaining and
treating certain disorders than others. Regardless of their orientation preference,
 22 Counseling: Theory, Skills and Practice

clinical and counseling psychologists are trained to assist a variety of individuals

with emotional difficulties.
Counseling programs, similar to clinical psychology programs, usually teach the
various theories of psychotherapy; however, training and supervision in the practice
of psychotherapy usually are not part of the education for counseling, i.e., they are not
an academic requirement. It is some practioners’ opinion that while psychotherapy
tends to involve a complex change in the basic character and often works with
unconscious conflicts, counseling tends to be more limited and concerned with the
immediate situation. Still, many counselors disagree among themselves about the
distinction between counseling and psychotherapy.

WHAT IS PSYCHOTHERAPY?

Psychotherapy is a process of change and self-discovery whose goal is modifying,

transforming, or getting rid of painful or troubled behavior. It also includes learning
and adding adaptive behavior patterns into the behavioral repertoire. The client and
the therapist work together to examine the existing patterns, and set goals for changes
in accordance with the client’s desire. The goals can be changing one or two specific
behaviors that the client would like to change or modify, or the client may wish to
work on deeper, long-standing issues from the past that are causing current problems.
In either situation, the therapist acts as a facilitator of the client’s goals. Ideally, therapy
proceeds at a comfortable pace, with the client setting that pace and the therapist
offering feedback on the areas that might otherwise be unnoticed. The client should
not feel overly pushed, or as though the therapist has his or her own agenda.
Thankfully, our society is now more open to talking about subjects that were
kept secretive. We are progressing beyond secretiveness and shamefulness. This is
true with many medical conditions as well as mental health issues. Now counseling
and psychotherapy are often discussed in the media as well as in the lunchroom.

THE COUNSELING AND PSYCHOTHERAPY DIVIDE

Reactions and emotions become apparent as we recognize the many feelings of

internal and sometimes painful conflicts. At this point, help may be needed to solve
the emotional conflicts by recognizing and acknowledging the emotions and feelings
that are not understood, thereby increasing our awareness internally and externally.
The aim of counseling and psychotherapy is to assist the individual in increasing
awareness by mastering conflicts and patterns that have previously determined his
or her thoughts, feelings, actions, and decision-making skills.
 Approaches to Therapy 23

There is a growing need in our society to bring out the differences between
counseling and psychotherapy. Most of the times, these terms are used
interchangeably. Counselors as well as clinical psychologists are trained in talking
therapy. While clinical psychologists cater to individuals with severe emotional
difficulties, counselors handle less intense problems. Thus, it can be said that clinical
psychologists deal with disease while counselors deal with distress.
While counseling and psychotherapy have several different elements, the
following information will also attempt to show the reader that there are some areas
where the two disciplines overlap. A fine line divides the two topics and one must
look carefully to see this division.

Definition of Counseling
A survey by Gustad (1953) suggests a definition of counseling in which he includes
three key elements. He describes it as a learning-oriented process, which is carried
on in a simple, one-to-one social environment, in which a counselor, professionally
competent in relevant psychological skills and knowledge, seeks to assist the client by
methods appropriate to the latter’s needs and within the context of the total personal
program to learn more about himself; to learn how to put such understanding into
effect in relation to more clearly perceived, realistically defined goals; and to the end
that the client may become a happier and more productive member of his society.
In lay terms, counseling can be described as a face-to-face relationship, having goals
that help a client to learn or acquire new skills, which will enable him/her to cope
and adjust to life situations. The focus is to help a person reach maximum fulfillment
or potential and to become fully functional as a person.

Definition of Psychotherapy
As mentioned before, psychotherapy is well suited to those with psychiatric disorders
and can also be very useful for people who lose meaning in their lives and who
search for a greater sense of fulfillment. It is typically used when dealing with severe
psychological disorders. The clinical psychologist first diagnoses the symptoms
with the help of the Diagnostic Statistical Manual, Fourth Edition (DSM-IV). The
DSM-IV is the classification system of psychological disorders. The client must
meet the specified criteria for that disorder in order to classify him or her as having
a particular disorder. The criteria are often a collection of symptoms exhibited by
someone with that particular disorder. The psychologist also notes the duration of
time for which the symptoms have been present.
Next, the psychologist, with the help of therapy models which are derived from
the theories developed, decides on the type of therapy, which is most appropriate
in treating the disorder. Each theory explains disorders differently; therefore,
 24 Counseling: Theory, Skills and Practice

recommending different treatments. Often, psychologists combine two or more

models into their therapy.
In addition to psychotherapy, psychologists may have to recommend medication
to calm psychotic clients or stabilize moods so that they become emotionally and
cognitively available for talking therapy. As psychologists are by law not allowed
to administer medications, clients are sent to a psychiatrist for administering
pharmaco treatment or any other drug. Another possible treatment for clients is
hospitalization for suicidal and extremely psychotic clients who may be in danger of
harming themselves or others. This method of treatment is only meant to stabilize
the client and will usually last a couple of days.
Psychotherapy is the process by which a therapist assists the client in reorganizing
his or her personality. The therapist also helps the client integrate insights into
everyday behavior.

The Practitioners: The Medical and the Non-medical Split

Freud strongly supported the idea of lay psychoanalysts without medical training, and
he analyzed several lay people who later went on to become leading psychoanalysts
like his daughter Anna Freud and Otto Rank. And when Ernest Jones brought
psychoanalysis to the UK, he followed Freud’s preference in this area and the
tradition of lay involvement continues to this day, where most psychotherapists and
counselors do not have a formal education in psychology.
In the United States of America Abraham Adrian Brill insisted that analysts
should be medically qualified. In 1926 New York State made lay analysis illegal;
and to this day almost all US psychoanalysts are medically qualified and counselors
typically study psychology as undergraduates before becoming counselors. As a
psychologist, Rogers was not originally permitted by the psychiatry profession to
call himself a psychotherapist. It was largely in response to the US prejudice against
lay therapists that Rogers adopted the word counseling originally used by the social
activist Frank Parsons in 1908.

Objectives of Counseling
The objectives of counseling, according to the Committee on Definition, Division
of Counseling Psychology, American Psychological Association are to “help
individuals toward overcoming obstacles to their personal growth, wherever these
may be encountered, and toward achieving optimum development of their personal
resources” (Arbuckle, 1967). Dr T. Millard, stated that “counseling provides clarity
and a positive and constructive venue for the individual to sensibly examine the
instinctive-emotional and rational (or irrational) motives which determine the drive,
content, and even the form of human conduct.”
 Approaches to Therapy 25

Objectives of Psychotherapy
According to Everett Shostrom (1967), the goal of psychotherapy is to help the client
become an actualizer, a person who appreciates himself and others as persons rather
than things, and who has turned his self-defeating manipulations into self-fulfilling
potentials (p. 9). Shostrom also felt that awareness is the goal of psychotherapy.
“The reason is that change occurs with awareness!” (1967, p. 103); that awareness is
a form of non-striving achieved by being what you are at the moment, even if what
you are means the phony manipulative role that we all play sometimes for external
support (1967, p. 103).

Focus
The main difference between counseling and psychotherapy lies in their focus.
Counseling focuses on the “here and now” reality situations, whereas psychotherapy
focuses on the unconscious or past issues, which could have had an impact on,
and led to, the present problem. Counseling and psychotherapy also differentiate
with regard to the level of adjustment or maladjustment of the client. Counseling
holds an emphasis on “normals.” One could classify “normals” as those without
neurotic problems but those who have become victims of pressures from the outside
environment. The emphasis in psychotherapy however is on “neurotics” or those
with other severe emotional problems. Counseling can also be described as problem-
solving whereas psychotherapy is more analytical.

Duration of Therapy
Psychotherapy tends to last longer, with sessions ranging from two to five years.
Psychotherapy aims at a comprehensive re-education of the client. The intensity
and length of therapy depends on how well the client can deal with all of the new
found information. It could take quite sometime for the client to be able to live
with these feelings, which originated in past experiences that are usually hurtful. A
psychotherapist also needs time to modify all existing defenses.

Duration of Counseling
Counseling, as opposed to psychotherapy, is generally short term––8 to 20 sessions,
sometimes even less. As people seeking counseling are fairly healthy and function
cognitively well, the duration of problem identification to problem solving is
relatively shorter. Counselors should refrain from long term counseling as it can
tax a person’s finances and schedule. It can also lead to undesirable dependency on
the counselor. Also, long term commitment to problem solving is impractical and
demotivating.
 26 Counseling: Theory, Skills and Practice

Setting
The setting of treatment between counseling and psychotherapy is also different.
A counseling session usually takes place in a nonmedical setting, such as an office.
Psychotherapy is conducted in a medical setting such as a clinic or a hospital.

Transference Issues
Another difference between counseling and psychotherapy is with regard to
transference. Though the counselor develops a close personal relationship with
the client, she/he does not encourage or allow strong feelings to develop as she/
he feels that they interfere with the counseling process or render the counseling
ineffective. Some counselors are also uncomfortable with the client’s transferences.
But the psychotherapist uses the transference to get an insight into the client’s
unconscious.

Resistance
Resistance is another area of counseling that tends to differ with psychotherapy.
Counselors see resistance as opposing or going against problem-solving and therefore
try to reduce resistance as much as possible. On the other hand, a psychotherapist
finds resistance to be very important. Much insight is got from understanding the
clients’ resistance. The therapist can then understand how to help the client change
his or her personality.

Similarities between Counseling and Psychotherapy

Clearly there are many differences between counseling psychotherapy. However,
there are some similarities too. Counseling and psychotherapy both concern
themselves with elements that build a person’s personality. Each of these processes
deal with attitudes, feelings, interests, goals, self-esteem, and related behaviors, all of
which are affected by counseling and psychotherapy.
Both counseling and psychotherapy involve talking with the client. The
communication and skills involved in both the processes are the same. The attitude
of respect, empathy, and genuineness with which the psychologist approaches the
client is the same. They are similar in the sense that each client brings with him or
her assets, skills, strengths, and possibilities needed by them for therapy. Counseling
and psychotherapy are similar in the way that they both use an eclectic approach.
The counselors and therapists do not use a particular technique, but they borrow
from all different techniques.
 Approaches to Therapy 27

Professional Opinions
Not all therapists feel that there is a distinction between counseling and
psychotherapy. C.H. Patterson feels that it is impossible to make a distinction; and
that that the definition of counseling applies equally to psychotherapy and vice versa.
Donald Arbuckle (1967) argues that counseling and psychotherapy are identical
in all essential aspects. Others believe that there is a distinction. Psychotherapy is
concerned with some type of personality change whereas counseling is concerned
with helping individuals utilize their full coping potential. In Donald Arbuckle’s
work, he included Leona Tyler’s thoughts on the differences between counseling
and psychotherapy. Leona Tyler attempts to differentiate between counseling and
psychotherapy by stating “to remove physical and mental handicaps or to rid of
limitations is not the job of the counselor, this is the job of the therapist, which is
aimed essentially at change rather than fulfillment” (Arbuckle 1967).
Arbuckle argues that “counseling and psychotherapy are in all essential respects
identical” (1967, p.144). He states that the nature of the relationship, which is
considered basic in counseling and psychotherapy, are identical. Secondly, Arbuckle
says that the process of counseling cannot be distinguished from the process of
psychotherapy. Thirdly, he feels that the methods or techniques are identical.
Arbuckle lastly states that in the matter of goals and/or outcomes may appear to be
differences but no distinction is possible.
Today the divide is largely academic. The use of psychoanalysis to denote long-
term therapy adhering to the dynamic tradition and counseling to short-term work
is largely prevalent. The two terms are used interchangeably in the United States
with the obvious exception of guidance counseling, which is often provided in
educational settings and focuses on career and societal issues.

THE BIRTH OF PSYCHOTHERAPY

In an informal sense, psychotherapy can be said to have been practiced through the
ages, with different theosophies as their theoretical background. In order to trace
the history of psychotherapy we need to travel back to the time of Prescientific
Psychology. Hellenistic philosophers like Socrates, Plato, and Aristotle who made
many a conjecture about the Transcendent (God), the perfect archetypes, of which
objects in the everyday world are imperfect copies; who advocated examination of
the world to understand the ultimate foundation of things, talked about the nature
of pleasure, advocating the development of self-control in order to attain peace of
mind. Indian philosophy including the Hindu, Buddhist and Jain philosophies
talked about human life, its purpose and actualization.
 28 Counseling: Theory, Skills and Practice

Then came Descartes––The Father of Modern Philosophy, a rationalist, who is

most famous for the principle cogito ergo sum (English: “I think, therefore I am”).
The simple meaning of the phrase is that if one is skeptical of existence, then that
in itself is proof that he does exist. His rationalism was later advocated strongly
by Spinoza and Leibniz. They were strongly opposed by the Empiricist School of
Thought consisting of Hume, Berkeley, Locke, Hobbes and Rousseau.
They were followed by physicalists like Mesmer, Gall, Weber, etc., who maintained
the philosophical position that everything that exists is no more extensive than its
physical properties. That is, there are no kinds of things other than physical things.
This term was coined by Otto Neurath who wrote, “According to physicalism,
the language of physics is the universal language of science and, consequently, any
knowledge can be brought back to the statements on the physical objects.” This
position equated the mind to the brain, and incorporates whatever is described by
physics––not just matter but energy, space, time, physical forces, structure, physical
processes, information, state, etc.
William Wundt conducted the first psychological experiment in 1879. He
restored the study of the conscious mental process to Psychology while encouraging
introspection.
In the 1800s, Phrenology (having the head literally examined), Physiognomy
(the study of the shape of the face), and Mesmerism (designed to relieve one of
psychological distress by the use of magnets, mental healing (something like the
modern concept of positive visualization), were some of the therapies that were
being practiced. Many of these went on to be rejected by empiricists and physicalists.
Mental illness was being studied by neurologists and psychiatrists.
The “Talking Cure” was first introduced by Sigmund Freud. Psychotherapy
began with the practice of Psychoanalysis, which later on diversified to introduction
of new concepts about psychological functioning and change by the Neo-Freudians.
The psychodynamic therapy includes various therapies based on Freud’s essential
principle of making the unconscious conscious.
In the 1920s, Behaviorism became the dominant paradigm, and remained so
until the 1950s. The cognitivism and the Humanistic-Existentialistic theories
and therapies based on them evolved independently, which focused less on
the unconscious and more on promoting positive, holistic change through the
development of a supportive, genuine, and empathic therapeutic relationship.
Other major perspectives like Transpersonal Psychology (which focuses on the
spiritual realm of human experience), Systems therapy (which focuses on family and
group dynamics), Feministic therapy, Somatic Psychology, Expressive therapy, and
Applied Positive Psychology were developed during the 1970s.
Today many psychotherapy methods are thus available and, for the most part,
not one is superior or inferior to the other. The best choice will depend on various
factors such as personality and value orientations of the counselor and counselee, the
 Approaches to Therapy 29

problem situation, and specific needs of the counselee. A vast majority of therapists
consider themselves to be “eclectic,” which means that they combine techniques and
approaches from several types of therapy.
Modern psychotherapy has benefited tremendously from the empirical tradition,
which was given much impetus by Carl Rogers. Additional work in the theoretical
and empirical arenas of cognitive psychology, learning theory, and behavior has
added to the knowledge bank of many therapeutic approaches.
The different strands of counseling and psychotherapy now number in hundreds,
though mainstream approaches are fewer in number. In time it is expected that
many of the less grounded theories will fade away and new ones will emerge, while
the main schools remain to dominate the academia due to their strong grounding
and time tested successful practice.

DIFFERENT FACETS OF COUNSELING AND

PSYCHOTHERAPY

The subject of counseling can be understood from many points of view.

The Clientele
Individual: Individual counseling facilitates the exploration and resolution of per-
sonal problems and issues according to the needs of the individual.
Some of the issues often addressed in individual counseling are the following:
Stress
Don’t know how to cope with life circumstances
Depression
Anxiety
Self-esteem
Identity issues
Body image, eating disorders
Loneliness
Difficulty forming or maintaining healthy relationships
Physical or emotional abuse (past or present)
Cross-cultural issues (including cultural conflicts between parents and child)
Difficulty defining problems
Marked changes in functioning
Irritability
Changes in thinking or perceptual abilities
Difficulty setting limits with others
 30 Counseling: Theory, Skills and Practice

Premarital: Premarital counseling and/or education is a therapeutic intervention

that occurs with couples who plan to marry where they try to gain a better
understanding of their would-be partner and themselves in the relationship.
Premarital education is “a skills training procedure which aims at providing couples
with information on ways to improve their relationship once they are married”
(Senediak, 1990, p. 26). Typically, couples who participate in premarital counseling
demonstrate overall positive psychological health (Stahmann, 2000) and do not have
serious relationship problems (Senediak, 1990). Premarital counseling occurs in a
wide range of settings and is provided by practitioners from a number of different
professions (e.g., clergy, professional and lay counselors, community agency
workers; Stahmann & Hiebert, 1997). It is a brief intervention, with programs
averaging about 4 hours of contact time with each couple (Silliman & Schumm,
1999). Premarital interventions include psychoeducation.
As risk of divorce is highest in the early years of marriage (Kreider and Fields,
2001) early intervention is beneficial. This counseling prepares them for marriage
and family life. As Hoopes and Fisher (1984) explain, couples receive no formal
training for marriage and family life and may have limited knowledge and experience.
The goals of premarital counseling generally include the following: (a) to provide
couples with information about married life, (b) to enhance their communication
skills, (c) to encourage them to develop conflict resolution skills, and (d) to allow
couples to speak freely about sensitive topics, such as sex and money (Senediak,
1990; Stahmann and Hiebert, 1997). Stahmann and Hiebert (1980) report that
“the goal of premarital counseling is to enhance the premarital relationship so that
it might develop into a satisfactory and stable marital relationship” (p. 11).
A concise list of seven relationship skill and knowledge areas that research has
shown to contribute to the success and endurance of marriage (Patty and Greg
Kuhlman, http://www.wedalert.com/content/articles/premarital_counseling.asp) is
given below:
Compatibility
Expectations
Personalities and families-of-origin
Communication
Conflict resolution
Intimacy and sexuality
Long-term goals

Family therapy: Family therapy is also referred to as couple and family therapy
and family systems therapy or Systemic therapy. This branch of psychotherapy
works with families and couples in intimate relationships to nurture change and
development. Viewed as systems of interaction between family members these
relationships are emphasized as an important factor in psychological health. Family
 Approaches to Therapy 31

problems arise due to maladaptive or inappropriate systemic interactions, rather

than the contribution of individual members. Marriage and Family Therapists
(MFTs) are most specifically trained in this type of psychotherapy.
This therapy is a professional and conscious attempt and method to study,
understand, and cure disorders of the interactional whole of a family and its
individual members as family members. The therapist or a family therapy team
meets the family members willing to participate in therapy. The aim is that the
interactional patterns that prevent individual growth will change. This is achieved
especially by emphasizing and trying to find the hidden positive resources in a
family’s interactional whole.
Rather than trying to identify the cause, family therapists focus more on how
patterns of interaction maintain the problem. Identifying the cause can be experienced
as blaming. Thus, therapists feel it is better to avoid that. Family therapy assumes
that the family as a whole is larger than the sum of its parts. It may also draw upon
the strengths of a social network to help address a problem that may be completely
externally caused rather than created or maintained by the family.
Family therapy has been used effectively where families, and or individuals in
those families experience suffering:
Serious psychological disorders (e.g., schizophrenia, anxiety, depression,
personality disorders, conduct disorders, ADHD, addictions and eating
disorders);
Interactional and transitional crises in a family’s life cycle (e.g., conflict,
estrangement, divorce, child and adolescent issues);
As a support of other psychotherapies and medication.
Family therapy uses a range of counseling and other techniques including the
following:
Psychotherapy
Systems theory
Communication theory
Systemic coaching
Psychoeducation
Although most of the founders of the field had psychoanalytic backgrounds, the
basic theory of classical systemic family therapy was derived mainly from systems
theory and cybernetics, and secondarily from behavioral therapy and cognitive
psychotherapy. More recent developments have come from feminist, postmodernist,
narrative, psychodynamic, and attachment theories.
Important schools of family therapy include the following:
Psychodynamic
Cognitive and behavioral approaches
Structural family therapy
 32 Counseling: Theory, Skills and Practice

Strategic family therapy

Constructivist (e.g., Milan systems, post-systems/collaborative/conversa-
tional, reflective)
Solution-focused therapy
Object relations
Intergenerational (Bowen systems theory, contextual therapy)
Emotionally Focused Therapy (EFT)
Experiential therapy, and most recently
Multicultural, intercultural, and integrative approaches are being
developed.
Most practitioners claim to be “eclectic,” using techniques from several areas
depending upon their own inclinations and/or the needs of the client(s). Family
therapy usually lasts anywhere between five and 20 sessions in which the therapist
usually meets several members of the family at the same time in order to study
the differences between the ways family members perceive mutual relations as well
as interaction patterns in the family. Family therapists are relational therapists;
therapy interventions focus on relationship patterns between individuals rather than
individual psychological processes. Depending on circumstances, the therapist may
point out to the family interaction patterns that the family might have not noticed
or suggest different ways of responding to other family members.
Characteristics of a Healthy Family (JM Lewis et al., 1976)
Communication: Clear, open, direct (verbal and non-verbal), feelings and
emotions freely expressed, anger seen as a need for change, each hears and
responds to others
Autonomy: Family consists of separate individuals––each takes responsibilty
for personal actions and behavior
Acceptance: Respect for the unique experience of others
Structure: Clear, flexible roles, the family script, consistent rules help
resolve conflict
Leadership: Power shared appropriately by parents, fair without domination,
humiliation or scapegoating, no one told what to think or feel––even the
youngest is considered able to contribute
Partnership: Strong bonding and coalition of parents
Flexibility: Give and take, adapt to individual needs and changing
circumstances, change not seen as threatening
Appreciation: Encouragement and praise create self-esteem, loving
acceptance without judgmental attitudes
Support networks: Inside and outside the family, provide strength and
stability for coping with problems and stresses
Family time: Attention is paid to doing things together
Growth: Warm, nurturing, fulfilling atmosphere
 Approaches to Therapy 33

Need for intimacy: Tenderness not seen as weakness, sexual interest

considered a generally positive force
Religion, philosophy and reality: Positive values and beliefs, world-view is
realistic but extends beyond the present

Relationship counseling: This is a process of counseling which seeks to

recognize, to better manage, and/or reconcile troublesome differences and repeating
patterns of distress among individuals. The relationship involved may be between
members of a family, couples, employees, or employers in a workplace, or between
a professional and a client.
Relationship counseling as a separate, professional service is a recent phenomenon.
Until recently, relationship counseling was informally carried out by close friends
and family members, HR department in the corporate sector, or local religious
leaders. Psychiatrists, psychologists, counselors, and social workers have historically
dealt primarily with individual psychological problems.
Today’s world is witnessing reduction or even cessation of socio emotional
support from close or extended family members. The rise of the isolated nuclear
family system is seeing the breakdown of old support structures. And hence the need
for relationship counseling is being felt greater than ever. In western society, the
trend is towards trained relationship counselors who are employed by government
institutions, universities and colleges, and the corporate sector to help people get
along in a more efficient and productive manner.
Relationship counseling works on the view that every individual has a unique
personal and interpersonal style of functioning. And it is important to recognize and
acknowledge that this uniqueness in personality and socioculturoreligioeconomic
background shapes his or her nature and behavior. Also, this counseling is based on the
fact that it is intrinsically beneficial for all individuals to interact with each other and
with society at large with the least conflict possible. Occasionally these relationships
get “strained,” which means that they are not functioning at the optimum extent.
There are many possible reasons for this, including ego, arrogance, jealousy, anger,
greed, etc. Counseling focuses on reorienting the individuals’ perceptions and the
resultant actions; sometimes fundamental changes in attitudes and value structures
may be warranted, finally leading to adopting conscious structural changes to the
interpersonal relationships.

Group: Group psychotherapy is a form of psychotherapy in which one or several

therapists treat a small group of clients together as a group. It is intended to help
people who would like to improve their ability to cope with difficulties and problems
in their lives. It focuses on interpersonal interactions, so relationship problems
are addressed well in groups. It aims to help solve the emotional difficulties and
encourage personal development of the participants in the group. The therapist
 34 Counseling: Theory, Skills and Practice

(called conductor, leader or facilitator) chooses as candidates for the group, people
who can benefit from this kind of therapy, and those who may have a useful influence
on other members in the group. There may be one or two therapists meeting the
group.
In group therapy, approximately 6 to 12 individuals meet face-to-face with a
trained group therapist. Members are encouraged to give feedback like expressing
feelings about what someone says or does. Interaction between group members is
highly encouraged. Group members make a commitment to keep the content of the
group sessions confidential.
Members of the group may meet once a week and share personal problems that
they are facing. They can talk about significant events during the week, their reactions
(emotional as well as behavioral), and any problem they had faced. Usually there is
continuity with the previous sessions as they share their thoughts and feelings about
what happened in the previous sessions, and relate to others’ issues or to the leader’s
words. They also welcome reactions of others, their feedback, encouragement and
support or criticism. The subject for discussion are generally not predetermined, or
decided by the leader. They are spontaneous.
Group therapy helps members see that they are not alone with their problems,
nor are they the only ones facing the same. The group becomes a source of support
and strength in times of stress. The feedback they receive from others helps them
see and change their maladaptive patterns of behavior. Group members can also at
times become role models to see and emulate constructive and effective behavior
patterns. It can also become a safe laboratory for practicing new behaviors through
role play or actual being, with the psychologist present to help.
Group therapy can be categorized according to the therapists’ theoretical
orientations, nature of the problem, structure and need of the target group, time
limits set on the duration of the group (length of the groups always depends on
purpose of the group, and group membership), and by the focus of the group and
the way group members are selected (homogeneous or heterogeneous).
There are many kinds of groups in the field of group psychotherapy.
The techniques used in group therapy can be verbal, expressive, and psychodramatic.
The approaches can vary from psychoanalytic to behavioral, Gestalt, or encounter
groups. Groups vary from classic psychotherapy groups, where the process is
emphasized, to psychoeducational, which usually the focus is on the most common
areas of concern, notably relationships, anger, stress management, etc.
Groups can be ongoing and open-ended, that is, continue indefinitely with some
group members completing treatment and leaving the group, and others joining
along the way as openings are available in the group; or they can be time-bound, that
is, the number of sessions can be fixed. Time limited and close-ended groups have
a distinct beginning, middle, and end, and usually do not add additional members
after the first few sessions.
 Approaches to Therapy 35

Groups can be homogenous or heterogeneous. Homogeneous groups are those

in which either the backgrounds of the individuals or the nature of the problems
are similar. Heterogeneous groups are those in which the group members will
have varying backgrounds, and varying psychological issues that they bring to the
treatment group.
The focus is an important aspect to take into account when starting a group.
Some groups are more general in focus, with goals related to improving overall
life satisfaction and effective life functioning, especially in the area of interpersonal
relationships. Other groups are “focused” or “topical” therapy groups where the
group members tend to have similar problems because the group is focused on a
specific topic or problem area. For example, support groups for people undergoing
similar problems like depression, addiction, families of alcoholics and parents of
children with ADHD, some focus therapy groups are skill development groups,
with an emphasis on learning new coping skills or changing maladaptive behavior.
There are groups to develop parenting skills, stress, time, anger management, etc.
Groups are also ideally suited to people who are struggling with relationship issues
like intimacy, trust, and self-esteem. The great advantage of group psychotherapy is
working on these patterns in the “here and now” in a group situation more similar
to reality and close to the interpersonal events.
Originally, group therapy was used as a cost-saving measure; however, research
has shown that the group experience benefited people in many ways that were not
always addressed in individual psychotherapy. Contradictorily, it was also discovered
that some people did not benefit from group therapy.

Online individual/Group counseling: The technological changes of the

1990s gave the counselor/computer relationship a boost. The boom of the World
Wide Web (www) and the Internet put computer access in the hands of the every
day user (Granello, 2000). Almost all professional counseling organizations have
web pages, list servers, and consumer information links. Information is abundant
and easily obtained on different therapies, different treatments, and different coun-
selor credentialing.
Online counseling refers to providing professional mental health services
concerns via Internet communication technology. Other names include e-therapy,
e-counseling, online therapy, or coaching. These services are typically offered via
email, real-time chat, and video conferencing. Some therapists/clients use online
counseling in conjunction with traditional psychotherapy, and others use it as an
occasional check-in tool.
The new millennium is seeing an increase in mental health services available on
line. Counselors are advertising and are developing practices that include online
therapy. Clients who, in the past, were unable or unwilling to receive services are
able to take advantage of this medium (Lunt, 2004). Online counseling opens a new
 36 Counseling: Theory, Skills and Practice

door to those who are in geographical locations where mental health providers are
scarce, following those with physical or mental disabilities an opportunity to link
into the system, providing access to those who might be better served by a specialist
regardless of geographical limitations and providing support for those who are too
busy, too burdened, or too reluctant to venture into a therapist’s office. It allows
counseling to begin, evolve, and provide opportunities to those who currently
have impediments for receiving mental health treatment through more traditional
methods (Sussman, 1998; Harris-Bowlsby, 2000).
This type of counseling has many benefits. Individuals who are unable or
unwilling to see a mental health professional in person, those who are home-bound
(such as the elderly or infirm) or those who reside in rural areas far from a therapist’s
office prefer it to the rigors of traditional counseling. Online counseling can also
be an option for individuals who suffer from a particular problem and wish to
work with a hard-to-find expert in that issue. In this day and age where comfort
is the priority, and the world’s being accessible in the palm of one’s hand, online
counseling provides the impetus for those who might be reluctant to access the
counselor’s services for one reason or another. For those who travel a lot, this is a
very convenient option.
This convenience is preferred by both clients and therapists alike; who may
engage in the counseling process from the comfort of their homes or offices; at times
that are most convenient for them.
Another benefit is that for some people talking about very personal, difficult
issues face-to-face to a stranger, is very uncomfortable; and may be more likely to
disclose when they cannot be seen. This effect is called disinhibition. Thus, online
counseling may allow for more privacy and confidentiality than traditional face-to-
face counseling.
Also, as online counselors do not have the overheads of maintenance office space
in key areas of the city or town, and also bearing in mind the travel expenses of the
clients, this mode of counseling is a lot less expensive than face-to-face counseling.
Though this modality of counseling seems perfect and an ideal choice for both
therapists and clients, it is not without challenges. There are verbal cues (or verbal
behavior), signs, and signals given by a client to a therapist that are missed in online
counseling. Many online counselors offer the option of phone counseling or video
conferencing during the chat. This enables both parties to pick up on some of the
missed cues.
Another major challenge is professionalism and security. Many people can hang
a virtual shingle and offer to do online counseling.
Another disadvantage is that communication on the Internet may be more
vulnerable to interception than face-to-face counseling.
 Approaches to Therapy 37

Counseling using Different Media

Traditional counseling: In most traditional counseling practices the spiritual
component of your life is ignored; without the fullness of you explored and welcomed
in the work, no real, lasting change can occur.

Life coaching: In life coaching, a linear approach of to-do lists, steps, and rules
is employed to engage the client. It is preferable to engage the client’s knowledge.
It may be seldom consulted, but the intuitive nature of the individual is ready and
able to engage in his or her life.

Spiritual coaching: Spiritual coaching is often linked to a clearly defined

religious path. People’s religious values and beliefs reflect in their attitudes towards
key development issues, their perceptions, experience, and pursuit of well-being,
and their attitudes. Religious values and practices are life dimensions that are often
overlooked in counseling practices and are related in complex ways to norms, human
action, and the construction of meaning. Faith provides many with a language of
ethics and often guidelines to live by.

Music therapy: Music therapy is the clinical and evidence-based use of music
interventions to accomplish individualized goals within a therapeutic relationship
by a professional who has the credentials and who has completed an approved
music therapy program (American Music Therapy Association definition, 2005). In
other words, music therapy is the use of music by a trained professional to achieve
therapeutic goals. The goal areas may include, but are not limited to, motor skills,
social/interpersonal development, cognitive development, self-awareness, and
spiritual enhancement.
Music therapists assess emotional well-being, physical health, social functioning,
communication abilities, and cognitive skills through musical responses using
music improvisation, receptive music listening, song writing, lyric discussion,
music and imagery, music performance, and learning through music; participate in
interdisciplinary treatment planning, ongoing evaluation, and follow up.
The idea of music as a healing modality dates back to the beginnings of history.
However, music therapy recognized as a field is a relatively new discipline. It is being
increasingly recognized at a time when there has never been such a variety of music
available to so many people.

Art therapy: Art therapy is the use of art materials for self-expression and
reflection in the presence of a trained art therapist (The British Association of Art
Therapists definition of Art Therapy). Clients need not have previous experience or
skill in art; the art therapist is not primarily concerned with making an aesthetic or
 38 Counseling: Theory, Skills and Practice

diagnostic assessment of the client’s image. The overall aim is to enable a client to
effect change and growth on a personal level through the use of art materials in a safe
and facilitating environment.
The relationship between the therapist and the client is of central importance,
but art therapy differs from other psychological therapies in that it is a three-way
process between the client, the therapist, and the image or artifact. Thus, it offers an
opportunity for expression and communication and can be particularly helpful to
people who find it hard to express their thoughts and feelings verbally.
Art therapists have a considerable understanding of art processes underpinned
by a sound knowledge of therapeutic practice, and work with both individuals and
groups in a variety of residential and community-based settings.

Play therapy: Association for Play Therapy (APT) defines play therapy as “the
systematic use of a theoretical model to establish an interpersonal process wherein
trained play therapists use the therapeutic powers of play to help clients prevent or
resolve psychosocial difficulties and achieve optimal growth and development.” It
is a dynamic interpersonal relationship between a child (or person of any age) and
a therapist trained in play therapy procedures who provides selected play materials
and facilitates development of a safe relationship for the child (or person of any
age) to fully express and explore self (feelings, thoughts, experiences, and behaviors)
through play, the child’s natural medium of communication, for optimal growth and
development. (Landreth, 2002, p. 16) play therapy is to children what counseling is
to adults. It utilizes play, which is a natural medium of expression, to help children
who have experienced trauma, and provides an opportunity to explore emotions
and inner healing. The therapist provides the child with selected play materials and
facilitates a safe relationship to express feelings, thoughts, experiences, and behaviors
through play, the child’s natural medium of communication.

Dance therapy: Dance therapy (also called dance/movement therapy) is the use
of choreographed or improvised movement as a way of treating social, emotional,
cognitive, and physical problems. Dance has been used by many cultures, from time
immemorial, to express powerful emotions, tell stories, treat illness, celebrate impor-
tant events, and maintain communal bonds. Dance as therapy came into existence
as a marriage of sorts between modern dance and psychiatry. It was pioneered by
Marian Chace (1896–1970).
Dance therapy harnesses this power of movement in a therapeutic setting and
uses it to promote personal growth, health, and well-being. Movement in a group
generates a good feeling that comes from belonging to a group, helps people come
out of isolation and creates powerful social and emotional bonds. The rhythmic
movements ease muscular rigidity, help diminish anxiety and increases energy. The
spontaneous movement helps people to learn to recognize and trust their impulses,
 Approaches to Therapy 39

and to act on or contain them as they choose. Moving creatively encourages self-
expression and opens up new ways of thinking and doing. On a physical level
the movement provides the benefits of exercise. On an emotional level it can be
very cathartic. On a mental level, dance therapy seeks to enhance cognitive skills,
motivation, and memory.

Drama therapy: Drama therapy is the systematic and intentional use of drama
and theater processes and products to promote emotional growth and psychologi-
cal integration. Drama therapy is an active, experiential approach that facilitates
the client’s ability to tell his/her story, solve problems, set goals, express feelings
appropriately, achieve catharsis, extend the depth and breadth of inner experience,
improve interpersonal skills and relationships, and strengthen the ability to perform
personal life roles while increasing flexibility between roles (National Association for
drama therapy, USA).

Yoga therapy: Yoga therapy addresses the physical, mental, and spiritual levels
of our existence. The theory of yoga therapy derives mainly from yoga, Ayurveda,
Samkhya, Tantra, and Vedanta. It uses a broad range of techniques and processes,
including techniques to purify the body and mind, to increase praana and vitality,
and meditation techniques to engage the power of the mind and consciousness in
healing (Swami Shankardev Saraswati).
Each branch of yoga has its own utility in supporting therapeutic intervention.
The most commonly used techniques come out of hatha yoga, mantra yoga, and
meditation.
Techniques used include the following:
Postures (asana)
Breath work (pranayama)
Hatha yoga cleansing techniques (shatkarmas)
Relaxation techniques
Meditation techniques
Karma yoga
Bhakti yoga
Jnana yoga
Mantra yoga
Kriya yoga
Tantric practices
Hatha yoga is the starting point for most yoga therapies. It works on the
physical organs as well as the energetic systems of the body. Asana and pranayama
recondition the physical body and mind, remove tensions, and support rebalance
and realignment. Meditation practices are powerful methods for healing and include
relaxation techniques, meditations that employ breath and mantra, awareness
 40 Counseling: Theory, Skills and Practice

development, and more powerful tantric methods to cleanse the deeper, causal,
and elemental levels of our being. Tantric systems employ mantras along with the
visualization of yantras, symbols and images, and mudras and bandhas.
Yoga therapy is most commonly used to manage a broad range of chronic disease
conditions like the following:
Psychosomatic illnesses, for example, coronary artery disease, high blood
pressure, asthma, eczema, diabetes, and multiple sclerosis.
Chronic degenerative diseases, for example, heart disease, diabetes,
arthritis, and cancer. The body organs affected begin to breakdown and
may eventually fail. Other body systems that rely on those organs are
detrimentally affected.
Yoga therapy has been found to be effective in the treatment and management of
the following problems and diseases:
Heart disease, such as coronary artery disease
High blood pressure
Back pain
Arthritis
Asthma
Sinusitis and hay fever
Headache
Certain endocrine diseases
Digestive disorders, such as heartburn and ulcers, constipation, colitis,
diabetes and many other conditions.

THE DIFFERENT THEORETICAL ORIENTATIONS

In keeping with the complexities of human nature, psychologists have proposed

different theories. Each theory seeks to integrate its postulates consistently with the
specified hypotheses constructed. On the basis of these theories, different approaches
to counseling have evolved. The varying conceptions of human personality structure
and dynamics, which are captured by the theories, reflect in their application to
helping individuals.

Therapy based on Cognitive Learning

This can be defined as any therapy that is based on the belief that our thoughts are
directly connected to how we feel. The cognitive therapies include rational-emotive,
cognitive-behavioral, reality, and transactional analysis.
 Approaches to Therapy 41

Common traits among the cognitive approaches include a collaborative

relationship between the client and the therapist, homework between sessions, and
the tendency of shorter duration. Therapists work with clients to solve present-
day problems by helping them to identify distorted thinking that causes emotional
discomfort.

Rational Emotive Behavior Therapy (REBUT)

Rational Emotive Behavior Therapy (REBUT) is a cognitive-behavioral therapy
that helps people change dysfunctional emotions and behaviors by showing them
how to become aware of and modify the beliefs and attitudes that creates these
unwanted states. REBUT was originally called “rational therapy,” but soon changed
to “rational-emotive therapy” and again in the early 1990s to “rational emotive
behavior therapy.”
The most basic premise of REBUT is that almost all human emotions and
behaviors are the result of what people think, assume, or believe (about themselves,
other people, and the world in general). It is what people believe about situations
they face—not the situations themselves—that determines how they feel and behave.
Human beings appear to think at three levels: (1) inferences; (2) evaluations; and
(3) core beliefs. The therapist’s main objective is to deal with the underlying, semi
permanent, general “‘core beliefs”’ that are the continuing cause of the client’s
unwanted reactions.

Cognitive Behavior Therapy (CBT)

According to the US-based National Association of Cognitive-Behavioral Therapists:
“There are several approaches to cognitive-behavioral therapy, including Rational
Emotive Behavior Therapy, Rational Behavior Therapy, Rational Living Therapy,
Cognitive Therapy, and Dialectic Behavior Therapy.” CBT combines two very
effective kinds of psychotherapy—cognitive therapy and behavior therapy. CBT
focuses on controlling symptoms through correcting faulty thinking patterns,
Cognitive therapy is based on the premise that emotions and their behavioral
manifestation are the consequence of irrational beliefs. If the former have to change
then the client has to be helped to correct the thinking. This will automatically
change the way the client feels, and therefore, behaves.
An event becomes a problem due to unpleasant emotions it evokes. These
unpleasant emotions are the result of a particular kind of interpretation. Often
feelings are related to interpretations of events more than the events themselves.
While it is natural to think that one is responding only to the events of life, in fact
one makes interpretations or judgments of these events, and these interpretations
play a key role in one’s emotional responses.
 42 Counseling: Theory, Skills and Practice

These interpretations are made so rapidly and so automatically that the client
may not even realize they are happening. Therapy helps the client learn to recognize
any tendencies she/he may have to distort events through interpretational styles like
these, and then practice choosing and committing to more valid interpretations.
The resulting emotions will be more accurate reflections of the events in life.
Behavior therapy works under the premise that situations evoke habitual reactions–
reactions that have been learnt consciously or inadvertently. These behaviors that
have been learnt need to be unlearned, and in their place new behavior needs to
be learnt. Behavior therapy helps weaken the connections between troublesome
situations and habitual emotional as well as behavioral reactions to them––reactions
such as fear, depression or rage, and self-defeating or self-damaging behavior.
Relaxation therapy which is one aspect of behavior therapy teaches how to calm the
mind and body, to feel better, think more clearly, and make better decisions.
The two most powerful levers of constructive change are the following:
1. Altering ways of thinking: This is the cognitive aspect of CBT.
2. Helping the client face trials and tribulations of life with a clear and calm
mind and then taking actions that are likely to have desirable results. This
is the behavioral aspect of CBT.

Reality Therapy
Reality therapy has been around since the 1960s when Dr William Glasser published
a book Reality Therapy in the United States. Reality therapy is based on the premise
that people have certain needs to fulfill when they make choices. These choices need
not necessarily result in effective or appropriate behavior. Therapy then focuses on
helping the client accept responsibility for the choices and the resultant maladaptive
behavior, and then make different choices, that is make a workable plan (the plan
that one can implement) to get what she/he wants. In other words, it concentrates
on the things that are in the client’s control.
In reality therapy, the needs are classified under five headings:
1. Power (achievement and feeling worthwhile, winning)
2. Love and belonging (groups, families or loved ones)
3. Freedom (independence, autonomy, own “space”)
4. Fun (pleasure and enjoyment)
5. Survival (nourishment, shelter, sex)

Dialectical Behavioral Therapy (DBT)

DBT is based on the premise that people react abnormally to emotional stimulation
due to many factors like invalidating environments during upbringing and due to
biological factors as yet unknown. This abnormal reaction is manifested in the form
 Approaches to Therapy 43

of quick arousal, greater intensity and more time to return to the baseline. This
explains why borderlines are known for crisis-strewn lives and extreme emotional
liability (emotions that shift rapidly). Because of their past invalidation, they don’t
have any methods for coping with these sudden, intense surges of emotion.
Swamy Paramarthananda Saraswathi calls it the FIR or emotionality. He says that
there are three dimensions of emotionality––Frequency of becoming emotional,
intensity of the emotion, and recuperation time. Therapy needs to focus on bringing
down the FIR in order to experience a balancing of emotions…which is really what
leads to emotional maturity.

Psychoanalysis
Psychoanalysis is the original “talking therapy” which is the parent of all the
others to follow. It maintains that the solution to all emotional problems lies in
the uncovering of the unconscious. Therapy explores the unconscious mind and
the conscious mind’s relation to it. In order to analyze the root causes of behavior
and feelings it utilizes free association, dreams, and transference, psychopathological
actions, hallucinations, delusions as well as other strategies to help the client know
the function of his or her own mind.
Freud’s theory was quite comprehensive. It included the following:
The levels of consciousness: the conscious, fore conscious, and
unconscious;
The stages of psychosexual development: oral, anal, phallic, latency and
genital;
Ego states: Id, ego, superego;
The two basic urges: eros and thanatos; and
Defensive mechanisms.
Many theories and therapies have evolved from the original psychoanalysis,
including transactional analysis, hypno-therapy, object-relations, Progoff’s intensive
journal therapy, Adlerian, Jungian, and many others. One thing they all have in
common is that they deal with unconscious motivation. Usually the duration of
therapy is lengthy; however, many modern therapists use psychoanalytic techniques
for short-term therapies.

Humanistic Approach
The humanistic approach was a response to the behavioristic and psychoanalytic
traditions which were therapy process and therapist-based. They were very
mechanistic in approach viewing the individual as something to cut open, detect
the problem and remove it. They felt that a more humane approach was desperately
needed. The humanists like Carl Rogers and Abraham Maslow felt that other issues
 44 Counseling: Theory, Skills and Practice

were equally important and needed to be addressed as the individual’s contribution

to the process of therapy, meaning of behavior, purpose of life, and healthy
development. The Humanistic approach placed emphasis on subjective meaning,
rejected determinism, and expressed a concern for positive growth rather than
pathology. This was the true precursor to modern-day counseling.
Therapy propagated by them was client-centered and even had educational
repercussions. Educationists started looking at student-centered educational
strategies and practices.

Existential Psychotherapy
Existential psychotherapy works on the premise that inner conflict within a person
is due to his or her confrontations with the ultimate concerns (which are given
or cannot be avoided) of existence like the inevitability of death, free-will and
responsibility, existential isolation (humans are essentially alone in the world) and
finally meaninglessness (there is no absolute meaning in life).
Therapy addresses these premises in the following manner: though these
ideas present a very bleak view of life, finally realizing and accepting those leads
to happiness. Even though we are all alone, we want to belong, to connect with
others. However, we must beware of becoming overly dependent on others for
our validation. Finally accepting that we are all actually lone islands leads to true
happiness. The Indian philosophy also teaches detachment (vairagya), from things
and people. This does not mean that we do not form relationships; it just means that
we are free from the bondages of these relationships. We neither miss them when
they are absent, nor are burdened by them in their presence.
Existentialists do not believe in psychological dysfunction or illness. They
maintain that every way of being is merely an expression of how one chooses to live
one’s life.
Free-will is a given. We are free to choose our expressions and reactions to
situations. Our life is finally our choice and thus we need to accept responsibility.
This is very difficult as we all like to pass the responsibility of our pain, failures, and
dissatisfactions onto others. Therapy is geared towards making the client understand
and accept the concept of free-will and help them take responsibility for it. Therapy
is not concerned with the client’s past. Emphasis is on the choices to be made in the
present and future, thus enabling a new freedom and responsibility to act.
In the existential view, there is no such thing as psychological dysfunction or
being ill. Every way of being is merely an expression of how one chooses to live one’s
life. The existential therapist helps the client accept these feelings rather than focus
on changing them as if something were wrong.
 Approaches to Therapy 45

Gestalt Therapy
Gestalt therapy is an existential/experiential form of psychotherapy. It emphasizes
personal responsibility. “Gestalt,” a German word meaning “whole,” operates as
a therapy by keeping the person in what is known as the here and now. This was
developed by Friz Perls, Laura Perls and Paul Goodman in the 1940s and 50s.
This therapy focuses on the individual’s experience in the present moment, by
helping clients to be attentive to all parts of themselves: physical, physiological,
emotional and cognitive. This state of awareness, when generalized to the social
and environmental contexts results in being as aware as possible at all times of
one’s interactions and hence one can achieve effective functioning. This usually
lengthy therapy is accomplished by the therapist asking questions and suggesting
experiments, which increases awareness and sensitivity to the many parts of the
client’s total self.

Eclectic Approach
This is essentially a common sense approach to helping people. This approach works
on the premise that people are different, their backgrounds, psychological processes,
and their behaviors as a result of it. Therapy has to be tailor-made for every client.
And, as we saw in the first chapter, no traditional theoretical orientation addresses
all facets of the human nature. Thus, the eclectic counselor selects from a wide
range of theory, methods and practices the one that will suit both his or her own
personality and disposition as well as the clients’
In order to do that the counselor should be deeply familiar with all the orientations
in order to make the most suitable choice. The eclectic counselor may also use a
combination of methods as and when the need arises. For instance, s/he may start
out as a person-centered therapist, eventually finding a way to add cognitive or
reality therapy techniques to his or her personal approach.

v Summary v
Generally, counseling can be described as a process that helps people to
examine and deal effectively with life issues. There has been a lot of debate
regarding the terms counseling and psychotherapy. There are several
differences between counseling and psychotherapy. The biggest difference
in my opinion is the time factor/focus faced in each of these approaches.
Counseling primarily deals with reality situations versus the unconscious
past focus of psychotherapy. Secondly, counseling has been described as
helping one to develop competencies in coping with life situations where as
psychotherapy is a reorganization of one’s whole personality. Finally a last
 46 Counseling: Theory, Skills and Practice

distinction is that the counselor deals with life adjustment problems while
the psychotherapist deals with past unresolved issues from the family of
origin. While there are many distinguishing differences between counseling
and psychotherapy, there are some aspects that do spill over into each
other. But now, the distinction relating to the theory, process as well as
practitioners is fading, with each becoming almost interchangeable with
respect to those parameters.

References
Alexandria, VA: American Counseling Association.
Arbuckle, D. S. 1967. Counseling and Psychotherapy: An Overview. New York: McGraw Hill.
Bettelheim, B. and A. Rosenfeld. 1993. The Art of the Obvious...Developing Insight For Psychotherapy
and Everyday Life. New York: Knopf.
Brammer, L. and E. Shostrom. 1977. Therapeutic Psychology: Fundamentals of Counseling and
Psychotherapy Third Edition. Englewood Cliffs, NJ: Prentice Hall.
michellemyers-therapist.com
Gustad, J. W, 1953. ‘The Definition of Counseling’, in RF Berdie (Ed.), Roles and Relationships
in Counseling. Minneapolis: University of Minnesota Press.
Harris-Bowlsbey, J. 2000. ‘The Internet: Blessing or Bane for the Counseling Profession’? In J.W.
Bloom & G.R. Walz (Eds.). Cybercounseling and cyberlearning: Strategies and resources for
the millennium, pp. 39–51.
JM Lewis et al. 1976. No Single Thread: Psychological Health in Family Systems, Brunner/Mazel,
New York (Study by the Timberlawn Foundation, Dallas, Texas) (http://www.covenant-
counseling.com/marriagefamilytherapy)
Landreth. 2002. Play Therapy: The Art of the Relationship Second Edition. New York: Brunner-
Routledge.
Lunt, Patricia Trompetter. 2004. Adolescents’ Willingness to Utilize Online Counseling. Dissertation
submitted to the faculty of the Virginia Polytechnic Institute and State University
in partial fulfillment of the requirements for the degree of Doctor of Philosophy in
Counselor Education.
Rogers, C. 1951. Client Centered Therapy. New York: Houghton Mifflin. Shostrom, E. (1967).
Man the Manipulator. Nashville, Tennessee: Abingdon Press.
Ruddy R, and D. Milnes. ‘Art therapy for schizophrenia or schizophrenia-like illnesses’;
Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003728. DOI:
10.1002/14651858.CD003728.
Senediak, C. 1990. ‘The value of premarital education’, Australia and New Zealand Journal of
Family Therapy, 11, pp. 26–31.
Silliman, B., and W. R. Schumm. 1999. ‘Improving practice in marriage preparation’, Journal of
Sex and Marital Therapy, 25, pp. 23–43.
Stahmann, R. F., and W. J. Hiebert. 1997. Premarital and remarital counseling: The professional’s
handbook (2nd ed. rev.). San Francisco, CA: Jossey-Bass.
Stahmann, R. F. 2000. ‘Premarital counseling: A focus for family therapy’. Journal of Family
Therapy, 22, pp. 104–117.
Sussman, R. J. 1998. ‘Counseling online’. Counseling Today, June 8.
Swami Shankardev Saraswati, http://www.bigshakti.com/articles/yoga-therapy
 Approaches to Therapy 47

www.nadt.org
Adapted from the following websites:
http://www.psychologistanywhereanytime.com
http://en.wikipedia.org
http://www.napayellowpages.com/napa-support-services/marriage-family-counselors.htm
http://www.statemaster.com/encyclopedia/Family-therapy
http://www.wcupa.edu
http://www.winentrance.com
http://psych.la.psu.edu
http://www.kmtherapy.com
http://www.group-psychotherapy.com
http://www.psychologyinfo.com/treatment/group_therapy.html
http://www.drbalternatives.com/articles/gc1.html
http://articlesbit.com/2010/health-nutrition/alternative-medicine/online-counseling-and-
therapy
http://www.onlinecounseling.co.za
http://www.musictherapy.org
http://www.qmu.ac.uk/otat
http://www.psychnet-uk.com/psychotherapy/psychotherapy_play_therapy.htm
http://cpt.unt.edu/about-play-therapy/what-is-play-therapy
http://www.allaboutcounseling.com/counseling_approaches.htm
http://www.psychnet-uk.com/psychotherapy/psychotherapy_rational_emotive_behaviour_
therapy.htm
http://en.wikipedia.org/wiki/Existential_therapy
http://counsellingresource.com
 3
Counseling in India

Chapter Overview
� Mental healthcare movement in India
� Counseling and the Indian scenario
� Culture and counseling
� Transpersonal psychology
� Dimensions of spiritual approach to therapy
� Inappropriateness of adhering to Western approaches
� Indigenous models of counseling
� Eastern approach to counseling: A combination of therapy and life
coaching

A
ny field of work that one undertakes should be studied in context of its
application and practice in the future. Thus, fieldwork and knowledge about
the true state of current India are a prerequisite to any psychology or human
development classes. In service, learning should focus on the understanding of the
nature and make-up of society, culture, and hence, the mindset and predispositions
of the clients.
There are a few questions that come up when we talk about counseling in India.
It would be good for teachers and students to focus on them while in preparation
for field work.
� What is Indian-ness and how do we define it?
� What kind of therapy can effectively cater to Indians?
� Are there any common characteristics we share regardless of our language,
caste, culture, religion, socioeconomic background, education, and personal
history?
� How do we make Indians adapt to Western theories?
� The attitude towards authority figures like parents, teachers and elders.
� Perceptions about counselors, and thus, the counseling process itself.
 Counseling in India 49

MENTAL HEALTHCARE MOVEMENT IN INDIA

Mental health care has been receiving a lot of attention in developing countries
at a time when a wide range of treatments for acute and chronic mental disorders
is available (Sartorius N, Girolomo G, Andrews G, et al., (eds): 1993). A striking
aspect of mental healthcare in developing countries is the choice of community
mental healthcare as the primary approach for the rural population. Almost all
developing countries have a limited number of institutional facilities for care of
mentally ill patients and very few mental health professionals (Murthy, S R 1998).
In 1975 the WHO expert committee published recommendations for expanding
mental health care emphasizing upon national priorities for use of mental health care
resources, involvement of all healthcare personnel in providing mental health care,
appropriate training for healthcare personnel, systematic research, and legislative
support in developing countries. Since then countries like India, China, Uganda,
Tanzania, Nigeria, Colombia, Sri Lanka, and the developing countries of Southeast
Asia have taken several initiatives at the national, regional, and local levels. National
mental health programs have been formulated and pilot programs for integration of
mental health care with primary health care have been established.
The community mental health movement in India began about three decades
ago. As a large number of people live in rural areas, India has developed primarily
rural mental healthcare services. The community health movement in India was
a response to a number of factors: expensive and/or harmful institutional care;
shortage of qualified professionals; and that general health care professional can be
trained to care for the mentally ill in their own settings.
The Bhore Committee Report of 1946, which laid the foundation for the
community health movement in India, not only combined the “top down” (building
three apex institutions, viz., All India Institute of Medical Sciences (AIIMS),
New Delhi; All India Institute of Hygiene and Public Health, Kolkata; and All
India Institute of Mental Health, Bangalore (later to become NIMHANS) and
the “bottom up” (providing primary health care, and ‘community orientation to
medical services and medical education) approaches, but also included substantive
emphasis on issues of mental health, recognizing psychiatry and mental health as
integral parts, much before some of the noted Western movements of community
mental health emerged.
The major guiding principle and strategy was to reach the people from the
remotest areas of the country and provide them with quality mental health care.
The movement was greatly inspired by the socialist ideology in the sociopolitical
atmosphere of the post-Independence period in India.
Following community medicine blindly without realizing the need for a more
mental health-specific framework, this movement had a mixed impact. The
 50 Counseling: Theory, Skills and Practice

community psychiatry initiatives in the 1960s and 1970s culminated in the National
Mental Health Programme (NMHP) in India, one of the earliest in the world, with
inadequate emphasis on the conceptual issues of community mental health.
Two projects that have influenced the development of India’s mental health
care services are the Raipur Rani Project and the Bellary District Project. WHO
conducted a seven-year study of seven developing countries from 1975 to 1981 on
strategies for extending mental health care, and integrating it with general health
care services. Raipur Rani, an agricultural zone of Haryana in northern India, was
the Indian project area with a population of 60,000 and served by four doctors
and more than a dozen paraprofessionals. Systematic efforts were made to collect
baseline data, select disorders that would have priority for intervention, develop,
and implement programs to meet specific needs and evaluate the impact.
The intervention period of one year had nearly 4,000 persons who started to
receive essential mental health care through the existing health facilities. Interviews
with patients in clinics showed changes in attitudes toward early recognition of mental
disorders, their treatment, reintegration of recovered patients, and acceptance of a
primary health care team. The results of the initial effort supported the possibility of
providing basic mental health care through general health services.
These experiments in integrating mental health care with general health care
were used in formulating the national mental health program for India (National
Mental Health Programme for India, 1982). This program has stimulated initiatives
for mental health care among professionals, non-governmental organizations, and
citizens using a variety community-oriented care programs (Murthy, 1998).
Karnataka’s Bellary District, which serves two million people, was the site of
another project which showed that it was possible to provide basic mental health
care as part of primary health care services. The project involved decentralizing
training of primary health care personnel, providing mental health care in all
health facilities, involving all categories of health and welfare personnel, providing
essential psychotropic drugs, a simple record-keeping system, and a mechanism for
monitoring the work of personnel in the provision of mental health care.
The British rule led to the development of the early mental hospitals, which were
actually established to cater to the needs of European patients in India (Rajkumar,
1991; Wig, 1990). After India gained independence in 1947, instead of more mental
hospitals being established, the psychiatric departments began to be incorporated in
the general hospitals resulting in a shift toward decreased stigma associated with the
mentally ill. Although this movement led to the Indian government formulating
policies to provide reduced-cost health care to the masses, the current state of mental
health services provided to the people of India is not up to the mark.
In India, there are only 37 government-run mental hospitals, 3,500 psychiatrists,
1,000 psychiatric social workers, and 1,000 clinical psychologists to serve a population
of more than 1 billion (Acharya, 2001). Data on mental health counselors could not
 Counseling in India 51

be obtained even though India has Master’s and Doctoral programs in counseling
psychology because there are no procedures for licensing (Clay, 2002). In spite of
this, indigenous models such as astrologers, palmists, and priests continue to be a
source of help to Indians. Although people are drawn to these healers resources are
insufficient to examine the ambivalent relationships of people to religious values,
translation of the latter into action, and the ways in which religion crosscuts other
dimensions of social difference in people’s perceptions, experience, and pursuit of
well being.

COUNSELING AND THE INDIAN SCENARIO

Transferring Western counseling theories and techniques to Indian (or any other
culture which is non-west) clients. India is a developing country with unique cultural
characteristics. The current state of mental health counseling in India necessitates
new laws, indigenous approaches, adaptations of culture-sensitive approaches,
and research projects to validate such approaches. It is the job of mental health
counselors to accomplish such complicated and trying tasks in the absence of social
and financial resources.
Counseling as a professional field is just emerging in India and that too only in
urban India. Even in urban areas, it is in an unenviable state. Not only is there no
specificity in the term or concept, but it is also used to denote a variety of activities
performed by people in all kinds of situations, with different kinds of training, or
even with no training at all! Students attend counseling for allotment of courses,
a talk show host with no training at all counsels her guests, and a manager in the
industry counsels his subordinate!
The functions of a counselor are not very well defined. There is no clearly
understood and widely accepted role description of the counselor. What she does
seems to overlap with the teacher, parent, boss, or friend. So how is she different from
all of these people? In India, even now there are people who feel that a counselor is
not necessary. They feel that we can solve our problems by ourselves. And to top it
all, some very well-educated people do not even know what a counselor does.
There is no governing authority that would set standards for training and conduct
of the field. Counselors have no platform for expression of grievances, nor do they
have a recognized professional organization like the RCI or MCI that would set
standards for professional and ethical conduct.
Moreover, economic and social issues, poverty, and illiteracy have kept the field
of counseling away from the common man. Only the elites are exposed to a broader
spectrum of the service professions. Only of late the family courts, educational
institutions, and the industrial organizations are realizing the importance of
counselors and the counseling profession.
 52 Counseling: Theory, Skills and Practice

In India we are passing through an unenviable phase of transition. There is a

tendency to cling to past values and simultaneously crave for things, which are not
consonant with the past values. This has resulted in an identity crisis, particularly
of the youth. The changes in our social systems, the forceful advent of the Western
media in our lives, and the world reducing to a global village is making people very
anxious. This is actually true of today’s youth. They are torn between the values
they are presented with and the values that they have been taught to uphold by
their parents. This has resulted in uncertainty as to what values to hold and what
to follow. Parents are their wit’s end. They are confused as to how to help their
children; they are finding it more and more difficult to compete with the outside
forces in controlling their children. This creates the parent-child gap that is tearing
families apart.
The family is important to counseling in India, but the structure of family is
changing. We have a wonderful tradition and culture in India. These traditions are
being upheld on the outside where everyone can see, but within the family, life is
showing signs of cracking up and breaking. There is an attitude that says, “I want
others to see that I have a good family. I would prefer to have a dysfunctional family
that nobody sees than to have a broken family or marriage that everybody can see,
even if that means that the brokenness can be repaired. It is important for me to
look good and proper in the eyes of my own larger family members and the society
around me. So I sweep and keep all problems under the carpet. I keep doing it until
it is too late and the bulge is visible to all concerned. Then I throw up my hands in
defeat, then blame and defend myself.”
With the world around changing so fast, families in India are caught up among
many developments for which they are not prepared. The difference in the pace
of life, in values, and in the capacity to adapt differs between the parents and their
children, but this is not attended to. As a result there is a great need for some
kind of intervention and help. Especially now, with growing epidemics of physical
and mental illnesses, there is much more need for this. Even the government is
looking out for models of intervention and the counselors need to wake up and
equip themselves if they want to impact the country in a very significant way.
An issue that is causing rifts in family relationships is the breakdown of the joint
family system, known traditionally to provide social and economic security to its
individual members. The unit families are confronted with problems that they had
not bargained for. This has meant for many people an increase in anxiety and stress
resulting from uncertainty and isolation. The wisdom of the elders is no longer
counted as one of our assets. It is a very sad situation. Thus for problems that can be
easily resolved by the intervention of our family elders, now a resolution is sought in
the courts or counselor’s offices.
Social change has affected not only family life but also several other things, for
example, the status of women. This issue involves a change in several other types
 Counseling in India 53

of relationships as well. These include parent–child and husband–wife relations.

Many families today are characterized by a lack of understanding even when there
is no open conflict between the generations. Sexual relation is another area, which
is not easy for the counselor to advise, in those families in which parents have one
set of standards and the children another. An interesting phenomenon increasingly
becoming apparent is “ascending education” in which the young become teachers of
the old. It is not uncommon to hear from the young that adults do not know about
new things and that they have to learn from them.
One aspect that is becoming increasingly important is our concern and anxiety
for modernization. We are engaged in a drastic movement from traditional to the
modern form of living, and by “modern” we tacitly mean westernized technological
modes of living. Many aspects of this movement are of considerable concern to
the counselor. What are the effects of this thrust? Is it true that the effects of rapid
industrialization are seen in the disruption of interpersonal relations, an increase in
crime, alienation of the youth, disrespect for elders, sharp increase in delinquent
behavior, and other maladjustments? How should the counselor deal with this
situation?
With advances in the field of medicine, environmental hygiene, and better
nutrition, man’s longevity has increased. Again, the breakdown of the joint family
system has a great impact on the role and status of these older people in society.
Retirement from positions of authority and prestige can be a very devastating
experience. How can the “retirement shock” be assuaged? The counselor’s role
should be to assist the “senior citizens” to make optimum adjustment.
The tremendous technological progress has created problems for youth seeking
employment as well as for the older people in employment. While the youth pass
out from their education that has the latest technological advances incorporated
into their curriculum, the older people have no idea of it. For example, the use of
computers: they feel lost when asked to use a computer in their work. The youth
on the other hand prove themselves very useful. But we cannot do away with the
experience and wisdom of the older people. The management has a tough job when
their offices are modernized with computers. They have to provide training for the
people working there, which is expensive and time consuming. The counselor will,
therefore, have to play the role of a cultural mediator and help individuals adjust
themselves to the new conditions of living.
The next issue concerns decision making. In the Western culture, autonomy
and independence and the ability to stand on one’s own feet and make one’s own
decisions are stressed upon. Even if the student decides to take a year off his or her
studies, the individual makes it on his or her own. But in oriental cultures in general,
and India in particular, decision making is to a certain extent culturally determined.
A young man or a woman is expected to consult the adult members of the family
in matters such as choosing a course of study, entering a specific occupation, or
 54 Counseling: Theory, Skills and Practice

choosing a life partner. The counselor should remember to include the parents and/
or other significant members of the family when the client has to make a decision.
The counselor has to be mature enough to strike an appropriate balance and
help the youth to have sound values. The counselor could have problems with his
counselees who may be struggling with the new values and trying to cling to the
past values. This may lead to a clash between loyalty to old values and the desire to
pursue new values. The counselee’s value structures are thus of a crucial nature and
the counselor has to work in terms of his or her own value structure, which may not
be similar to that of the counselees.
As has been mentioned earlier, the attitude towards women has undergone a
considerable change. They are no longer confined to their homes but are taking
up careers, which earlier were exclusive only to men. The counselor, therefore,
should not look askance at a female counselee who does not propose to enter into
matrimony or one who proposes to enter such fields as mountaineering, forestry,
and the like. The counselor would do well to present the facts in full and not try to
influence the counselee.
The Indian attitude towards sex has been that it is looked upon as something
intimate, precious, and sacred. It is not identified with the fulfillment of carnal
desire. Premarital sex is considered to be a sin. Women are not expected to freely
mix with men and they are expected to maintain a certain distance. Questions,
such as what should be done about premarital sex, sex outside marriage, bigamous
relations, etc. loom large. The bias in the favor of males in this regard is still upheld
in most Indian societies. A man is virile but a woman is promiscuous. One should
admit, though, that this attitude is fast disappearing in urban, educated societies.
Different standards for men and women create avoidable confusion, conflict, and
also crisis.
The counselor must necessarily widen his field of work to include the new
problems, which are surfacing as a result of rapid change. If the counselor is
understood to be a culture interpreter, culture mediator, and an agent for culture
change, he must necessarily move into a wider area (of human life) and make it the
canvas for his work.
Training programs were once easily identifiable as subscribing to the tenets of a
single theoretical base, such as psychoanalytic, humanistic, or behavioral. It is now
somewhat rare to find allegiance among all staff members to a particular counseling
approach but even when there is, methods of instruction among faculty are likely to
be more different than similar. One of the joys of the profession is that each of us is
permitted to discover ways of helping others that fit us best, as long as we maintain
ethical and competence standards established by our peers.
Nevertheless, in spite of the variations in methods of instruction, approaches to
counseling, and even personality styles of faculty, many departments do espouse
a particular philosophy of counselor education. This mission statement may be
 Counseling in India 55

simply the requirement of an accreditation standard, or in many cases, it represents

a well-thought-out summary of what the program intends to do and how these goals
are to be carried out.

CULTURE AND COUNSELING

As globalization continues to bring the world closer, it is imperative to assess the

usefulness of transferring Western counseling philosophies to cultures that are very
different from the West (McGuiness, Alfred, Cohen, Hunt, & Robson, 2001). The
notion that counseling theories and approaches can be transported across cultures
is based on certain assumptions: that human beings are similar regardless of their
race, ethnicity, or culture; that theories of counseling are fairly culture-free and can
be applied to most individuals; and that if therapeutic strategies are used correctly,
they can work for any individual (Pope-Davis & Coleman, 1997).
Cultural sensitivity requires the mental health counselor to be aware of clients’
worldview and to use clients’ perspective in interpreting the world (Wrenn, 1962).
This understanding is imperative in a society that is a fusion of several subcultures
within the dominant Indian culture. Although the Indian culture traditionally has
been considered collectivistic, research has indicated that the Indian society is rapidly
transforming into a coexistence of both collectivism and individualism (Sinha, Sinha,
Sinha, & Sinha, 2001; Sinha, Vohra, Singhal, Sinha, & Ushashree, 2002). India is
a land of high diversity in almost every aspect of life. And that includes acceptance
of mental illness and help-seeking behaviors. With respect to culture-specific factors
that influence help-seeking behaviors, some experts have argued the importance
of cultural epidemiology. Cultural epidemiology is an integrative approach that
examines the social and cultural features of a community from an epidemiological
and anthropological framework (Chowdhury, Chakraborty, & Weiss, 2001). One
such feature is the presence of stigma among Indians with respect to mental health
counseling, which makes it difficult for those who need help to seek it (James et al.,
2002). Other features include apathy on the part of the mental health professionals
who are not motivated to work with individuals with severe mental illness for a long
period of time (Nagaswami, 1990). Such apathy extends to family members and
others who have direct contact with those who are mentally ill. Thus, stigma about
mental health counseling among the general population and professional apathy
on the part of mental health counselors help to highlight certain unique cultural
factors.
A study conducted by Chowdhury et al., (2001) in West Bengal, India, for
example, revealed that people equated mental illness with seriously disruptive
behaviors. Individuals with such illnesses often were termed as pagal or pagla (i.e.,
 56 Counseling: Theory, Skills and Practice

mad) and were teased. Treatment in early stages usually was characterized by visiting
a healer such as a shaman or an alternative medicine practitioner. However, if the
condition was not lifted, then families were known to abandon such people as a
result of hopelessness.
Thus, an ethnographic perspective like the inclusion of mental health in the area
of primary care, establishing awareness of such mental health concerns and focusing
on cultural and social components of illness, and interactions with the community,
health workers, local leaders, village administrative systems, and non-governmental
organizations can help to mobilize resources for optimum health care (Chowdhury et
al., 2001). In keeping such cultural factors in mind, Indian mental health counselors
need to learn to adapt their Western training to the Indian milieu.

TRANSPERSONAL PSYCHOLOGY

“Psychiatrists need to consciously move away from the medication-based approach of

Western psychology and integrate spiritual practices in their therapy.”
—Dayal Mirchandani

The West has shown an increasing receptiveness to the philosophical voice of the
East. A keen interest in Eastern attitudes towards life, have been shown particularly
in the writings of Carl Jung, Karen Horney, and Erich Fromm. Aware of this
growing interest, Alan Watts, a skillful interpreter of Eastern religions, presents in
his latest book his views on how “Eastern and Western psychotherapies can fertilize
each other.” (www.lifepositive.com)
Ironically, therapists in India don’t make use of the powerful spiritual techniques
available in India. When the entire world is looking towards India for personal and
spiritual guidance, the Indian professionals are maintaining a very guarded distance
from the arena. This is probably because spiritual approach relies on techniques that
seek direct contact with the sacred, through which one understands the true nature
of reality. And unfortunately, professionals are neither trained in them nor, at least,
realize their significance.
This is primarily because contemporary mental health movement has shifted
towards a western mechanistic worldview where most forms of psychological
problems are seen as being caused by biochemical changes in the brain for which
medication is used extensively; or of a worldly nature, which then are provided only
superficial “band-aid” solutions.
The bright side of the scenario is that now practioners are realizing that there
is a wealth of treasure in spiritual traditions, especially Eastern ones, which can be
advantageously pooled with modern techniques to bring about therapeutic change.
 Counseling in India 57

As the West starts to endorse this approach, which is called transpersonal psychology,
it is increasingly finding a place in modern Indian therapy.
The body of research on these techniques is growing, which shows that it has
great potential to help people suffering from anxiety, depression and psychosomatic
disorders. Earlier the entire philosophy behind a spiritual approach was often seen
to be at variance with that of the modern materialistic culture. Now the integration
of spirituality and therapy is seen as the most obviously winning combination for
alleviation of pain, be it existential pain or worldly problems.

Definitions
Transpersonal psychology is the extension of psychological studies into consciousness
studies, spiritual inquiry, body–mind relationships, and transformation. Carl
Jung first coined the term transpersonal (uberpersonlich) when he used the phrase
“transpersonal unconscious” as a synonym for “collective unconscious” (Institute of
Transpersonal Psychology, USA).
Transpersonal Psychology is the formal study of experiences, beliefs, and
practices which seem to suggest that the sense of one’s self may extend beyond our
personal and individual perceptions of reality (http://www.leftfield-psi.net/glossary/
glossary_t.html).
Transpersonal Psychology and Parapsychology may seem to overlap but they
are very different in that the former focuses more on ‘universal’ or spiritual aspects,
whereas the latter is primarily focused on investigation of evidence to either support
or disclaim the reality of “paranormal” phenomena.
Transpersonal psychology is known as the “fourth-force” in psychology, meaning
that it is at the forefront of the field of psychological study. Stan Grof calls it the
“psychology of the future”. It combines knowledge from all spiritual traditions world-
wide with the study of psychology (http://www.simpleformat.com). Transpersonal
psychology is a school of psychology, considered by proponents to be the “fourth
force” in the field (after the first three: psychoanalysis, behaviorism, and humanism).
It was originally founded in 1969 by Abraham Maslow, Stanislav Grof, Anthony
Sutich, and others in order to pursue knowledge about issues connected to mystical
and transcendent experiences. According to transpersonal theory, these other schools
of psychology have failed to give weight to transpersonal or “transegotic” elements
of human existence, such as religious conversion, altered states of consciousness,
trance and spirituality, in their academic reflection. Thus, transpersonal psychology
strives to combine insights from modern psychology with insights from the world’s
contemplative traditions, both East and West. (Cowley & Derezotes, 1994; Miller,
1998).
Lajoie and Shapiro (1992) reviewed 40 definitions of transpersonal psychology
that had appeared in literature over the period 1969 to 1991. They found that five key
 58 Counseling: Theory, Skills and Practice

themes in particular featured prominently in these definitions: states of consciousness,

higher or ultimate potential, beyond the ego or personal self, transcendence, and the
spiritual. A short definition from the Journal of Transpersonal Psychology suggests
that transpersonal psychology is concerned with the study of humanity’s highest
potential, and with the recognition, understanding, and realization of unitive,
spiritual, and transcendent states of consciousness (Lajoie and Shapiro, 1992:91).
Transpersonal psychology is a school of psychology that studies the transcendent
or spiritual dimensions of humanity. Among these factors we find such issues as
self-development, peak experiences, mystical experiences, and the possibility of
development beyond traditional ego boundaries.
Transpersonal psychology can effectively be used for (Simple format.com)
1. Healing
2. Personal Growth
3. Spirituality

The Development of Transpersonal Psychology

Among the thinkers who are considered to have set the stage for transpersonal studies
are William James, Sigmund Freud, Otto Rank, Carl Jung, Abraham Maslow,
and Roberto Assagioli (Cowley & Derezotes, 1994; Miller, 1998; Davis, 2003).
Research by Vich (1988) suggests that earliest usage of the term “transpersonal”
can be found in lecture notes which William James had prepared for a semester at
Harvard University in 1905–06. A major motivating factor behind the initiative
to establish this school of psychology was Abraham Maslow’s already published
work regarding human peak experiences. Maslow’s work grew out of the humanistic
movement of the 1960s, and gradually the term “transpersonal” was associated with
a distinct school of psychology within the humanistic movement.
In 1969, Abraham Maslow, Stanislav Grof, and Anthony Sutich initiated the
publication of the first issue of the Journal of Transpersonal Psychology, the leading
academic journal in the field. This was soon to be followed by the founding of the
Association for Transpersonal Psychology (ATP) in 1972. In the 1980s and 1990s
the field developed through the works of such authors as Jean Houston, Stanislav
Grof, Ken Wilber, Michael Washburn, Frances Vaughan, Roger Walsh, Stanley
Krippner, Michael Murphy, Charles Tart, David Lukoff, and Stuart Sovatsky.
Today transpersonal psychology also includes approaches to health, social
sciences, and practical arts. Transpersonal perspectives are also being applied to such
diverse fields as psychology, psychiatry, anthropology, sociology, pharmacology,
cross-cultural studies (Scotton, Chinen and Battista, 1996; Davis, 2003), and social
work (Cowley & Derezotes, 1994).
By common consent, the following branches are considered to be transpersonal
psychological schools: Jungian psychology, depth psychology (more recently
 Counseling in India 59

rephrased as the Archetypal psychology of James Hillman), the spiritual psychology

of Robert Sardello (2001), psychosynthesis founded by Roberto Assagioli, and the
theories of Abraham Maslow, Stanislav Grof, Ken Wilber, Michael Washburn, and
Charles Tart.
A key stimulus for the establishment of transpersonal psychology as a distinct field
of inquiry was Abraham Maslow’s research on self-actualizing persons. Maslow’s
work addressed not only psychological wounding and personal development, but
the study of peak experiences, inspired creativity, altruistic ideals, and personal
actions that transcend “ordinary” personality as well.

Transpersonal Psychology: Integrating Spirituality in

Counseling Practice
Effective counseling addresses the body, mind, and spirit. The field of counseling has
been slow in recognizing the need to address spiritual and religious concerns. There is
now widespread interest in the role of spirituality in both assessment and treatment.
Evidence for this interest is found in the many books and articles written on spiritual
and religious values in counseling. Spiritual and religious matters are therapeutically
relevant, ethically appropriate, and potentially significant topics for the practice
of counseling in secular settings. Counselors must be prepared to deal with their
clients’ issues of the human spirit (Gerald Corey, 2006, counselingoutfitters.com).
Increasingly therapists are realizing that religion and spirituality are often part
of the client’s problem. Ergo, rather than as something to be ignored, they should
also be part of the client’s solution. Because spiritual and religious values can play a
major part in human life, spiritual values should be viewed as a potential resource
in therapy.
Personal spirituality or some form of religious faith can be a powerful source of
meaning and purpose. For some, religion does not occupy a key place, yet a personal
spirituality may be a central force. Spirituality helps many people make sense out
of the universe and the purpose of our lives on this earth. It can help us get in
touch with our own powers of thinking, feeling, deciding, willing, and acting, thus
becoming a major force in the field of therapy.
Spirituality and religion are significant bases of strength for many clients, is the
core for finding meaning in life, and can be instrumental in promoting healing
and well-being. There is growing empirical evidence that our spiritual values and
behaviors can promote physical and psychological well-being. Exploring these values
with clients can be integrated with other therapeutic tools to enhance the therapy
process (Benson & Stark, 1996).
Counseling can help clients gain insight into the ways their fundamental beliefs
and values are reflected in their behavior. Clients may sometimes discover that they
need to re-examine these values. Clinicians must remain open and nonjudgmental,
 60 Counseling: Theory, Skills and Practice

recognizing that there are multiple paths toward solving problems. It is not the role
of the counselor to prescribe any particular pathway. Counselors can make use of
the spiritual and religious beliefs of their clients to help them explore and resolve
their problems. To effectively be able to address spiritual concerns in assessment and
treatment, counselors need to have competencies in working with values. Training
programs must incorporate discussion son how to work with values as a part of the
therapeutic process.
Religious beliefs can provide a deep sense of purpose and meaning in life. These
beliefs can offer hope in the face of adversity and suffering and can offer a perspective
when we are overwhelmed by life’s problems.

Infusion of Spirituality in Counselor Preparation Programs

Recent surveys of the general public and of counseling professionals suggest the
pervasive importance of spirituality in the lives of all individuals (Myers and Williards,
2003). Yet, the infusion of spirituality in counselor preparation programs continues
to be a concern. Counselors and counselor educators need to value and address
spirituality as an integral component of optimum human functioning. They need
to conceptualize spirituality as a developmental phenomenon span that is essential
for achieving wellness. And thereafter, by distinguishing between religiosity and
spirituality and operationally conceptualizing spirituality counselor educators can
more readily incorporate spiritual issues within the philosophy of the counseling.

DIMENSIONS OF SPIRITUAL APPROACH TO THERAPY

Assumptions of a Spiritual Approach to Therapy

(Bill O’Hanlon)
People are not defined by or determined by the circumstances of their lives. There is
more to people than nature or nurture, personality, genetics, biochemistry, or cause
and effect. People have spiritual resources, even when they are not religious that they
can drawng on in order to facilitate therapy outcomes.

Pain Management by Psychosocial and Spiritual Methods

(Gayle Newshan, 1999)
Spirituality is an important though aspect of pain management. The spiritual domain
involves: (1) meaning, (2) hope, and (3) love and relatedness. Understanding these
aspects carries several implications for any pain therapist such as it is important for
 Counseling in India 61

the pain therapist to be closer to his/ her own spirit in order to be there for the patient
in pain, in order to promote comfort and diminish pain. Spiritual assessment can
also be done in order to know where the client is and how the counselor can help.

Spirituality and Religion (Ruth A. Tanyi, 2002)

Spirituality is an inherent component of being human, and is subjective, intangible,
and multidimensional. Spirituality and religion are often used interchangeably, but
the two concepts are different. Spirituality involves humans’ search for meaning in
life, while religion involves an organized entity with rituals and practices about a
higher power or God. Spirituality may be related to religion for certain individuals,
but for others, such as an atheist, it may not be.

Pain: Spiritual Assessment

(Byock I. Dying Well, 1997; Cassell E. J, 1999;
Paice JA, 2002)
Many individual factors can affect a person’s experience of pain and subsequent
response to treatment, including their past experiences with pain, the meaning
they assign to their current pain, and underlying mood disorders (e.g., anxiety,
depression, anger). At times affective and cognitive dimensions of pain along with
psychosocial and spiritual issues can produce an overwhelming amount of suffering.
However, pain and suffering are not inextricably linked. That is, some patients with
pain report no suffering. Attending to suffering, by listening, and offering empathy
is a critical nonpharmacologic intervention. Obtaining a spiritual history can help
patients and their caregivers further understand and attend to the suffering aspects
of pain.
Spiritual interventions are used to alleviate despair and hopelessness (Jari Kylma,
2005)
Some of the consequences of living with terminal illness include despair and
hopelessness. Despair consists of two subprocesses. The downward subprocess of
despair refers to stopping and being stuck in a situation, losing grip and sinking
into a narrowing existence, and focusing on impossibility and losing perspective
of the future and questioning the possibility of hope. The upward subprocess of
despair implies fighting against sinking and fighting to rise back up with a glimmer
of hope.
A philosophical source of remarkable insights into personal suffering is
exemplified in Victor Frankl’s account of Second World War of his internment
in a Nazi concentration camp. (Kotur PF 2006) Frankl, a psychiatrist, maintains
 62 Counseling: Theory, Skills and Practice

that physical discomfort and deprivation, no matter how extreme or brutal, do not
cause suffering. The true root of suffering is loss of meaning and purpose in life, he
says. Being free of physical suffering, he believes, is not enough to sustain a person.
Quoting Friedrich Nietzsce “He who has a why to live, can bear almost any how.”
He says pain and privation can be endured if it is for a purpose.

INAPPROPRIATENESS OF ADHERING TO WESTERN

APPROACHES

Because of cultural differences between Eastern and Western countries, a direct

application of Western approaches to persons of Eastern descent may have
negative consequences. It can alienate people from mental health counseling, cause
deterioration of clients’ conditions, and waste counselors’ resources (Azuma, 1984).
In addition, applying Western approaches to people of Eastern cultures imposes
the Western values of independence and self-sufficiency on people who value
interdependence and harmony (Mocan-Aydm, 2000).
In light of the cultural differences between Eastern and Western countries, rather
than imposing Western values and counseling approaches on clientele from Eastern
countries, a more useful approach is to integrate Eastern philosophies and indigenous
approaches into mental health delivery. Indian mental health counselors may want
to include clients’ family and friends in counseling and incorporate the healing
power of religious interventions (Raguram et al., 2002). Similarly, mental health
counselors could refer their clients to indigenous healers so that both indigenous
healing methods and Western counseling approaches can be used simultaneously
(Hohmann et al., 1990).
An integration of culturally sensitive, indigenous methods with the Western
approaches to mental health can be useful (Raney and Cinarbas 2005). Including
family and friends in counseling may be beneficial, as is encouraging and supporting
clients’ religious practices. Both Western and indigenous approaches to mental health
have scientific and heuristic value and should be utilized in conjunction. Rather
than using either approach in isolation, integration of Western and indigenous
counseling approaches will be more effective for Indian clients.
In summary, we see that counseling in India actually employs a multidisciplinary
approach. There are pranic healers, astrologers, spiritual gurus, yoga and meditation
gurus, the temple priests as well as the mental health professionals who work
towards alleviation of problems. Counselors in India should take into account,
and systematize the knowledge gained from these sources, and integrate ancient
scriptural texts into today’s body of counseling knowledge.
 Counseling in India 63

INDIGENOUS MODELS OF COUNSELING

The search for the meaning of life has nagged man from time immemorial. Every
man, subject to his working knowledge of the dynamics of human behavior, has
formed his own theory of how best to live. There are scientists who try to make some
sense of this seemingly chaotic world around us. And in order to give meaning to
all this, there are ideas generated, theories formulated, and laws set down, ensuring
that the mechanism of life is well oiled. Yet, in spite of all the efforts, both at the
micro and macro levels, the concepts of individual and global psychology seems to
have yielded little toward alleviating human problems with permanent solutions.
People are still struggling with their anxieties, conflicts, and confusion. Any joy
or happiness experienced is transient. Peace of mind and contentment seem just a
little further away at best, or a pipe dream at worst. Where do we find that? More
importantly, what can we DO to find that? Or should we ask—what do we have to
BE to find that!
As one goes through life, one faces problems of a myriad dimensions. In India
people approach solutions in different ways. Some problems are solved with the
help of significant people around; some problems are shelved and hoped that time
would heal the wounds and alleviate the situation whereas some remain unsolved
and intensify, further causing stress levels to sky rocket.
Sociocultural changes like breakup of the joint family, more women entering the
work force, technological advancement, etc., have changed the way in which people
young and old seek solutions to their life problems. Now, people typically enter
counseling because they are feeling hurt, frustrated, or overwhelmed by problems.
Gone are the days when counseling was just for “the mentally ill.” In spite of lame
jokes and a dying, but lingering, stigma sometimes attached to counseling, many
individuals and families are seeking professional help to deal with the trauma of life
in a fallen world. More the globalization, and more the technological advancement,
more the restlessness and anxieties accorded to insecurity.
The goal of counseling often varies, and experienced counselors tailor their
approaches to their clients’ needs. But, it is important to understand that different
schools of therapy have different end goals. Counseling is grounded in humanism,
and most often seeks to help a person adjust to difficult circumstances. The processes
may include client education, behavioral techniques, and cognitive restructuring
(changing one’s thoughts), just to name a few. But the end goal will most likely be
some type of adaptation that provides symptom relief.
Man makes systems for his survival and progress. They have to be relevant to the
present. Our needs have changed. Hence, the values on which they must be based
must also be understood and assimilated contextually. One of the most essential
virtues of man is his rationality and congruence. He must therefore present himself
 64 Counseling: Theory, Skills and Practice

as a total entity, living according to the values he has understood and assimilated,
exhibiting absolute consistency and intense authenticity.
Developing multicultural and multidisciplinary counseling competencies are
identified as key aspects of developing overall counseling competency. There are
multiple aspects of developing multicultural and multidisciplinary counseling
competencies including gaining knowledge about key cultural practices and
awareness of ethnic identity development within the cultures involved, and further
insight into how ethnic identity development influences the counseling process.
The SWOT analyses presented in the special issue of Applied Psychology on
International Perspectives on Counseling Psychology propose numerous possibilities
for building a strategic plan for the new Counseling Psychology Division (16) in the
International Association of Applied Psychology. Reducing multiple possibilities
to a few common themes may suggest a realistic and meaningful way forward in
formulating a strategic plan for Division 16. Elements of this plan might include (a)
defining counseling psychology from an international perspective, (b) crystallising
a cross-national professional identity, (c) encouraging construction of indigenous
models, methods, and materials, and (d) promoting international collaboration.
(Mark L. Savickas, 2007).
According to Clay (2002), there is a trend in India toward incorporating Indian
traditions into Western approaches to counseling. Yoga and meditation have been
integrated into mental health counseling. For instance, Aruna Broota (Clay), an
Indian therapist educated in the US, developed a relaxation technique that combines
four yogic postures and the repetition of a religious word such as shanti (i.e., peace).
Yoga and meditation have been known to increase self-awareness, concentration,
and calmness of the mind. This creates the right climate for cognitive therapy
and behavioral interventions. Similarly, Sangram Singh Nathawat, a professor of
psychology and editor of the Indian Journal of Clinical Psychology, recommends
that his clients go to meditation and yoga camps to increase positive emotions and
decrease negative symptoms before entering mental health counseling (Clay).
Besides yoga and meditation, visiting religious centers is commonly used for
healing purposes in India (Raguram, Venkateswaran, Ramakrishna, & Weiss, 2002).
The authors investigated the effectiveness of a “healing temple” in South India.
Persons identified by family members as mentally ill were brought to this temple
where they lived for an unspecified period of time free of charge (Raguram et al.,
2002). No specific healing rituals took place in the temple. The persons seeking these
services took part in the daily activities of the temple, such as cleaning the courtyard
and watering plants in the temple’s garden. Results of the study revealed that 22
of 31 clients who were initially diagnosed with paranoid schizophrenia, delusional
disorder, and bipolar disorder had less severe psychopathology following their stay
at the temple. The authors believed that, in addition to specific healing powers of
the temple, clients’ improved mental health stemmed from the temple’s supportive,
 Counseling in India 65

non-threatening, and reassuring environment (Raguram et al., 2002). Prayer has

proved to be very effective in calming the mind, instilling hope in people.
One of the oldest systems of medicine, Ayurveda, has its origins in the 6th century
B.C. (Rajkumar, 1991). Ayurveda is divided into eight different specialties, one
being Bhuta Vidya, which deals with psychiatry (Das, 1987; Rajkumar, 1991; Sethi,
Gupta, & Lal, 1977). The importance of mental health can be seen in the classification
of Ayurveda into three categories: exogenous, endogenous, and psychic. Traditional
systems of medicine such as Ayurveda make up 70 percent of overall health care as
compared to that which is provided by physicians and general practitioners (Taylor,
1976). These traditional systems existed before, during, and after the British rule.
Indians also may seek help from indigenous healers when residing outside of India.
For example, Dein and Sembhi (2001) found that Indian psychiatric patients in
the United Kingdom often visited hakims or mullahs, who are religious healers, for
treatment. These religious healers prescribed herbal preparation and included the
patient’s entire family in the consultation. This practice differs from the one usually
followed by general practitioners who prescribe only biomedical drugs and meet
with the patient alone.
Incorporating indigenous methods of healing has a therapeutic value for Indians.
Thus, mental health counselors working with Indian clientele need to incorporate
traditional modes of healing into their counseling practices (e.g., referral) to increase
counseling effectiveness and to ensure client satisfaction. Also, integrating mental
health care with primary care in India will increase awareness and reduce stigma
about mental illness, and it will result in the availability of good, low-cost, effective
treatment because mental health care will no longer be an elusive treatment available
only to rich people (James et al., 2002).

EASTERN APPROACH TO COUNSELING: A COMBINATION

OF THERAPY AND LIFE COACHING

Many Indians know about counseling as an intervention field; but now the whole
approach to counseling is changing into mentoring/coaching, etc., as the postmodern
generation is emerging. Indian approach to counseling is a combination of therapy
and life coaching. And the medium is spiritual teaching.
Globalization is not only affecting families and socio-cultural orientations; it is
also having a profound effect on work culture and ethics. Integration with Western
society is creating conflict in the collective unconscious of the Indian people.
Working hours are longer, more work is expected of them, competition is very
high as the number of skilled personnel is growing. For every person who does
not perform up to the employer’s standards, there are many more alternatives. So
 66 Counseling: Theory, Skills and Practice

the margin of error allowed has dropped drastically. This has resulted in insecurity
and anxiety. Work timings are very irregular (the BPOs work during the night to
cater to the needs of the waking customers at the other end of the globe. The many
challenges being faced are causing a lot of stress. Husbands and wives meet only
during the weekends. That is the time they get to meet their children too. This
causes tension and dissatisfaction on the home front. The standard of living has
gone up exponentially and to deal with this people in India are working longer and
harder than ever before, thus raising the stress levels.
Indians, who earlier took advice from worldly-wise elders who were the pillars
of strength in a joint family system, have nowhere to turn to after its breakdown.
Thus it is alright to embrace coaching and all that coaching can offer. Life-coaching
provides what is no longer being provided by family support and sharing. Coaches
understand the world out there and are able to empathize and provide guidance.
With so many changes taking place simultaneously, people who do not have a direct
experience of the outside world are unable to help effectively.
Essentially, coaching is about helping one to reach self-actualization, a point
at which one not only truly knows oneself but within this knowledge possesses a
feeling of comfort with and understanding of the person one discovers. With regard
to the career options, these are many and varied. Approximately 25–30 percent
of coaches trained go into coaching full-time. The rest add coaching to whatever
they already do––such as counseling, therapy, training, management consultancy,
business advising, human resources, personnel managers, etc.
In India, there are many retreats budding on the outskirts of big cities and
towns providing design, aesthetics, and service and comfort levels, modeled after
exclusive and luxurious small hotels. They have a small number of rooms spread
across different plantations, gardens, and fields where a few people are unobtrusively
tended to as they go about their daily agendas in complete privacy and quiet.
These are places where one can connect with the rich and vibrant spiritual
tradition of India that encourages us to search for a meaning and purpose of our
existence by looking into the depths of our souls. Numerous processes derived from
the tradition of Yoga and a range of self-discovery modules allows guests to truly
recharge their body and mind energies and set about resetting their priorities and
goals. This is all provided in a private, serene, and spiritual environment.
In the Indian tradition, all round excellence is the manifestation of the purpose for
which our lives have been given to us. This excellence is inherent within us [tat tvam
asi – that (which you are moving towards) you are] and is to be achieved through
harnessing, refining, and purifying our body/mind energies and spiritualizing our
actions and emotions, thereby allowing the divine qualities within to shine forth.
The retreat centers help to achieve this by catalyzing the thinking process with
inputs from the Indian spiritual tradition.
 Counseling in India 67

Apart from these retreat centers, there are many ashrams, or spiritual retreat
centers that have existed for a long time, run by various trusts and cater to spiritual
aspirants from various fields. These people get authentic spiritual guidance in these
ashrams. Of late, more and more people seem to be flocking to these retreat centers
that run various camps and workshops. With the stresses attributed to technological
advances and the resultant mechanized lifestyles, people’s thirst for self-knowledge
and self-discovery is increasing by leaps and bounds.
Coaching initiates and sustains the individual’s journey into self-discovery. As
we have seen earlier, in India, life is considered to be a journey of experiences that
leads us to discover the excellence inherent within us. People nowadays are looking
to spend some time reflecting and connecting with their inner selves, and the
retreat centers provide a sacred space and structure their stay with dedicated yoga
classes, rejuvenation and relaxing massages, light, but wholesome vegetarian food,
guided meditation sessions, mouna (silence) and karma yoga (working with a selfless
attitude) hours, and scriptural classes.
Yoga classes are based on classical hatha yoga and combined with pranayama
(breathing related) and pratyahara (internalization) processes drawn from the Yoga
sutras, an ancient yogic doctrine that aims to integrate our body, mind, heart and
soul for complete living. The programs and yoga classes are dedicated to applying
the wisdom of the Vedas and Indian spiritual tradition to enrich the professional
and personal lives the people.
Some retreat centers also include nature-based activities that one can experience,
for example, the opportunity to spend time in the herb and agricultural fields.
This seems to be an immensely therapeutic experience in itself with their stresses
disappearing as they were working in the fields.
Yoga tells us that the laws governing external nature are identical to the laws
governing our psychophysical personalities. Through the process of observation and
mindfully participating in our carefully designed farming activities, one can learn a
lot about the self.
Another significant therapeutic experience that these retreat centers provide
the guests is an opportunity to participate in many community-based activities
organized by them like serving meals to village school children, renovating the
village school or other essential structures, reading to the villagers, or organizing
recreational programs for the villagers. This gives them the chance to interact and
experience the real India. This exercise which is known as seva or service, changes
negative emotions into positive ones such as arrogance into humility, sympathy
and indifference into empathy and compassion, and anger into love. The Indian
tradition believes that selfish ego personality is just maya or illusion. And beneath
it we all have a genuine desire to give—for the sake of giving, and not for the sake
of personal aggrandizement. This aspect of our personality when harnessed and
employed in our daily work and personal life gives a lot of peace and satisfaction.
 68 Counseling: Theory, Skills and Practice

Nature walks and agricultural and medicinal herb gardens farming provide the
necessary physical stress relief. Yoga classes, wellness and stress management modules,
regular yoga retreats where individuals can learn from the physical, physiological,
and therapeutic benefits of a simple yoga practice, stress management packages, and
retreats for psychosomatic ailments like asthma, high blood pressure, back, neck
and hand pain etc., seem to be the order of the day in these places. Meals served
are vegetarian, and thoughtfully planned to complement the lifestyle one will be
experiencing at the retreats.
According to yoga, “stress,” causes many emotional disorders through an inability
of the body/mind system to cope with the demands made on it both professionally
and in personal life. While Western medicine and psychiatry deals with stress with
medicine that induces the release of “feel good” hormones, this does not eliminate
the problem. Vedanta says that the root cause of stress lies in our inability to see
the world as one unbroken stream of consciousness flowing through everything and
everyone. When the realization that we are not separate from the world, and hence
we need not compete with the world for our happiness is the one that will save us all
from this meaningless, competition and rat race.
Yoga encourages one to deal with stress at the physical (with proper diet and
asanas [physical postures]), physiological (with pranayama-breathing practices),
mental and intellectual level (with meditation) and is therefore referred to as a
holistic healing science.
Many retreat centers offer massages, which are designed to remove knots of stress
out of the muscles. Insomnia can be tackled with yoga nidra or deep yogic sleep
practices, light meals at night, avoiding intoxicants, and meditation. Back pain can
be helped with various yoga postures that help stretch, relax, and strengthen the
spine as well breathing and meditation practices.

v Summary v
The discussion on counseling cannot be complete without making it relevant
to the Indian setting. With the world around us changing so fast, families in
India are caught up amongst many developments for which they were not
prepared. The difference in the pace of life, in values and ethics, and in the
capacity to adapt, which differs between the parents and their children, the
family, society, and culture changing to adapt itself to globalization, work,
and career issues expanding to herald in the capitalized world, issues relating
to personal, and social and professional insecurity are looming large. As a
result, there is a great need for some kind of intervention and help.
Attention in counseling should be drawn towards culture-specific issues as
they determine clients’ attitudes and perceptions, which in turn contribute
to their problems. Also, spiritual and religious values play a major part in
 Counseling in India 69

the clients’ problems in India. Having acknowledged this fact, counselors

must understand the potency of pursuing them as a focal point in their
resolution. Only then will healing be wholesome. Especially now, with
growing epidemics of physical and mental illnesses, there is much more
need for properly focused intervention. Even the government is looking out
for workable models of intervention and the counselors need to wake up
and equip themselves if they want to impact the country in a very significant
way.
Mental health care is receiving increased attention in developing countries
at a time when a wide range of treatments for acute and chronic mental
disorders is available (6). Availability of these treatments enables the use
of a variety of levels of care for mentally ill patients with different needs (5)
and makes it feasible to consider issues of quality assurance for treatment
approaches that go beyond institutionalization.
Life coaching and spiritual retreats, which have existed for thousands
of years, have picked up popularity again, whether it is for commercial or
spiritual purpose.

References
Acharya, K. 2001. Poverty and Mental Health. Multinational Monitor. http://multinationalmonitor.
org/mm2001/01october/oct01front.html#pov
Azuma, H. 1984. ‘Psychology in a Non-western country’. International Journal of Psychology, 19, pp.
45–55.
Benson, Herbert, and,Marg Stark. 1996. Timeless healing: the power and biology of belief:
Scribner.
Bill O’Hanlon [email protected]; http://www.brieftherapy.com
Chandrashekar C. R. 2005. ‘Development of Community Psychiatry’. In: Bhugra D, Ranjith G,
Patel V eds. Handbook of Psychiatry–A South Asian Perspective. New Delhi: Byword Viva;
pp. 422–33.
Chowdhury, A.N., A. K. Chakraborty and M. G. Weiss.2001. ‘Community Mental Health and
Concepts of Mental Illness in Sundarbans’ Delta of West Bengal’, India’: Anthropology
and Medicine, 8, pp. 109–129.
Clay, R. A. 2002. ‘An Indigenized Psychology: Psychologists in India blend Indian traditions
and Western Psychology’. Monitor on Psychology. http://www.apa.org/monitor/may02/
india.html
Cowley, Au-Deane S. and David Derezotes. 1994. ‘Transpersonal Psychology and Social Work
Education’. Journal of Social Work Education, 10437797, Winter, Vol. 30, Issue 1
Das, A. K. 1987. ‘Indigenous models of therapy in traditional Asian societies’. Journal of
Multicultural Counseling and Development, 15, pp. 25–37.
Davis, John V. 2003. ‘Transpersonal psychology in Taylor, B. and J. Kaplan, Eds. The Encyclopedia
of Religion and Nature. Bristol, England: Thoemmes Continuum.
Desai NG. Public Mental Health: An evolving imperative. Indian J Psychiatry [serial online].
2006. [cited. 2010. Jul 2]; 48:135–7. Available from http://www.indianjpsychiatry.org/
text.asp. 2006./48/3/135/31574
 70 Counseling: Theory, Skills and Practice

Hohmann, A. A., M. Richeporte, B. M. Marriott.,G. J. Canino, M.,Rubio-Stipec and H. Bird

1990. Spiritism in Puerto Rico: Results of an island-wide community study. British
Journal of Psychiatry, 156, pp. 328–335.
http://www.allpsychologyschools.com/schools/ID982
http://www.psychegames.com/transpersonal-psychology.htm
http://www.simpleformat.com/transpersonalpsychology/transpersonal_psychology
http:// www.shreyasretreat.com
James, S., D., Chisholm, R. S., Murthy, K. K., Kumar, K. Sekar, K. Saeed, et al. 2002. ‘Demand
for, Access to and Use of Community Mental Health Care: Lessons from a Demonstration
Project in India and Pakistan’: International Journal of Social Psychiatry, 48, pp. 163–
176.
Maddux, James E., and Barbara A. Winstead. 2007. Psychopathology: Foundations for a Contemporary
Understanding. CRC Press.
Kapur, R.L. 2004. ‘The Story of Community Mental Health in India’. In: Agarwal SP ed. Mental
health: An Indian Perspective: 1946–2003. New Delhi: Directorate General of Health
Services, Ministry of Health and Family Welfare, pp. 92–100.
Kotur Pf. 2006. ‘Editorial: Pain Management by Psychosocial and Spiritual Methods’; Indian
Journal of Anesthesia, October.
Lajoie, D. H. and S. I. Shapiro. 1992. Definitions of transpersonal psychology: The
first twenty-three years. Journal of Transpersonal Psychology, Vol. 24.
Mark L. Savickas. 2007. Internationalisation of Counseling Psychology: Constructing Cross-
National Consensus and Collaboration, Applied Psychology 56(1), doi:10.1111/j.1464-
0597.2007.00284.x.
McGuiness, J., G. Alfred, N. Cohen, K., Hunt and M. Robson. 2001. Globalizing
Counselling: Humanistic Counselling in Kenya. British Journal of Guidance and Counseling,
29, pp. 293–300.
Miller, John J. 1998. ‘Book Review: Textbook of Transpersonal Psychiatry and Psychology’.
Psychiatric Services 49: pp. 541–542, April. 1998. American Psychiatric.
Association.
Mocan-Aydin, G. 2000. ‘Western Models of Counseling and Psychotherapy within Turkey:
Crossing Cultural Boundaries’. The Counseling Psychologist, 28(2), pp. 281–298.
Murthy, R. Srinivasa. 1998. ‘Rural Psychiatry in Developing Countries Psychiatric Services, 49:
pp. 967–969.
Myers, Jane E.and Kirk Williard. 2003. ‘Integrating Spirituality into Counselor Preparation: A
Developmental,Wellness Approach’; Counseling and Values, Volume 47 Retrieved from
http://www.QUestia.com.
Nagaswami V. 1990. ‘Integration of Psychosocial Rehabilitation in National Health Care
Programmes’. Psychosocial Rehabilitation Journal, 14, pp. 53–66.
National Mental Health Programme for India. New Delhi, Ministry of Health and Family
Welfare. 1982.
Newshan G. 1998. Transcending the Physical: Spiritual Aspects of Pain in Patients with HIV
and/or Cancer.J Adv Nurs. Dec; 28(6). 1236-4.
Pope-Davis, D. B., and H. Coleman. 1997. Multicultural Counseling Competencies. Thousand
Oaks, CA: Sage.
Raguram, R., J. R., Venkateswaran and J.,Ramakrishna and M. G. Weiss. 2002. ‘Traditional
Community Resources for Mental Health: A Report of Temple Healing from India’.
British Medical Journal, 325, pp. 38–40.
Rajkumar, S. 1991. ‘Mental Health Services in India’. Journal of Sociology and Social Welfare, 18,
pp. 41–55.
 Counseling in India 71

Raney, Shonali and Cinarbas, Deniz Canel. 2005. ‘Counseling in Developing Countries: Turkey
and India as Examples’, Journal of Mental Health Counseling, Vol. 27.
Sartorius N, G.,Girolomo and G. Andrews, et al (eds): Treatment of Mental Disorders: A Review of
Effectiveness: Washington DC.
Sartorius N, and T Harding: ‘The WHO Collaborative Study on Strategies for Extending Mental
Health Care: I. The Genesis of the Study’. American Journal of Psychiatry 140:1470–
1479, 1983.
Scotton, Bruce W, Allan B. Chinen, and John R. Battista, Eds. 1996. Textbook of Transpersonal
Psychiatry and Psychology. New York: Basic Books.
Dein, S. and S. Sembhi. 2001. ‘The Use of Traditional Healing in South Asian Psychiatric Patients
in the U.K: Interactions Bet1dc ween Professional and Folk Psychiatries, Transcultural
Psychiatry : Volume 38 Issue 2.
Sethi, B. B., S. C Gupta,and N. Lal. 1977. ‘The Theory and Practice of Psychiatry in India’.
American Journal of Psychotherapy, 31, pp. 43–65.
Sinha, J. B. P., T. N., Sinha, J. V., Sinha, and R. B. N. Sinha. 2001. ‘Collectivism Coexisting with
Individualism: An Indian Scenario’. Asian Journal of Social Psychology, 4, 133–145.
Sinha, J. B. P., N.,Vohra, S., Singhal, R. B. N., Sinha and S. Ushashree. 2002. ‘Normative
Predictions of Collectivist-Individualist Intentions and Behavior of Indians’, International
Journal of Psychology, 37, pp. 309–321.
Srinivasa Murthy R, Economics of Mental Health Care in Developing Countries, in International
Review of Psychiatry, Vol 2. Edited by Lieh Mak F. and CC. Nadelson Washington, DC,
American Psychiatric Press. 1996.
Tanyi RA. 2002. Towards clarification of the meaning of spirituality. J Adv Nurs. 2002. Sep;
39(5) :500-9.
Taylor, C. E. 1976. ‘The place of indigenous medical practitioners in the modernization of
health services’. In C. Leslie (Ed.), Asian Medical Systems: A Comparative Study (p. 286).
Berkeley, CA: University of California Press.
Vich, M.A. 1988. ‘Some historical sources of the term “transpersonal”.’ Journal of Transpersonal
Psychology,
Wig, N. N. 1990. ‘Mental Health and Spiritual Values: A view from the East’, International Review
of Psychiatry, 11, pp. 92–97.
World Health Organization and American Psychiatric Press. 1993.
Wrenn, C. G. 1962. ‘The Culturally Encapsulated Counselor’. Harvard Educational Review, 32,
pp. 444–449.
http//:www.lifepositive.com/Mind/psychology/psychotherapy/spiritual-psychiatry.
 4
Counseling through
the Lifespan

Chapter Overview
v Developmental psychology
v Counseling and developmental psychology
v Theories of human development
� Theories from mechanistic worldview perspective
� Jean Piaget’s theory of cognitive development
� Theories from the organismic worldview perspective
� Theories from the contextualistic worldview perspective
v The Indian focus: Philosophy of Indian counseling
� Four types of human goals

W
hy are humans the way they are? Why do abilities of children seem to
be so different from those of adults? What can one do to help children
become fully developed adults? These are the kinds of questions that
theorists of human development try to answer.
Over the course of the 20th century, counseling grew from supplementing vocational
guidance in education to a full blown profession in its own right. The foundation
of the profession included a heavy commitment to preventing problems, promoting
development, and resolving concerns of non-psychotic people of all ages.
Many counselors feel frustrated that most counselor training programs place a
greater emphasis on diagnosing and treating psychopathology. The result is the
loss of attention to prevention of and treating life adjustment problems and the
promoting of healthy development. They say that the reality is that everyone faces
adjustment problems, while only a relatively small minority of individuals qualifies
for DSM diagnosis. There is also a growing concern that counselors, counseling
psychologists, social workers, and other mental health practitioners are not being
 Counseling through the Lifespan 73

adequately trained to deal with life adjustment problems that almost everyone
experiences in the course of their lifetime. The concern, implicit in the current
emphasis on pathology and psychotherapy, is the assumption that service providers
need not be trained in the strategies of preventing mental illness, and that if they are
taught to understand the nature and treatment of psychopathology, they will be able
to develop effective strategies for preventing psychopathology.
The issue is dealt with keeping in mind this perspective. Mental health service
providers need a strong foundation in normal human development and problem
prevention strategies in order to meet the mental health needs of the 21st century.
Students should be acquainted with prevention and treatment of developmental
concerns. A developmental approach to counseling acknowledges not only the
potential for positive growth and change within each individual, but also the
ongoing tendency towards change, both positive and negative, throughout the
lifespan. It is therefore essential for counselors to develop an understanding of these
natural progressions in the life of an individual. Such an understanding enables
the counselor to approach each client from the most suitable perspective and assist
each individual better. This chapter gives an overview of some of the important
developmental theories needed to effectively bring about positive change.

DEVELOPMENTAL PSYCHOLOGY

Also known as human development, developmental psychology is the scientific study

of progressive psychological changes that occur in human beings as they grow and
age. Originally this branch of psychology was concerned with infants and children
only. Later on it expanded to include adolescents, adults and more recently, the
geriatric population too. Thus, it covers the entire lifespan. This field examines
changes across the different areas of development such as physical, motor, cognitive,
emotional, social, moral, and much more recently, the spiritual. It studies the
milestones of acquisition of motor skills and other psychophysiological processes,
problem-solving abilities, conceptual understanding, and acquisition of language,
moral understanding, and identity formation (adapted from wikipedia).
The field examines human developmental processes and transitions through
different stages and phases in the individual’s lifespan. Developmental psychology is
concerned with two areas of human functioning:
1. Describing the characteristics of psychological change over time
2. Trying to explain the principles and internal workings underlying these
changes, with the aid of models.
These models explain the means by which a process takes place. For instance they
talk about the changes in the brain and the corresponding changes in the behavior
of an individual over the course of development.
 74 Counseling: Theory, Skills and Practice

Researchers in this field primarily gather evidence through observation, with each
study adding to the overall body of material in developmental psychology. They
systematically present the theoretical paradigms and current trends relating to the
different subfields. They also integrate the various fields providing information not
only on the processes but also their interaction with other processes. The various
areas of development do not occur mutually exclusive of others. They dynamically
interact with each other and have a profound influence on each other.
It is a field of study very significant to counselors as it is critical to understanding
how humans mature, what their normal milestones are and why they might
not achieve them. Lagging behind in normal development, or failing to meet
development targets at a specific age, can be an early sign that a child is experiencing
problems which need to be addressed (wisegeek.com).
Other fields, such as educational psychology, child psychopathology, and forensic
developmental psychology draw their information from developmental psychology.
The field also complements several other basic research fields in psychology including
social psychology, cognitive psychology, cognitive development, and comparative
psychology.

COUNSELING AND DEVELOPMENTAL PSYCHOLOGY

Counseling includes, but is not limited to, assisting personal problem solving,
decision making, and life planning. Assistance by way of facilitating the development
of clients by helping them become aware of the factors and forces at work in their
lives and in the process learn to exert some degree of control over those forces.
In order to be an effective counselor, one needs to organize the helping process
around a set of unifying and clarifying ideas, principles, and commitments regarding
human beings, and the physical and social world they live in. Any counselor who has
been practicing for some time will agree that the knowledge of developmental stages,
milestones, and developmental tasks is of paramount importance to understand and
assess the situation accurately. The divide between what is and what is expected is
the main cause of adjustment problems.
As people pass through a life cycle, they pass through a sequence of chronological
stages, and the number and complexity of social roles in which they engage increase
rapidly. Often, these roles conflict or compete, sometimes taking on contradictory
and incompatible expectations and conceptions. As this occurs, the life space of the
individual is characterized by role strain. When role strain among very central and
significant roles occurs, the individual may be subject to intense anxiety or stress.
Similarly, as individuals move through a life cycle, new roles, relationships, and
responsibilities are often thrust on them. They may be poorly prepared to handle
 Counseling through the Lifespan 75

these new roles. The anthropological concepts of continuity and discontinuity link
human ecology and counseling and are important in conceptualizing the functions
of developmental counselors.
Changes in psychology and in society, in terms of perception and actuality, with
age, bring about a lot of confusion and therefore stress. This results in maladaptive
behavior. If the counselor is aware of how much the presenting problem is caused by
these developmental factors, she/he would be able to provide clarity quite easily.
In choosing formulas or techniques to be used, counselors build on eclectic
integrative approaches, that is, an approach drawn from many sources. Eclectic
counseling uses concepts, constructs, and behavior change principles from a variety
of psychological or therapeutic models or bodies of research and theory (Poznanski
& McLennan, 1995). Thus, knowledge of various developmental theories is a must
for counselors. The understanding of the developmental factors should be along the
following lines.

Understanding Human Development from Early Childhood

to Adulthood
The period of life from early childhood to adulthood includes stages and
characteristics of physical and motor, social and emotional, language and cognitive
development from early childhood to young adulthood; developmental theories,
their characteristics and their limitations; and developmental issues of particular
importance during the various stages of human growth and development.

Understanding the Ways in Which Developmental Stages

and External Factors Affect Counseling and Assessment
An understanding of the ways in which development during early childhood, middle
childhood and adolescence may affect educational counseling and assessment
strategies and techniques; the influence of gender, family, peers, community; and
the effect of racial, ethnic, cultural, linguistic, and socio-economic background on
personal growth, development, learning, behavior, and educational achievement;
and the application of developmental theories to various situations, education or
counseling.

Understanding Characteristics of Students with Special

Educational Needs
Special educational needs for children include characteristics of students with
special educational needs (e.g., learning disabilities, emotional impairments, mental
impairments, physical impairments); learning characteristics and educational needs
 76 Counseling: Theory, Skills and Practice

of such students; and implications of impairments and disabilities on human

development, learning, behavior, educational achievement, and career planning.

Understanding Principles of Learning and Motivation

Learning and motivation includes learning theories, behavioral and cognitive concepts
of learning (e.g., reinforcement, transfer of learning, retention), the relationship
between motivation and learning, factors that affect student motivation and attitudes
toward school, and the application of learning concepts and motivational principles
in various educational situations.

Understanding the Principles of and Methods for Promoting

Cognitive Development
The principles and methods for promoting cognitive development include principles
of and methods for helping students develop goal-setting, problem-solving, and
decision-making skills; techniques and activities for helping students acquire, apply,
and adapt to efficient learning strategies; and techniques for encouraging students to
assess their own needs, interests, and talents, and direct their own learning behaviors
in response to various demands and tasks.

THEORIES OF HUMAN DEVELOPMENT

Developmental psychology, as a discipline, is currently undergoing a paradigmatic/

worldview change. Consequently, several different theoretical approaches to the
study of development and life course have been proposed and advocated. Different
theorists study different aspects of human development and their work is based on
the different sets of assumptions they make. These differing assumptions reflect
theoretical debates about four aspects of human behavior:
1. Should it be the individual’s actual behavior or the presumed internal
psychological processes that might be reflected in behavior?
2. Are humans autonomous, self-directed individuals, or do they act largely
in response to external events?
3. Is there one theory that explains the development of all people in all places
at all times, are there many theories, each specific to a historic time and
place?
4. The actual methods that should be used to divine the answers to all of
these questions.
Different approaches to the study of human development reflect relatively
distinct worldviews. A worldview represents a set of assumptions that a theory may
 Counseling through the Lifespan 77

draw upon to serve as the foundation of that theory’s investigations. The worldview
framework was first introduced by philosopher Stephen Pepper (1961) and is
viewed as providing the most complete explanation differentiating three worldviews
(Goldhauber, 2000). Three worldviews referred to as the mechanistic worldview,
the organismic worldview, and the contextualist worldview strive to answer the
following three questions put forth by Pepper (Goldhauber, 2000):
1. Is the data on human development an accurate reflection of development
for all times and in all places (universal), or is development so situation-
specific that it is impossible to generalize across time and place?
2. What causes us to be the way we are, and what causes us to change?
3. How do causes relate to one another? Is it possible to separate causes
(reductionistic) or do they interact with each other (holistic)?

1. The Mechanistic Worldview

The Mechanistic Worldview equates living things or organisms to machines or
artifacts. These are believed to be composed of parts which are not intrinsically
interconnected or interrelated, and their order is imposed from the outside. From a
mechanistic viewpoint, human development and behavior are naturally occurring,
universal, behavior changes that are measurable and observable, and are therefore
predictable, lawful phenomena that can, theoretically at least, be fully understood
through the use of systematic, objective empirical research methods (empirical
meaning that the methods rely on observation or experimentation). They also
believe that behavior is caused either by factors external to the individual (efficient
causes––external factors like parenting style, educational opportunities, and peer
group composition), or those defining the individual’s biological makeup (material
causes––inherited genetic characteristics and more general biological qualities
such as temperament or information processing capability). It is a reductionistic
paradigm, highly testable. It deals with behavior that is directly present, factual and
observable. The researchers/ practitioners separate and dissect a single behavior so
that each variable influencing that behavior can be examined independent of every
other variable.
The preeminent theorists associated with the Mechanistic Worldview are the
proponents of the learning theory (also referred to as stimulus-response theory,
behavior theory, and social learning theory). They are Ivan Pavlov, BF Skinner, JB
Watson and Albert Bandura.

2. The Organismic Worldview

The Organismic Worldview explains rather than predicts. It uses qualitative processes
to explain behavior and its causes. From their view point human development is
a holistic, sequential process of structural changes that lead to increasingly more
 78 Counseling: Theory, Skills and Practice

effective modes of adaptation, primarily for maintaining a sense of equilibration––

to exist in harmony with the environment (Piaget, 1950). Change or development
is the result of the human being’s effort to stay the same or maintain equilibrium.
Learning and growing, and building on the knowledge already accrued, is the
consequence of adapting to the environmental changes.
Organismic Worldview theorists recognize both efficient (external) and material
(genes) causes as important but place even more emphasis on what they see as
formal and final causes. Formal causes reflect the organizational quality of all living
systems, while final causes reflect the organicists’ belief that human development is
a directional process. Organicists argue that humans are each more than the sum of
their parts and that human beings are actively involved in their own construction.
They say that the organism is composed of interconnected, interrelated parts and go
to constitute a complex, organized system.
There are three major issues related to this. The human organism thus can be only
studied and understood as a whole entity (a gestalt). Second, the organism is seen as
active rather than passive. The change within and its movement is a response to the
processes within rather than in response to external or environmental influence the
source of its acts according to this worldview, the organism is genetically prewired.
And third this change is qualitative and unidirectional. Psychologists operating
from this frame of reference define development as a series of progressive changes in
structure, directed toward some goal. .
The major theoretical traditions within the Organismic Worldview are the
psychoanalytic models associated with the work of Sigmund Freud, Erik Erikson, and
the cognitive developmental model associated with the work of Jean Piaget, Kohlberg’s
theory of moral development.

3. Contextualist Worldview
Though the mechanistic and organismic worldviews are very different, nevertheless,
they share one important characteristic—each views the process of development as
universal. And it is this emphasis that contrasts them to the contextualist worldview.
Contextualists argue that the forces that contribute to development are specific to
historical time and social place. They do not believe that there are universal laws of
development.
Contextualists make their non-universal argument for two reasons: one empirical
and one conceptual. From an empirical perspective, they argue individuals are too
different and their behaviors too variable to hold on to the ‘universality’ theory.
From a conceptual perspective, contextualists argue that since it is impossible to ever
have an objective (i.e., context-free) perspective on human development, then it is
impossible to make judgments that are not culturally based. Thus, this worldview is
both realistic and idealistic, internally as well as externally driven.
 Counseling through the Lifespan 79

Lev Vygotsky’s cultural-historical theory of human development which places

great emphasis on the role of culture in first defining and then transmitting the sign
and symbol systems used in that culture is a good example of a theory rooted in a
contextualist worldview. Sign and symbol systems are the ways in which cultures
note and code information. They are reflected in the nature of the language, in
ways of quantifying information, in the expression of the arts, and more generally
in the ways in which people establish, maintain, and transmit social institutions and
relationships across generations.

THEORIES FROM THE MECHANISTIC WORLDVIEW

PERSPECTIVE

Give me a dozen healthy infants, well-formed, and my own specified world to bring them
up in and I’ll guarantee to take any one at random and train him to become any type
of specialist I might select––doctor, lawyer, artist, merchant-chief and, yes, even beggar-
man and thief, regardless of his talents, penchants, tendencies, abilities, vocations, and
race of his ancestors. —John Watson, Behaviorism, 1930

Behaviorism is one of the theories from the mechanistic worldview perspective.

It is a school of thought that assumes that learning occurs through interactions with
the environment––the environment shapes behavior. It also assumes that mental
states, such as thoughts, feelings and emotions are useless in explaining behavior.

Classical Conditioning Model

Classical conditioning (also Pavlovian or respondent conditioning) was first
demonstrated by Ivan Pavlov. It is a form of associative learning––a learning process
that occurs through associations between an environmental stimulus and a naturally
occurring stimulus. In order to understand this process, it is necessary to be familiar
with the following concepts:

The Unconditioned Stimulus (US): This is one that unconditionally, naturally,

and automatically triggers a response.

The Unconditioned Response (UR): This is the unlearned response that

occurs naturally in response to the unconditioned stimulus.

The Conditioned Stimulus (CS): This is initially a neutral stimulus. It could

be any event that does not result in an overt behavioral response from the organism
under investigation. This neutral stimulus, after becoming associated with the US
 80 Counseling: Theory, Skills and Practice

eventually comes to trigger a response similar to the UR. This becomes the CR. The
CR and UR are the same. Just the difference is that they are responses to different
stimuli. When the response was to the unconditioned stimulus it was called the
unconditioned response. The same response when following the conditioned
stimulus becomes the conditioned response.

The Process of Classical Conditioning: Classical conditioning has been

demonstrated in numerous species using a variety of methodologies.
Classical conditioning first starts with the teacher/therapist/investigator
identifying the response to be achieved. The next step is to find out which stimulus
elicits this response naturally. After this the therapist identifies the stimulus to which
she/he wants the natural response to follow.
The US and the CS are paired for several trials after which the UR, which initially
followed US starts following CS too. The connection, or the association between
the hitherto unconnected CS and CR is formed.
Thus “unconditioned” means unlearned, untaught, pre-existing, already-present-
before-we-got-there and “conditioning” means to associate, connect, bond, link
something new with the old relationship.
Initially (Pavlov’s experiment),
Unconditioned Stimulus Æ Unconditioned Response
(Food) (Salivation)
Conditioned Stimulus Æ No Response
(Bell)
Then,
Unconditioned Stimulus + Conditioned Stimulus Æ Unconditioned Response
(Food) (Bell) (Salivation)
After several trials,
Conditioned Stimulus Æ Conditioned Response
(Bell alone) (Salivation)
The stimulus, which did not originally evoke a particular response, on close
temporal proximity with another, which does elicit a particular response naturally,
starts to elicit a similar response.

Types of Classical Conditioning

1. Forward conditioning
The onset of the CS precedes the onset of the US. Three common forms of forward
conditioning are: short-delay, long-delay, and trace.
 Counseling through the Lifespan 81

2. Simultaneous conditioning
The CS and US are presented at the same time.

3. Backward conditioning
The onset of the US precedes the onset of the CS. In this method the CS actually
serves as a signal that the US has ended rather than being a reliable predictor of an
impending US (such as in forward conditioning).

4. Temporal conditioning
The US is presented at regular time intervals, and CR acquisition is dependent upon
correct timing of the interval between US presentations.

5. Unpaired conditioning
The CS and US are not presented together. Rather they are presented as independent
trials that are separated by a variable, or pseudo-random, interval. This procedure
is used to study non-associative behavioral responses, such as sensitization which
is a progressive amplification of a response following repeated administrations of a
stimulus.

6. Response extinction
The CS is presented in the absence of the US and eventually, the CR frequency is
reduced to pretraining levels.

7. Stimulus discrimination/reversal conditioning

In this procedure, two CSs (CS+ and CS–) are identified which can be similar
(different intensities of light) or different (auditory and visual). The US is paired
only with the CS+ and not with CS–. After a number of trials, the organism learns
to discriminate CS+ trials and CS– trials such that CRs are only observed on CS+
trials.
During reversal training, the CS+ and CS– are reversed and subjects learn to
suppress responding to the previous CS+ and show CRs to the previous CS–.

8. Stimulus generalization
This is the tendency for the conditioned stimulus to evoke similar responses after
the response has been conditioned.

9. Secondary conditioning
The CS takes on the role of the US and is paired with another and the process
of conditioning continues further. Attitudes, values, beliefs, and thinking patterns
 82 Counseling: Theory, Skills and Practice

are quite often learned in this manner. Thus to help make changes in therapy the
same principle can be applied to unlearn what has been learned. Many behavior
modification techniques for example, aversion therapy, flooding, systematic
desensitization, and implosion therapy owe their origin to the classical conditioning
theory.

Operant (Instrumental) Conditioning Model

This model examines the relationship between a behavior and its consequence. It
was developed by Edward Thorndike, John Watson, and B.F. Skinner. This theory
proposes that learning is the result of the consequences. The learners begin to connect
certain responses with certain stimuli causing the probability of the response to
change (i.e., learning occurs). As a model of human development, it demonstrates
how changes in the consequences of one’s behavior can in turn modify that behavior.
Responses are more likely to increase if followed by a positive consequence and less
likely if followed by a negative consequence.
Thorndike labeled this type of learning as instrumental. Skinner renamed
instrumental as operant, i.e., in this learning, one is “operating” on, and is influenced
by, the environment. The stimulus follows a voluntary response which then changes
the probability of whether the response is likely or unlikely to occur again. The two
types of consequences, positive (sometimes called pleasant) and negative (sometimes
called aversive) can be added to or taken away from the environment in order to
change the probability of a given response occurring again (Huitt, W., & Hummel,
J. 1997).
Classical conditioning illustrates S–>R learning, whereas operant conditioning
is often viewed as R–>S learning. It is the consequence that follows the response
that influences whether the response is likely or unlikely to occur again. Voluntary
responses are learned through operant conditioning. (Huitt, W. and Hummel, J.
1997).

General principles: There are four major techniques or methods used in

operant conditioning. They are the result of combining the two major purposes
of operant conditioning (increasing or decreasing the probability that a specific
behavior will occur in the future), the types of stimuli used (positive/pleasant or
negative/aversive), and the action taken (adding or removing the stimulus).
There are five basic processes in operant conditioning: reinforcements (positive:
pleasant, and negative: unpleasant or aversive) strengthen behavior; punishment,
response cost, and extinction weaken behavior.
Positive reinforcement: A positive reinforcer is added after a response and increases
the frequency of the response. For, e.g., reward, appreciation, etc., increase the
probability that a particular behavior will occur again.
 Counseling through the Lifespan 83

Negative reinforcement: After the response the negative reinforcer is removed,

which increases the frequency of the response. For, e.g., stop scolding once the
child apologises. (Note: There are two types of negative reinforcement: escape and
avoidance. In general, the learner must first learn to escape before he or she learns
to avoid.)
Response cost or omission: Omission or response cost weakens behavior by subtracting
a positive stimulus. After the response the positive reinforcer is removed, which
weakens the frequency of the responsee. Withdrawal of privileges like watching TV,
books, lunch hour play, etc.
Punishment: It weakens a behavior by adding a negative stimulus. After a response
a negative or aversive stimulus is added which weakens the frequency of the
response.
Extinction: No longer reinforcing a previously reinforced response (using either
positive or negative reinforcement) results in the weakening of the frequency of the
response.

Outcome of Conditioning
Increase Behavior Decrease Behavior
Positive Positive Reinforcement Response Cost
Stimulus [add (positive) stimulus] [remove (positive) stimulus]
Negative Negative Reinforcement Punishment
Stimulus [remove ( negative) stimulus] [add (negative) stimulus]

Schedules of Reinforcement
Skinner found that the timing of the contingent reinforcement is an equally
significant variable. Continuous reinforcement is generally seen as being more
effective in establishing a response; variable or intermittent reinforcement is seen
as being more effective at maintaining a response at a high level once it has been
established.
Continuous reinforcement simply means that the behavior is followed by a
consequence each time it occurs.
Intermittent schedules are based either on the passage of time (interval schedules)
or the number of correct responses emitted (ratio schedules). This results in four
classes of intermittent schedules:
1. Fixed interval: The first correct response after a set amount of time has
passed is reinforced (i.e., a consequence is delivered). The time period
required is always the same.
 84 Counseling: Theory, Skills and Practice

2. Variable interval: The first correct response after a set amount of time has
passed is reinforced. After the reinforcement, a new time period (shorter
or longer) is set with the average equaling a specific number over a sum
total of trials.
3. Fixed ratio: A reinforcer is given after a specified number of correct
responses. This schedule is best for learning a new behavior.
4. Variable ratio: A reinforcer is given after a set number of correct responses.
After reinforcement, the number of correct responses necessary for
reinforcement changes. This schedule is best for maintaining behavior.

Behavior Genetic Model or the Nature-Nurture Debate

A behavior genetic model tries to bring about some understanding of the perennial
nature-nurture debate. It offers a different approach altogether. These debates concern
the relative importance of an individual’s innate qualities versus personal experiences
in determining or causing individual differences in physical and behavioral traits
They attempt to determine, through elaborate statistical procedures, how much of
the individual differences can be said to be due to genetic factors and how much due
to environmental factors.
Behavior genetic researchers cannot of course do research which involves selective
breeding procedures with humans, which is the preferred technique when working
with animals so they look for situations that they believe allow for “experiments in
nature.”
The two most common research designs behavior genetic researchers employ for
humans involve:
1. The comparison of individuals of different degrees of genetic relatedness,
i.e., twin and family studies, and
2. The comparison of adopted children to both their biological and adopted
parents (adoption studies).
Behavior genetic researchers report that many characteristics show a significant
genetic contribution. That is, identical twins appear more similar than fraternal twins
or siblings, who are in turn more similar than cousins, who are in turn more similar
than unrelated individuals. Further, adopted children share many characteristics
with their biological parents, even if they are adopted at birth.
Two different types of environmental effects are distinguished during the
investigations: shared family factors (i.e., those shared by siblings, making them
more similar) and non-shared factors (i.e., those that uniquely affect individuals,
making siblings different). In order to express the portion of the variance that is due
to the “nature” component, behavioral geneticists generally refer to the heritability–
the extent to which variation among individuals in a trait is due to variation in the
genes those individuals carry––of a trait.
 Counseling through the Lifespan 85

Also another component of the nature-nurture debate is the gene-environment

interaction. Environmental inputs affect the expression of genes, that is, the
environment influences the extent to which a genetic disposition will actually
manifest. Individuals with certain genotypes are more likely to find themselves
in certain environments. Thus, it appears that genes can shape (the selection or
creation of) environments.
Thus, there are the predominantly environmental traits (specific language,
religion), predominantly genetic (blood type, eye color) and interactional (height,
weight, skin color).

THEORIES FROM THE ORGANISMIC WORLDVIEW

PERSPECTIVE

Psychoanalytic Theory
The psychoanalytic theory was developed by Sigmund Freud. Even as his theories were
considered outrageous at the time, and went on to create dispute and disagreement,
his work had a reflective influence on a number of disciplines, including psychology,
sociology, anthropology, literature, and art.
Psychoanalysis is the term used to refer to Freud’s work and research, including
the therapy and the research methodology he used to develop his theories. Freud
relied heavily upon his observations and case studies of his patients when he formed
his theory of personality development. There are six main dimensions of this
theory:
1. Psychosexual stages of development
2. Levels of consciousness
3. Structure of the mind
4. Life instincts
5. Defense mechanisms
6. Therapy

1. Freud’s Stages of psychosexual development

(Kendra Cherry, About.com Guide)

What is psychosexual development?

The concept of psychosexual development was first envisioned by Sigmund Freud.
It posits that personality is mostly established by the age of five; early experiences
play a large role in personality development; and continue to influence behavior later
in life. Freud believed that, from birth, humans have instinctual sexual appetites
(libido) which unfold in a series of stages. Thus, the human personality develops
 86 Counseling: Theory, Skills and Practice

through a series of childhood stages during which the pleasure-seeking energies of

the Id become focused on certain erogenous areas. This psychosexual energy, or
libido, was described as the driving force behind behavior (psychology.about.com).
A healthy personality results if the stages are completed successfully. Every stage
has a set of developmental tasks which have to be learnt, certain issues which have
to be resolved. Each stage is characterized by the erogenous zone that is the source
of libidinal drive during that stage. If this fails to happen, fixation can occur. A
fixation is a persistent focus on an earlier psychosexual stage. It is the state in which
an individual becomes obsessed with an attachment to another human, an animal,
or an inanimate object. Until this conflict is resolved, the individual will remain
“stuck” in this stage. For example, an oral (stage) fixation can later on manifest as
overdependence on others, or may seek oral stimulation through smoking, drinking,
or eating.
The different stages according to Freud are as follows:

The oral stage

During the oral stage, the rooting and sucking reflex is especially important. This
stage is characterized by the infant deriving pleasure from oral stimulation through
gratifying activities, such as tasting and sucking, that is the infant’s primary source
of interaction occurs through the mouth. As the infant is entirely dependent upon
caretakers (who are responsible for feeding the child) this oral stimulation provides
the setting for the development of trust and comfort. The primary conflict at this
stage is the weaning process. Fixation at this stage means the individual would have
psychological issues like dependency or aggression, or behavioral problems like the
various addictions or nail biting.

The anal stage

During the anal stage, the primary focus of the libido is on controlling bladder and
bowel movements. The developmental task for this stage includes toilet training,
i.e., the child has to learn to control his or her bodily needs. Developing this control
leads to a sense of accomplishment and independence. The approach of the parents’
of major caregivers’ to this training determines the success of this stage. Too much
pressure (being too strict) or too much leniency have their own negative outcomes.
Praise and rewards encourage positive outcomes and help children feel capable
and productive. This serves as the basis for people to become competent, productive,
and creative adults. Negative approaches like the use of punishment, ridicule, or
shaming a child for accidents can result in negative outcomes.
If the parents are too lenient the child develops a messy, wasteful, or destructive
personality (anal expulsive). If parents are too strict or begin toilet training too early,
Freud believed that the child develops an anal-retentive personality in which the
individual is stringent, orderly, rigid, and obsessive.
 Counseling through the Lifespan 87

The phallic stage

During the phallic stage, the primary focus of the libido is on the genitals. Children
also discover the differences between males and females. This is the stage in which
the Oedipus and Electra complexes develop. Boys develop the oedipus complex and
view their fathers as rivals for the affections and experience the desire to replace the
father. Knowing that these feelings to be inappropriate the child, fears that she/
he would be punished by his/her father. This fear was termed castration anxiety by
Freud. The term electra complex has been used to describe a similar set of feelings
experienced by young girls. However, Freud posited, girls instead experience penis
envy. Eventually, the child begins to identify with the same-sex parent as a means of
vicariously possessing the other parent.

The latent period

This stage begins around the time that children enter into school and become more
concerned with peer relationships, hobbies, and other interests––the developmental
tasks to be acquired during this stage is development of social and communication
skills and self-confidence. During this period, the libido interests are suppressed.
This is a period of calm contributed by the development of the ego and superego.
This is a time of exploration in which the sexual energy is still present, but it is
directed into other areas, such as intellectual pursuits and social interactions.

The genital stage

This is the final stage of psychosexual development. The goal of this stage is to
establish a balance between the various life areas. During this stage the individual
develops a strong sexual interest in the opposite sex. In the earlier stages the focus
was solely on individual needs. This stage marks the growth of interest in the welfare
of others. If the other stages have been completed successfully, the individual should
now be well-balanced, warm, and caring.

2. Levels of Consciousness: States of the Mind

This is Freud’s topographical model of the human personality. According to Freud,
the mind can be divided into two main parts:

The conscious mind: The conscious mind includes everything that is in our
awareness. This is the aspect of our mental processing that we can think and talk
about in a rational way. The conscious mind holds the present perceptions, feelings,
thoughts, memories (which is not always a part of our conscious but can be retrieved
easily at any time), and fantasies at any particular moment. It is the part that is
cognitively aware. Here, one can communicate about their conscious experiences. It
is the realm of constructed, logical thinking.
 88 Counseling: Theory, Skills and Practice

The preconscious mind: The preconscious mind is related to that data of

which one is not conscious but can readily be brought to consciousness; or an area
for distant memories to remain until the conscious calls upon them.

The unconscious mind: The unconscious mind is a reservoir of feelings,

thoughts, urges, and memories that are outside of our conscious awareness. Freud
believed that most of the contents of the unconscious are unacceptable or unpleasant.
Like anxieties, conflicts, and pain, repressed feelings and ideas. This data, though
not easily available to the individual’s conscious awareness or scrutiny continues
to influence our behavior and experience. These feelings find expression through
dreams, free association, and parapraxis, (Freudian slips). This is where most of the
work of the Id, Ego, and Superego take place.

3. Structure of the Mind: Id, Ego, Superego

This is Freud’s Structural model of Personality. According to the psychoanalytic
theory, personality is composed of three elements known as the Id, the Ego, and the
Superego, which work together to create complex human behaviors.

The Id: This is that aspect of personality which is entirely unconscious and includes
the instinctive and primitive behaviors. It is the only component of personality
that is present from birth. It is very important part of the personality as it ensures
that the basic needs are met. It is the source of all psychic energy, making it the
primary component of personality. Being the unconscious reservoir of drives, it
remains constantly active. It is ruled by the pleasure principle demanding immediate
satisfaction of its urges, with no consideration for the reality of the situation or the
needs of anyone else. The primary concern is the satisfaction of their needs. If these
needs are not satisfied immediately, the result is a state anxiety or tension.

The Ego: This part of the personality develops as the child interacts more and
more with the world. It is ruled by the reality principle operating mainly in the
conscious and preconscious levels. The ego is responsible for dealing with reality.
Developing from the Id the ego ensures that the impulses of the id can be expressed
in a realistic and socially appropriate manner. However, the ego also discharges
tension created by unmet impulses.

The Superego: According to Freud, the Superego begins to emerge at around

age five or the end of the phallic stage of development. This is the last component
of personality to develop. This is the moral part of the individual. The Superego
provides guidelines for making judgments. Only partially conscious, it serves as a
censor on the ego functions.
 Counseling through the Lifespan 89

There are two parts of the Superego: The ego ideal that holds all of our internalized
moral standards and ideals that we acquire from both parents and society, By
obeying these rules one experiences feelings of pride, value, and accomplishment.
The conscience includes information about things that are viewed as bad by parents
and society, i.e., our sense of right and wrong, and leads to bad consequences,
punishments, or feelings of guilt and remorse.
The Superego is present in the conscious, preconscious, and unconscious working
to suppress all unacceptable urges of the Id. It constantly struggles to make the ego
act upon idealistic standards rather that upon realistic principles, which of course
results in much conflict among the three competing forces. Ego strength refers to
the ego’s ability to effectively manage the pressures from the Id and the Superego.
The balance between the three forces is the key to a healthy personality.
According to Freud the ego is the strongest in the healthy person, wonderfully
satisfying the needs of the Id, not upsetting the Superego, while still taking into
consideration the reality of the situation.

4. Life Urges or Instincts

Freud believed that all behavior is motivated by drives or instincts. They are life
instinct or Eros, and the death instinct or Thanatos.
• Eros: These instincts perpetuate (a) the life of the individual by motivating him
or her to seek food and water and (b) the life of the species by motivating him
or her to have sex.
• Thanatos: The death instinct. Freud posited that every person has “Under”
and “Beside” the life instincts an unconscious wish to die. Death promises a
relief from life’s pain and suffering. People look to escape this struggle by using
alcohol and narcotics. One’s desire for peace, escape from stimulation results
in having a penchant for escapist activity, such as losing oneself in books or
movies, or one’s craving for rest and sleep. Sometimes it presents itself openly
as suicide and suicidal wishes.

5. Defense Mechanisms
The ego is pulled on either side, back and forth, with the reality and society
represented by the Superego; and biology, which is represented by the Id. This
results in the individual feeling overwhelmed and fear that she/he is going to collapse
under the weight of it all. This feeling is called anxiety. The individual experiences
anxiety when the ego cannot deal with the demands of desire, constraints of reality
and moral standards. According to Freud, anxiety is an unpleasant inner state that
acts as a signal to the ego that things are not going right. Freud identified three types
of anxiety:
 90 Counseling: Theory, Skills and Practice

1. Neurotic anxiety: This is the fear of being overwhelmed by the Id impulses.

It is the unconscious worry that that the individual will lose control of
the Id’s urges and will engage in inappropriate behavior resulting in
punishment.
2. Reality anxiety: This is the fear of real world events and is not disproportionate
to the threat of the object.
3. Moral anxiety: This involves the fear of violating one’s own moral
principles.
The defense mechanisms help shield the ego from the pain and conflict. When
the anxiety experienced is beyond the tolerance of the individual these defenses
occur unconsciously and work to distort reality which helps the individual feel safe.
The different defense mechanisms are as follows:
• Denial: An outright refusal to admit or recognize that something has occurred
or is currently occurring.
• Repression: Acts to keep information out of conscious awareness. However,
these memories don’t just disappear; they continue to influence our behavior.
• Suppression: Consciously forcing unwanted information out of awareness.
• Displacement: Involves taking out our frustrations, feelings, and impulses on
people or objects that are less threatening.
• Sublimation: Acting out unacceptable impulses by converting these behaviors
into a more acceptable form. Freud believed that sublimation was a sign of
maturity that allows people to function normally in socially acceptable ways.
• Projection: Involves taking our own unacceptable qualities or feelings and
ascribing them to other people.
• Introjections: Sometimes called identification, involves taking into our own
personality, characteristics of someone else, because doing so solves some
emotional difficulty.
• Intellectualization: Thinking about the stressful, emotional aspect of the
situation and focus only on the intellectual component in a cold clinical way.
• Rationalization: Explaining an unacceptable behavior or feeling in a rational or
logical manner, avoiding the true explanation for the behavior.
• Regression: Abandoning coping strategies and revert to patterns of behavior
used earlier in development. Behaviors associated with regression can vary
greatly depending upon which stage the person is fixated at:
An individual fixated at the oral stage might begin eating or smoking
excessively, or might become very verbally aggressive.
A fixation at the anal stage might result in excessive tidiness or mess.
• Reaction formation: Taking up the opposite feeling, impulse, or behavior.
 Counseling through the Lifespan 91

• Compensation: Overachieving in one area to compensate for failures in

another.
• Avoidance: Refusing to deal with or encounter unpleasant objects or
situations.
• Aim inhibition: The individual accepts a modified form of their original goal.
• Altruism: Satisfying internal needs through helping others.
• Humor: Pointing out the funny or ironic aspects of a situation.
• Passive aggression: Indirectly expressing anger.
• Acting out: Coping with stress by engaging in actions rather than reflecting
upon internal feelings.
• Affiliation: Turning to other people for support.

6. Therapy
Much of Freudian therapy grew directly out of Freud’s work with his psychoanalytic
patients. As he tried to understand and explain their symptoms, he grew increasingly
interested in the role of the unconscious mind in the development of mental illness.
Some of the major observations are as follows:
• Relaxed atmosphere: Where the client feels free to express thoughts and feelings
without feeling judged.
• Free association: The client may talk about anything and everything that he or
she is thinking about.
• Resistance: At this stage, the client finds some of his thoughts and feelings
threatening. Also the client is unable to accept the process of change.
• Dream analysis: Dreams are those threatening thoughts and feelings which
creep into the awareness during sleep when resistance is minimal. They are in
symbolic form and provide the therapist with a lot of clues about the anxieties
of the client.
• Parapraxes: Or a slip of the tongue (Freudian slip!). These are also clues to the
unconscious.
• Projective test: The TAT, Rorschach, etc., where the stimulus is vague, the
client fills it with unconscious themes.
• Transference occurs when a client projects feelings toward the therapist that
more legitimately belong with certain important others.
• Catharsis the sudden and dramatic outpouring of emotion that occurs when
the trauma is resurrected.
• Insight is being aware of the source of the emotion of the original traumatic
event. The major portion of the therapy is completed when catharsis and
insight are experienced.
 92 Counseling: Theory, Skills and Practice

Erikson’s Psychosocial Theory

Erik Erikson’s theory of psychosocial development is one of the best known theories
of personality in psychology Erikson believed that childhood is very important in
personality development. Erikson both agreed as well as disagreed with Freud. He
agreed with Freud in that he believed that personality develops in a series of stages.
He accepted many of Freud’s theories, including the id, ego, and superego, and
Freud’s theory of infantile sexuality. But he rejected Freud’s attempt to describe
personality solely on the basis of sexuality, and, unlike Freud, felt that personality
continued to develop beyond five years of age. Unlike Freud’s theory of psychosexual
stages which stops at the genital stage, Erikson’s theory describes the impact of social
experience across the whole lifespan.
Erikson posited in his theory that all of the stages are implicitly present at birth
(at least in latent form), and these unfold according to both an innate scheme and
one’s upbringing in a family that expresses the values of a culture. As with any stage
theory, each stage builds on the preceding stages, and paves the way for subsequent
stages. Every stage is characterized by a psychosocial crisis, which is based not only
on physiological development, but also on environmental demands put on the
individual. Ideally, the crisis in each stage should be resolved by the ego in that
stage, in order for development to proceed correctly.
While Freud believed that the damages caused by unresolved issues or trauma
can be rectified only by long term therapy, Erikson believed that the outcome of one
stage is not permanent, and can be altered by later experiences. Every individual is a
mixture of the traits attained at each stage, but personality development is considered
successful if the individual has more of the “good” traits than the “bad” traits.

Ego Psychology
Erikson’s theory of ego psychology holds certain beliefs that make his theory different
from Freud’s. Some of these include:
• One of the main elements of Erikson’s psychosocial stage theory is the
development of ego identity. Ego identity is the conscious sense of self that we
develop through social interaction and its development is of utmost importance.
New experiences and information acquired through interactions with others
keep it constantly changing.
• Each stage in Erikson’s theory is concerned with becoming competent in an
area of life. Part of the ego is able to operate independently of the id and the
superego. If the psychosocial crisis during this stage is handled well, the person
will feel a sense of mastery (called ego strength or ego quality); and if managed
poorly, the person will emerge with a sense of inadequacy.
 Counseling through the Lifespan 93

• In each stage, Erikson believed people experience a conflict (which he called

the psychosocial crisis) that serves as a turning point in development. These
conflicts are centered on either developing a psychological quality or failing to
develop that quality. During these times, the potential for personal growth is
high, but so also is the potential for failure.
• Then the individual develops a sense of competence which motivates behaviors
and actions. The ego is a powerful agent that can adapt to situations, thereby
promoting mental health.
• Erikson believed that not only sexual but more importantly social factors, play
a role in personality development.
Erikson’s theory was more comprehensive than Freud’s as, in addition to
neuroticism, it also included information about “normal” personality. The scope
of personality was broadened to incorporate social and cultural factors, not just
sexuality.
The stages of psychosocial development are given below.

Psychosocial stage 1: Trust vs. mistrust

The first stage of Erikson’s theory of psychosocial development occurs between birth
and one year of age and is the most fundamental stage in life. The developmental
task during this stage is the development of the capacity to trust. If we notice,
the newborn is utterly dependent on the caregiver for almost all his basic needs.
Thus the dependability and quality of the caregiver is instrumental in forming a
bond between the infant and the caregiver. This bond results in the infant trusting
the caregiver and eventually generalizing this to the others. That is the capacity
to trust develops in the child. If during this stage and requirement the caregiver
does not prove himself or herself trustworthy, then the child develops a mistrust
in his interactions with others which he will carry into the following stages. Thus,
it is important for the caregiver to make the child feel safe and secure by being
consistent, emotionally available, and accepting of the children they care for as
failure to develop trust will result in fear and a belief that the world is inconsistent
and unpredictable.

Psychosocial stage 2: Autonomy vs. shame and doubt

The second stage of Erikson’s theory of psychosocial development takes place during
early childhood and is focused on children developing a greater sense of personal
control. This is the second and third year of the child during which time the child is
experiencing more and more autonomy in terms of movement, communication and
physiological functions. This leads to a feeling of control and a sense of independence.
Food choices, toy preferences, and clothing selection can be communicated––what
 94 Counseling: Theory, Skills and Practice

the child wants he or she can reach (the child has started walking) and the child is
able to control bowel movements and communicate his need to go to the toilet.
Children who successfully complete this stage feel secure and confident, while those
who do not are left with a sense of inadequacy and self-doubt.

Psychosocial stage 3: Initiative vs. guilt

This is the stage when children are admitted to preschool. Till now, they were
engaged in parallel play, but gradually they start to go to school and enjoy playing
with other children. During these social interactions they begin to assert their power
and control over the world through directing play and other interactions. They
learn to make rules and break them. They learn to argue and make up. They start
to learn the importance of giving in and compromising, as well as fighting for what
they want. They learn to lead and also follow. This sense of control and autonomy,
if learnt well, results in the child’s feeling capable and able to lead others. Those
children who fail to acquire these skills are left with a sense of guilt, self-doubt, and
lack of initiative.

Psychosocial stage 4: Industry vs. inferiority

This stage covers the early school years from approximately age five to 11. This is
the time when school work and wanting to prove their mettle becomes important.
Children start to learn the value of working to get what they want.
In India a sad scenario exists––parents begin to start comparing their children with
others. Marks have turned to grades in the evaluation system. Tests are not held until
Class V in many schools. The system of continuous evaluations has been introduced.
Evaluations have become more descriptive, at least in the lower grades. All this is
an effort to minimize competition. Even so parents find many a way to compare
their offspring with other children, pressurize them to put in more and more efforts
and achieve more and more laurels, both in academics or extra-curricular activities.
The children imbibe all this. The younger children are bewildered by this attitude
of their parents. Slowly they start to become very competitive. This is okay if the
child’s performance is satisfactory to the parent. Otherwise it causes disappointment
which is very well observed and internalized by the child. If the child gets a negative
response, she/he experiences a feeling of shame and inferiority.
That is the present academic scene. Also through social interactions, children
begin to develop a sense of pride in their accomplishments and abilities. Children
who are encouraged and commended by parents and teachers develop a feeling of
competence and belief in their skills.
 Counseling through the Lifespan 95

Psychosocial stage 5: Identity vs. confusion

During adolescence, children are exploring their independence and developing a
sense of self. Those who emerge from this stage with a strong sense of self will
experience a feeling of independence and control.
This identity forms the basis of all the interactions of the individual. The person
who is sure of who she/he is, will be happy and confident. This identity is based
on one’s family, social class, community culture and geographical factors. Thus
children who are raised in a particular culture but actually belong to another culture
experience feelings of conflict and confusion.
Generally immigrants in a particular country feel this way. They are being raised
in a certain way, with certain values imparted. This may conflict and contrast with
the social and cultural environment they interact in. Thus they become unsure of
their beliefs and desires. This will lead to insecurity and confusion. This also results
in anger and bitterness towards the parents, as they do not understand where they
are coming from.

Psychosocial stage 6: Intimacy vs. isolation

This stage covers the period of early adulthood when people are exploring personal
relationships. Erikson believed it was vital that people develop close, committed
relationships with other people. This stage has its basis in the first stage. Those who
have had problems then, will find it difficult to develop trusting relationships. They
have a fear of intimacy and commitment. Also, Erikson believed that a strong sense
of personal identity was important to developing intimate relationships. If there is
confusion in identity formation during the previous stage it leads to a poor sense of
self. These individuals tend to have less committed relationships and are more likely
to suffer emotional isolation, loneliness, and depression.

Psychosocial stage 7: Generativity vs. stagnation

Adulthood is the stage when the individual is continuing to build his or her life,
focusing on career and family. The experience of success during this phase will have
the individual feel that they are contributing to the world by being active in their
home and community. Those who fail to attain this skill will feel unproductive and
uninvolved in the world.

Psychosocial stage 8: Integrity vs. despair

This phase occurs during old age. In this last stage Erikson believes that the
individual is focused on reflecting back on life. This is the time that many in India
turn to spirituality. They attend spiritual gatherings, go on pilgrimages, and begin
 96 Counseling: Theory, Skills and Practice

to learn about their respective theosophies. A look back at their lives can cause many
people to feel that their life was wasted and therefore experience many regrets. This
leaves the individual with feelings of bitterness and despair. Those of who feel proud
of their accomplishments will feel a sense of integrity. Successfully completing this
phase means looking back with few regrets and a general feeling of satisfaction.
These individuals will attain wisdom, even when confronting death.

Jean Piaget’s Theory of Cognitive Development

Jean Piaget’s theory of cognitive development was one of the most historically
influential theories. His theory provided many central concepts regarding the
growth of intelligence. Piaget said the child’s understanding of the world changes as
a function of age and experience. He called this ability to more accurately represent
the world and perform logical operations on these representations intelligence. The
development of this intelligence, or cognitive ability is both qualitative (quality
of knowledge and understanding) as well as quantitative (amount of information
acquired). Piaget suggested that children go through four separate stages in an order
that is universal. When the child reaches the appropriate level of maturation and
is exposed to relevant types of experiences, he or she moves from one stage to the
next. Piaget believed that these experiences are of paramount importance if the child
has to achieve the highest level of cognitive ability. As opposed to Nativist theories
(which describe cognitive development as the unfolding of innate knowledge
and abilities) or empiricist theories (which describe cognitive development as the
gradual acquisition of knowledge through experience), Piaget referred to his view as
“constructivism,” because he believed that the acquisition of knowledge is a process
of continuous self-construction. While the child is constructing this knowledge,
Piaget assumed that there is an interaction between heredity and environment, and
also labeled his view “interactionism” (Driscoll, 1994).
The theory concerns the emergence and acquisition of schemata—schemes of
how one perceives the world in “developmental stages,” times when children are
acquiring new ways of mentally representing information.

Key Concepts of Piaget’s Theory of Development

Piaget divided schemes that children use to understand the world through four main
periods, roughly correlated with and becoming increasingly sophisticated with age:
• Sensorimotor period (years 0–2)
• Preoperational period (years 2–7)
• Concrete operational period (years 7–11)
• Formal operational period (11–adulthood)
 Counseling through the Lifespan 97

The Sensorimotor period (birth to 2 years)

Piaget believed that children’s cognitive system is limited to motor reflexes at birth,
but then they build on these reflexes to develop more sophisticated procedures.
Their initial schemes are formed through differentiation of these reflexes. Children’s
schemes, or logical mental structures, change with age and are initially action-based
(sensorimotor). During this stage, infants and toddlers “think” with their eyes, ears,
hands, and other sensorimotor equipment. They learn to generalize their activities
to a wider range of situations and coordinate them into increasingly lengthy chains
of behavior. This stage is further divided into six sub-stages:
1. Birth to six weeks: This sub-stage is associated primarily with the
development of reflexes and their conversion into voluntary actions.
2. Six weeks to four months: This sub-stage is associated primarily with
development of habits or what Piaget called primary circular reactions or
repeating of an action involving only one’s own body, for, e.g., the motion
of passing their hand before their face.
3. Four to nine months: This sub-stage is associated primarily with the
development of coordination between vision and prehension. Three
new abilities occur at this stage: intentional grasping for a desired object,
secondary circular reactions (the repetition of an action involving an external
object), and differentiations between ends and means. This is perhaps one
of the most important stages of a child’s growth as it signifies the dawn of
logic (Gruber et al., 1977). Towards the end of this stage children begin
to have a sense of object permanence.
4. Nine to 12 months: This sub-stage is associated primarily with the
development of logic and coordination between means and ends. Piaget
calls this “the first proper intelligence”. This is an extremely important
stage of development. Also, this stage marks the beginning of goal
orientation, the deliberate planning of steps to meet an objective (Gruber
et al., 1977).
5. 12 to 18 months: This sub-stage is associated primarily with the discovery
of new means to meet goals. Piaget describes the child at this juncture
as the “young scientist,” conducting pseudo-experiments to discover new
methods of meeting challenges (Gruber et al., 1977).
6. This sub-stage is associated primarily with the beginnings of insight, or
true creativity. It marks the passage into the preoperational stage.

The role of imitation

Piaget postulated that imitative activity is the forerunner of mental symbolism. Or
seen the other way around, mental symbols are internalized imitation. For, e.g.,
even perception of an object is an imitative activity; the eye tracing the shape of an
 98 Counseling: Theory, Skills and Practice

object is forming a pre-symbolic concept of the object. Such imitative formations

provide the basis upon which mental symbolic activity can later build. The symbol
is, according to Piaget, an internalized imitation.

Preoperational thought (2 to 6/7 years)

Operation in Piagetian theory is any procedure for mentally acting on objects.
The hallmark of the preoperational stage is sparse and logically inadequate mental
operations. This stage includes the following processes:
• Symbolic functioning: Use of mental representations, symbols, words or
pictures fior objects which are not physically present.
• Centration: Focusing on or attending to only one aspect of a stimulus or
situation. For, e.g., when water from a tall narrow glass is poured into a short
broad glass, the child perceives the level alone and responds that the quantity
has reduced, even though this exercise is done in front of him or her.
• Intuitive thought: Occurs when the child is able to believe in something
without knowing why she or he believes in it
• Egocentrism: This is a version of centration, which is the tendency of child to
only think from their own point of view.
• Inability to Conserve: Mass, volume and number. This is again a version of
centration.

Concrete operations (6/7 to 11/12 years)

This stage is characterized by the appropriate use of logic. As opposed to the
preoperational stage, children in the concrete operations stage are able to take into
account another person’s point of view and consider more than one perspective
simultaneously. Their thought process becomes more logical, flexible, and organized.
They can also represent transformations as well as static situations. Important
processes during this stage are:
• Decentering: Where the child takes into account multiple aspects of a problem
to solve it.
• Reversibility: Where the child understands that numbers or objects can be
changed, then returned to their original state.
• Conservation: Understanding that quantity, length or number of items is
unrelated to the arrangement or appearance of the object or items.
• Serialization: The ability to arrange objects in an order according to size, shape,
or any other characteristic.
• Classification: The ability to name and identify sets of objects according to
appearance, size or other characteristic, including the idea that one set of objects
can include another. A child is no longer subject to the illogical limitations of
animism (the belief that all objects are animals and therefore have feelings).
 Counseling through the Lifespan 99

• Elimination of Egocentrism: The ability to view things from another’s

perspective (even if they are incorrect).

Formal operations (11/12 to adult)

This stage is characterized by acquisition of the ability to think abstractly and
draw conclusions from the information available. Children who reach this stage
are capable of thinking logically and abstractly therefore is able to understand such
things as love, “shades of gray”, and values. They can also reason theoretically.
Piaget considered this the ultimate stage of development, and stated that although
the children would still have to revise their knowledge base, their way of thinking
was as powerful as it would get.

How Does Cognitive Change Take Place?

According to Piaget, development is driven by the process of equilibration.
Equilibration encompasses:
1. Assimilation is the process of taking in new information and transforming
them so that it fits within the existing schemes or thought patterns. This
process can be subjective as one tends to modify experience or information
somewhat to fit it in with the preexisting beliefs.
2. Accommodation is the process of altering one’s existing schemas, or ideas,
as a result of new information or new experiences. New schemas may also
be developed during this process. People adapt their schemes to include
incoming information.
Piaget suggested that equilibration takes place in three phases.
1. State of equilibrium—Children are satisfied with their mode of thought.
2. Awareness of the shortcomings in their existing thinking therefore
dissatisfaction (i.e., state of disequilibration and experience of cognitive
conflict).
3. Adoption of a more sophisticated mode of thought that eliminates the
shortcomings of the old one (i.e., more stable equilibrium).
Examples of environmental, interactional, and genetic traits are as follows:

THEORIES FROM THE CONTEXTUALISTIC WORLDVIEW

PERSPECTIVE

Lev Vygotsky’s social contextualism

Both the mechanistic and organismic worldviews view the process of development
as universal. However, the contextualists do not believe that there are universal laws
 100 Counseling: Theory, Skills and Practice

of development; rather, they argue that the forces that contribute to development
are specific to historical time and social place.
Lev Vygotsky’s (1896–1934) cultural-historical theory of human development is
a good example of a theory rooted in a contextualist worldview. His theory asserts
three main themes:
1. Social interaction plays a fundamental role in the process of cognitive
development. While Jean Piaget believed that development precedes
learning, Vygotsky posited that social learning precedes development. To
Vygotsky, culture is a uniquely human phenomenon, allowing history to
replace biology as the defining element in the lives of humans. “Every
function in the child’s cultural development appears twice: first, on the social
level, and later, on the individual level; first, between people (interpsychological)
and then inside the child (intrapsychological).” (Vygotsky, 1978).
2. The more knowledgeable other: Anyone who has a better understanding
or a higher ability level than the learner, with respect to a particular task,
process, or concept.
3. The zone of proximal development: This is the distance between a student’s
ability to perform a task under guidance or peer collaboration, and his or
her ability to independently solve the problem.
Vygotsky focused on the connections between people and the sociocultural
context in which they act and interact in shared experiences (Crawford, 1996). He
said that language was the defining characteristic of humans as a species that sets them
apart from other species. Humans use language to mediate their social environment.
Initially children use it to communicate their needs. Later on Vygotsky believed that
the internalization of these tools led to higher thinking skills.
Language allows for a shared communication, which in turn allows for collective
effort or labor. This effort, in turn, sets the foundation for the progressive evolution
of culture across generations. Language and culture have an influence in the ways
people establish, maintain, and transmit social institutions and relationships across
generations.
Vygotsky investigated the role of culture and interpersonal communication in
the development of the child. He believed that higher mental functions developed
through social interactions. Through these interactions the child came to learn
the habits of mind of her/his culture, which affected the construction of her/his
knowledge. “Every function in the child’s cultural development appears twice: ...first
between people (interpsychological) and then inside the child (intrapsychological)”
(Vygotsky, 1978, p. 57).This key premise of Vygotskian psychology is often referred
to as cultural mediation. The specific knowledge gained by children through these
interactions also represented the shared knowledge of a culture. This process is
known as internalization (Santrock, J, 2004).
 Counseling through the Lifespan 101

Psychology of play: Vygotsky viewed play or child’s game as a psychologi-

cal phenomenon. He considered it to have a big role in a child’s development.
Through play the child develops abstract meaning separate from the objects in the
world, which is a critical feature in the development of higher mental functions
(Paul Tough, 2009). As the child gets older, his or her reliance on pivots such as
sticks, dolls, and other toys diminish. He or she has internalized these pivots as
imagination and abstract concepts through which he or she can understand the
world (Vygotsky, 1978).
Another aspect of play that Vygotsky referred to was development of social rules
that develop, for example, when children play house and adopt the roles of different
family members. As well as social rules the child acquires what we now refer to as
self-regulation.

Thinking and speaking: Perhaps Vygotsky’s most important contribution

concerns the interrelationship of language development and thought; the explicit
and profound connection between speech (both silent inner speech and oral lan-
guage), and the development of mental concepts and cognitive awareness (Wikipe-
dia). Vygotsky described inner speech as being qualitatively different than normal
(external) speech. Vygotsky believed that younger children only really able to “think
out loud,” it was via a gradual process of internalization that inner speech developed
from external speech. Hence, thought itself develops socially.
Language starts as a socio-cultural process. Initially language is a tool external
to the child and used in a kind of self-talk or “thinking out loud.” and for social
interaction. This self-talk then tapers to negligible levels when the child is alone or
with deaf children and is used more as a tool for self-directed and self-regulating
behavior. Then, because speaking has been appropriated and internalized, self-talk
is no longer present around the time the child starts school. Self-talk “develops along
a rising not a declining, curve; it goes through an evolution, not an involution. In
the end, it becomes inner speech” (Vygotsky, 1978; p. 57). Inner speech develops
through its differentiation from social speech. Speaking has thus, developed along
two lines, the line of social communication and the line of inner speech (Santrock,
J, 2004).

Kohlberg’s Stages of Moral Reasoning

Lawrence Kohlberg’s stages of moral development were created while he wrote his
doctoral dissertation at the university of Chicago in 1958, outlining what are now
known as the stages of moral development, how children develop the sense of right,
wrong and justice. He theorized that (similar to Piaget’s theory) human beings
progress consecutively from one stage to the next in an invariant sequence––they
 102 Counseling: Theory, Skills and Practice

do not skip any stage or go back to any previous one. These are stages of thought
processing, implying qualitatively different modes of thinking and problem solving
at each stage.
This theory holds that moral reasoning, which is the basis for ethical behavior,
has six identifiable developmental constructive stages of moral reasoning grouped
into three levels––pre-conventional, conventional and post-conventional; each
stage more advanced in responding to moral dilemmas than the previous stage.
The process of moral development was principally concerned with justice and its
development continues throughout the lifespan.

Kohlberg’s Theory of Moral Development

Level One: Stage 1: Punishment-Obedience Orientation
Pre-conventional Morality —Individual obeys rules in order to avoid
punishment.
Stage 2: Instrumental Relativist Orientation
—Individual conforms to society’s rules in order
to receive rewards.
Level Two: Stage 3: Good Boy-Nice Girl Orientation—
Conventional Morality Individual behaves morally in order to gain approval
from other people.
Stage 4: Law and Order Orientation—Conformity
to authority to avoid censure and guilt.
Level Three: Stage 5: Social Contract Orientation—Individual is
Post-Conventional Morality concerned with individual rights and democratically
decided.
Stage 6: Universal Ethical Principle Orientation—
Individual is entirely guided by his or her own
conscience.

Ecological Systems Theory of Urie Bronfenbrenner

Ecological systems theory, also called “development in context” or “human ecology”
theory, specifies four types of nested environmental systems, with bidirectional
influences within and between the systems. The theory was developed by Urie
Bronfenbrenner, generally regarded as one of the world’s leading scholars in the
field of developmental psychology.
Bronfenbrenner’s structure of environment: There are four systems and each
system contains roles, norms, and rules that can powerfully shape development.
1. Microsystem: This is the layer closest to the child and contains the structures
with which the child has direct contact. The microsystem encompasses the
relationships and interactions a child has with her immediate surroundings
(individual’s biology, family, school, peer group, neighborhood, and
 Counseling through the Lifespan 103

childcare environments: Berk, 2000) It is in the microsystem that the

most direct interactions with social agents take place. The individual is
not a passive recipient of experiences in these settings, but someone who
helps to construct the settings. This relationship is bidirectional––both
away from the child and toward the child.
2. Mesosystem: This layer provides the connection between the structures of
the child’s microsystem (Berk, 2000). A system comprised of connections
between immediate environments (i.e., a child’s home and school)
3. Exosystem: Involves links between a social setting in which the individual
does not have an active role and the individual’s immediate context. The
structures in this layer impact the child’s development by interacting
with some structure in her microsystem (Berk, 2000). Parent workplace
schedules affect the child though he does not have a direct active role in
it.
4. Macrosystem: This layer may be considered the outermost layer in the
child’s environment. While not being a specific framework, this layer is
comprised of cultural values, customs, and laws (Berk, 2000). The effects
of larger principles defined by the macrosystem have a cascading influence
throughout the interactions of all other layers. The larger cultural context
(Eastern vs. Western culture, national vs. international)
5. Chronosystem: The patterning of environmental events and transitions
over the life course, as well as sociohistorical circumstances. This system
encompasses the dimension of time as it relates to a child’s environments.
Elements within this system can be either external, such as the timing of
a parent’s death, or internal, such as the physiological changes that occur
with the aging of a child. As children get older, they may react differently
to environmental changes and may be more able to determine more how
that change will influence them. It covers the patterning of environmental
events and transitions over the course of life (Urie Bronfenbrenner,
1979).

Levinson’s Life Structure Theory

Yale psychologist Daniel Levinson (1986) developed a comprehensive theory
of adult development. Daniel J. Levinson was one of the founders of the field of
positive adult development. Through a series of intensive interviews with men
(1978) and women (1987), Levinson proposed a theory based on a series of stages
that adults go through as they develop. Daniel Levinson worked out his theories of
adult development in two landmark studies, Seasons of a Man’s Life and Seasons of a
Woman’s Life.
 104 Counseling: Theory, Skills and Practice

At the center of his theory is the life structure. An individual’s life structure is
the underlying pattern of an individual’s life at any particular time which is shaped
by the social and physical environment. Life structures primarily involve family
and work, although other variables such as religion, race, and economic status are
often important. Levinson talked about four “seasonal cycles”. They include pre-
adulthood, early adulthood, middle adulthood, and late adulthood. Each of the
periods are themselves divided between entry or initial stages and culminating
or more-or-less stable stages. The divisions between the life eras are marked by
significant transitionary periods that can last for some years. Life during these
transitions (Age 30 transition, mid-life transition [early 40s], Age 50 Transition,
etc.) can be either rocky or smooth, noisy or quiet, but the quality and significance
of one’s life commitments often change between the beginning and end of such
periods.
Levinson (1978) originally studied forty adult males between 35 and 45 years
of age. Early adulthood is entered when men begin careers and families. After an
evaluation of themselves at about age 30, men settle down and work toward career
advancement. Then another transition occurs at about age 40, as men realize some
of their ambitions will not be met. During middle adulthood, men deal with their
particular individuality and work toward cultivating their skills and assets. Finally,
the transition to late adulthood is a time to reflect upon successes and failures and
enjoy the rest of life.

THE INDIAN FOCUS: PHILOSOPHY OF INDIAN

COUNSELING

Religious faith, or some form of personal spirituality, can be a powerful source of

meaning and purpose. For some, religion does not occupy a key place, yet personal
spirituality may be a central force. It can help us get in touch with our own powers
of thinking, feeling, deciding, will, and acting. Spirituality and religion are critical
sources of strength for many clients, and are the bedrock for finding meaning in
life. They can also be instrumental in promoting healing and well-being. There
is growing empirical evidence that our spiritual values and behaviors can promote
physical and psychological well-being. Exploring these values with clients can be
integrated with other therapeutic tools to enhance the therapy process. Counseling
can help clients gain insight into the ways their core beliefs and values are reflected
in their behavior. Training programs must incorporate discussions on how to work
with values as part of the therapeutic process (Corey, 2006: www.counselingoutfitters.
com)
 Counseling through the Lifespan 105

Life coaching has been prevalent and practiced in India from the Vedic times. The
varnashrama–vyavastha is the Vedic scheme of life. This is the life style prescribed
by the Vedas.

Varna–Vyavastha
Varna indicates a particular group or class. This classification is not from one
standpoint; it is done from three standpoints. This can be seen in the following
table.

Category Brahmanas Kshatriyas Vaishyas Shudras

By birth Born of Born of Born of Born of
Brahmanas Kshatriyas Vaishyas Shudras
By character Contemplative Selflessly active Selfishly Idle
active
By occupation Scriptural Administration Commerce Unskilled
education and and Defence and labor
Priesthood Agriculture

From the table it is seen that there is more than one way to be the most respected and
accomplished in the society.

The Ashrama–Vyavastha (Stages in Life)

The ashrama vyavastha is the scheme of stages of life. The scriptures talk about four
stages of life everybody has to go through, either externally or at least internally.
Mentally everyone has to go through these four stages in life.
The word ashrama means a stage of life in the progress of one’s spiritual journey.
The scriptures talk about four stages:
1. Brahmachari – student life
2. Grhastha – householder’s life
3. Vanaprastha – hermit or ascetic stage
4. Sannyasa – the monk or the renunciate stage.
Coaching is set in different directions for different purposes at two of these stages,
the first stage and the third stage. As a brahmachari, a person has to go through a life
of learning, professional learning as well as religious learning. These learnings help
the person in professional life as well as to achieve the purusharthas. The concepts
are explained in the next chapter. While scriptural learning is common, acquiring
skills differs from one individual to another. This scriptural learning is life coaching,
i.e., coaching the person as to how to lead a life of goodness and dignity.
During the third stage the person gives up all his worldly possessions, positions,
and designs to put into practice the highest scriptural learning—the seeking for the
 106 Counseling: Theory, Skills and Practice

final and eternal goal—the goal of moksha or liberation. There is a gradual withdrawal
from the artha, kama, and dharma goal seeking. The concentration is on attaining
moksha. Thus, the individual is coached to shift the vision and focus to dedicating
himself/herself wholly to the pursuit of moksha.
The scriptures prescribe a series of disciplines to help the individual attain moksha.
This series of disciplines can be divided into three stages or three-fold discipline or
sadhanas:
1. Karma yoga
2. Upasana yoga
3. Jnana yoga
By following these sadhanas a person will ultimately attain moksha. Coaching in
these disciplines involves very rigorous commitment and discipline on both the part
of the coach and the coachee.
Hindu idealism is a precursor of western idealism and the philosophical opposite
of materialism. Idealism and materialism are the principal monist ontologies. This
philosophy is the basis of the cosmology of the Vedas and most religions of India
and the Far East. Hinduism has one ideal-growing up to be a complete person.
This completeness involves many aspects such as adhering to values, empathy, and
emotional maturity.
As human beings we are endowed with this unique quality of being aware of
ourselves. Slowly, through the processes of growth and development, we develop
a sense of self-identity. This self-identity is based on our circumstances, past
experiences, roles, relationships, etc. Founded upon this self-identity are all of our
interactions with ourselves and with the world around us. We act upon the world
to achieve something for ourselves. This action leads to a result, which may be
desirable or undesirable to us. Based on how we label the result, we emote. These
emotions, when unpleasant, inflict pain and suffering on our psyche.
Our interactions are primarily directed toward helping us feel happy and secure
within ourselves. With every interaction and exchange with the world we constantly
make revisions in our self-image and self-identity. These revisions contribute toward
our apparent inner sense of joy and security. That is because instead of searching for
that identity within ourselves—the journey inward—we want our society, culture,
relationships and perceptions to resolve our crisis. The more we look outward, the
more we feel powerless.
This urge to become something different from what we are is innate. The
journey towards being a self-satisfied human being is constant and continuous. Even
when certain targets are reached, new ones take form. Hence, we may be rid of that
particular goal, but the seeking never ends. Finally, we come to understand that in
this manner we may never reach complete satisfaction.
Everyone, at some time or other, grapples with the questions “what is the meaning
of life?” or “why live at all?” or “why should I keep living?” What is the whole process
 Counseling through the Lifespan 107

of living about? What is the purpose of this life? Where is the end? And when will
it all be over? This goes on until the day one dies and probably beyond. It is human
nature to seek and become.
The answers can be found in the concept of what is the purpose in life, not what
is the purpose of life.

Four Types of Human Goals

As many human beings are there, so many different goals are also possible. Each
human being has got his purusarthas. And if you take one human being, he himself
has many goals. And these goals keep on changing too. Though the goals are
innumerable, they can all be categorized into four types as caturvidha-purusartha:
dharma, artha, kama, and moksha.
1. Dharma or punyam (the invisible factor) – This is the third purusartha.
This is because there is a belief of rebirth in the Indian culture. There is
an acceptance of past birth, and a belief in future birth, even though one
does not know the details. And a believer in future birth is also interested
in their well-being in that future birth. And we have to invest in this life
for the well being in that future life. Punyam is the invisible result gained
through noble activities. Papam is the invisible result gained through
ignoble activities. Only the invisible results for one into the next life and
affect it accordingly. Thus believers tend to acquire Punya for well being
in future life.
2. Artha – All types of wealth, moving or non-moving, i.e., all forms of
wealth, which are meant for one’s security so that the person can safeguard
himself from pain and threats. This goal corresponds to the physiological
and safety needs in Maslow’s hierarchy of needs.
3. Kama – or seeking pleasure. This is the second level of pursuit because only
after the first need is taken care of can one seek pleasure, entertainment,
leisure or recreation. Kama refers to one’s preferences, likes and dislikes.
4. Moksha – Or liberation or freedom – freedom from all types of dependence
on external factors. Discovering happiness and security, atmaneya atmana
tustah. Finally there is no dependence even on the Papam and Punyam for
security and pleasure.
The pursuit of Dharma-artha-kama is a permanent struggle. But it has many
limitations:
• Pain
• Dissatisfaction
• Dependence
• Emotional instability
• Helplessness
 108 Counseling: Theory, Skills and Practice

• Insecurity
• Insignificance
But all this can be overcome by achieving emotional maturity.

v Summary v
A counselor’s awareness of the progression of human development and the
significance of this process to the counseling experience can be one of the
most useful understandings the professional draws upon throughout the
helping relationship. This understanding is also of benefit to the counselor in
pursuit of his/her own personal growth. For client and counselor alike it is of
clear benefit to be able to distinguish between developmentally appropriate
changes, concerns, and anxieties and those issues or concerns which are
indicative of disruptions or distortions of this potential for positive growth.
It is very important for the counselors to understand human development
from early childhood to adulthood, how the developmental stages and
external factors affect counseling and assessment; the characteristics of
students with special educational needs, the principles of learning and
motivation, as well as the principles of and methods for promoting cognitive
development.
This chapter has approached the study of human development from
the worldview perspective. It has briefly described the three view points
organismic, mechanistic, and contextualistic; and the developmental
theories that fit into these categories.
The author has finally included the Indian perspective, which is also a
theory in its own right, and will be useful for the counselors practicing in the
Indian context.

References
<ahref=”http://social.jrank.org/pages/658/Theories-Development.html”>Theories of Development -
The Mechanistic Worldview, The Organismic Worldview, The Contextualist
Worldview</a>.
Berk, L. E. 2000. Child Development (5th ed.). Needham Heights, MA: Allyn and Bacon.
Carver, C.S. and M.F. Scheir. 2000. Perspectives on Personality. Needham Heights, MA: Allyn
and Bacon.
Crawford, K. 1996. ‘Vygotskian approaches to human development in the information era’.
Educational Studies in Mathematics. (31), pp. 43–62.
Erikson, E.H. 1963. Childhood and Society. (2nd ed.). New York: Norton.
Erikson, E.H. 1968. Identity: Youth and Crisis. New York: Norton.
Goldhaber, D. 2000. Theories of Human Development: An Integrative Perspective. NY; Wiley
http://en.wikipedia.org/wiki/Developmental_psychology.
 Counseling through the Lifespan 109

http://en.wikipedia.org/wiki/Lev_Vygotsky#cite_ref-NYT-2009_3-0.
http://psychology.about.com/od/theoriesofpersonality/ss/psychosexualdev.htm.
http://www.haverford.edu/psych/ddavis/p109g/erikson.stages.html.
http://www.wisegeek.com/what-is-developmental-psychology.htm.
Huitt, W., and J. Hummel. 1997. ‘An introduction to operant (instrumental)
conditioning’. Educational Psychology Interactive. Valdosta, GA: Valdosta State University.
Retrieved July 14. 2010. from http://www.edpsycinteractive.org/topics/behsys/operant.
html.
Paul Tough, ”Can the right kinds of play teach self-control?”,New York Times, 2009/09/27
(reviewing the “Tools of the Mind” curriculum based on Vygotsky’s research).
Piaget, J. 1977. The Essential Piaget. Edited by Howard E. Gruber and J. Jacques Voneche Gruber,
New York: Basic Books.
Piaget, J. 2001. The Psychology of Intelligence. London: Routledge.
Rodgers, Emily M. ‘Interactions that Scaffold Reading Performance’. Journal of Literacy Research.
FindArticles.com. 15 Jul, 2010. http://findarticles.com/p/articles/mi_qa3785/is_200401/
ai_n11826120/.
Santrock, J. 2004. ‘A Topical Approach to Life-Span Development’. Cognitive Development
Approaches (Chapter 6 ), pp. 200–225). New York: McGraw-Hill.
Urie Bronfenbrenner.ý. 1979. The Ecology of Human Development: Experiments by Nature and
Design. Cambridge, MA: Harvard University Press. ISBN 0-674-22457-4.
Vygotsky, L.S. 1978. Mind and Society: The development of higher mental processes. Cambridge,
MA: Harvard University Press.
Woolf, Linda M. 1998. Theoretical Perspectives Relevant to Developmental Psychology: A discussion
of the structural, information processing, and developmental dimensions approaches to the
analysis of age/development/life course trends. http://www.webster.edu/~woolflm/theories.
html.
 5
Preparing to be a Counselor

Chapter Overview
Education and training for careers in counseling psychology
Preparation of counselors
Qualifications of counselors
Counselor certification
Selection and training of professional counselors
Counselor supervision
Choosing a graduate program

T
he world is changing rapidly. Technology is becoming obsolete very quickly.
Technological advances are growing in quality and quantity. Cell phones,
which were considered “cool” yesterday, are thrown away for a “cooler”
model today. In the same manner, issues which were significant in the recent past
are not relevant today. For example, the eternal mother-in-law–daughter-in-law
tangle is no longer considered important. Changes in the family structure, with an
increase in working women population, and sophisticated lifestyle facilitated by a
variety of luxury items available in the market, have resulted in people paying less
attention to home and more attention to material life. Thus it is no longer easy to
apply past truths to the problems of present and future. The need of the hour lies
in a world that needs new approaches to experiences, both in acquiring them and in
using what we already have. Never in the history of mankind have so many changes
occurred simultaneously and with such acceleration in a broad a spectrum of human
activities. Changes witnessed in the recent past are seen to represent an even greater
acceleration compared to those of previous decades.
The rapid changes in human invention, the speed of generation of new knowledge,
human population growth and the evolution and speed of human transportation,
the swiftness of communication, all have bestowed upon us much ease and comfort
 Preparing to be a Counselor 111

in day-to-day life. However, they bring with them a host of problems, such as
mechanical and hurried lifestyle, less importance given to leisure and relaxation,
and social and family life. The explosion of knowledge is now so rapid that most of
the things that young children are currently learning will be obsolete by the time
they grow up. We have never been in this situation before.
The counselor’s objective is to provide support to clients’ goals by assisting in
decreasing their stress, aiding the effort to provide a healthy environment, helping
them focus on personal and career goals, thereby contributing to clients’ motivation,
performance, and satisfaction with their life. The counselor listens, understands, and
facilitates a better understanding between the individuals involved. A nonjudgmental
attitude and confidentiality agreement is part of the whole process.
Successful counselors are those who have a mature and balanced state of mind and
disposition, who can place themselves in the shoes of those they are counseling, and
have the ability to respect their opinions, thoughts, feelings and (more importantly)
emotions.
After evaluating the situation as it is narrated, a realistic, practical solution can be
developed by the counselor; individually at first if this is beneficial and then jointly
to encourage the participants to give their best efforts toward reorienting their
relationship with each other. It has to be remembered that changes in situations like
financial state, physical health, and the influence of other family members can have
a profound influence on the conduct, responses, and actions of the individuals.
Counseling psychologists, being in one of the largest and most popular fields
in psychology, can be found working in individual practices, industry, educational
institutions, hospitals, and other mental health facilities. Counseling psychologists
are often influenced by the theoretical orientation they adhere to. Their method of
therapy will be according to their theoretical orientation.
As there are a total of over 200 theoretical orientations, each providing a different
explanation behind the causes of psychological disorders and their appropriate
treatments, most psychologists are largely eclectic; they integrate two or more
interests into their therapy. Regardless of their orientation preference, counseling
psychologists are trained to assist a variety of individuals and their emotional
difficulties. Counseling involves working with a variety of individuals and addressing
their everyday problems in individual, family, or group settings. Counseling
psychologists typically work by helping clients with a variety of problems, which
are not usually severe disturbances. Career planning, stress, and anxiety are a few
examples of problems they could encounter. Another issue these psychologists might
encounter is the feelings and emotions surrounding the death of a loved one. Grief
and other strong emotions are often difficult to overcome. Counseling psychologists
could assist their clients in the healing process.
112 Counseling: Theory, Skills and Practice

There are some areas in which counseling psychologists could specialize. Family
therapy focuses on the interactions between family members. The family is viewed
as a single unit and their goal is to change the functioning and relationships within
that unit. Another specific area in counseling psychology is couples and marriage
therapy. This therapy focuses on strengthening communication between couples.
Couples are the subject of a large amount of research, specifically involving marital
adjustment and satisfaction. Finally, group therapy is popular because it can serve
more than one person at a time. Within groups, individuals can learn newer and
more effective ways of relating to others and gain support from other members.
There are many considerations that one has to take into account when training
to be a counselor, and educationists have to focus on them when training students
to venture into and be successful in this very important profession.

EDUCATION AND TRAINING FOR CAREERS IN

COUNSELING PSYCHOLOGY

Skills, abilities, and knowledge: In the United States of America licensure is

needed in order to work independently in a private practice. Different states follow
different policies. Licensing laws vary from state to state. While most states require
that a psychologist complete a doctoral degree before becoming licensed, some per-
mit a license with just a master’s degree. However, all states require that applicants
pass an examination prior to getting a license. In addition, some states require that
clinical and counseling psychologists continue their education for license renewal.
In any case, a psychologist without a license, is required to work under the supervi-
sion of a doctoral-level psychologist.
In India, we do not have such stringent requirements for being a professional
counselor. There is no governing body, which sets down standards and rules that
hold the counselors accountable for their actions. This is probably one of the reasons
why counseling is such a vague field, where people from many related fields, with
little or no training at all, call them to be professionals.
There are a number of possible areas of specialization within the field of counseling
psychologist. This helps to make the career more interesting and exciting for
students. However, there are positive and negative aspects of counseling psychology.
On one hand, this field can be personally very rewarding; one the other hand, it
often requires a great deal of education. Among the degrees that could be earned by
students, the doctoral degree offers utmost career freedom, including the possibility
to practice counseling psychology privately.
 Preparing to be a Counselor 113

PREPARATION OF COUNSELORS

A balanced and sound training program should include the following:

Basic theoretical preparation: Understanding of motivation, psychodynamics
of human adjustment, learning principles and other concepts that underlie
counseling, psychodiagnostic principles and procedures, psychopathology,
social psychology, principles and process of counseling, and counseling
theory.
Technical and applied knowledge: Knowledge of test use and interpretation,
interviewing skills and competencies in specialized procedures of
intervention.
Practical training: A broad-based practicum and training for enabling the
counselors to meet any exigencies.
The program should subscribe to the developmental-reflective model for
professional preparation of counselors. It must provide the students with the
theoretical understanding of healthy as well as unhealthy human growth and
development, with focus on the application of mental health, psychological, and
human development principles through various cognitive, affective, behavioral, and
systemic intervention strategies that address wellness, personal growth, and career
development, as well as pathology.
The program should also provide the students with strategies to integrate the
theoretical knowledge base with ongoing self-reflective development. Continued
active professional development is the ultimate goal. The students should be helped
to develop a theory-based approach that is congruent with their unique personal
qualities. The theory developed should include personal, cultural, social, vocational,
psychological, and educational concerns.
Finally, the emerging counselor must be familiar with the cultural background
of the clients. Multicultural counseling is now gaining significance in any society,
as all societies are becoming more and more pluralistic. Counselors need to have
a sound knowledge and critical understanding of individual differences and their
significance. The impact of culture on human development is very important. The
belief and value systems of the individual need to be understood well in order to
design good intervention strategies.
For further specialization, a desirable counseling program must include
educational and vocational counseling, group approaches, and counseling of special
groups. Counselors are in demand, in every field, from clinical areas to sports. Most
of the national teams have a counseling psychologist with them to help the players
reduce stress and keep them mentally fit. There are some who work with cancer and
AIDS patients, with children, in various areas of deficiency and growth, addictions
114 Counseling: Theory, Skills and Practice

and in homes for the homeless. As the need base expands, so does the demand for
counselors.
Educationists should not make the mistake of combating this demand with
sending out half-baked counselors into the field. It may work in the short term. But
eventually counselors will lose their credibility and respect. And we will come back
a full circle to where anyone can profess to be a professional.
At the end of the theory cum training program, the counselors should possess the
list of the following counseling competencies:
Knowledge of human development, the both normal and abnormal
Understanding the theories of counseling and personality
Knowledge of and sensitivity to social, cultural, and ethnic issues
Knowledge of ethical and legal aspects of counseling
Knowledge of the learning process
Knowledge of decision making and transmission models
Ability to diagnose student problems
Ability to help students form and clarify their educational values and
goals
Ability to help students learn problem-solving and decision-making skills
Ability to work with students to develop optimal student educational
plants
Ability to facilitate groups and workshops
Capability to develop effective curriculum
Knowledge of effective instructional methods and strategies
Ability to teach counseling courses effectively
Ability to provide crisis intervention and support
Ability to provide mental health counseling and a referral to community
resources
Knowledge of career development matters, techniques, and instruments
Knowledge of changes taking place in the economy and the job market
Knowledge of the use and misuse of assessment instruments and test data
Knowledge of educational programs and their requirements
Knowledge of the structural and institutional relationships in higher
education
Ability to develop and coordinate service programs
Ability to provide effective consultation to students, teachers, peers,
administrators, and community members.
As is obvious from the exhaustive list, students who come out of the program
will be able to tackle most of the problems that people face in the society. They
will be eligible to work in most fields that require counseling assistance. This is just
a broad base. In order to further specialize, students can attend short-term courses
and workshops in the field, and also receive on-the-job training.
 Preparing to be a Counselor 115

QUALIFICATIONS OF COUNSELORS

The usual route to becoming a counselor is via a college counseling degree. As

mentioned before, it is important to know the theory thoroughly to make informed
and intelligent choices regarding the right intervention strategy. Albeit, all theory
and no practical training is of no use.
If a student wants to pursue a course in counseling, he or she has to find out
first about the field and what it involves and ensure that it involves both theory and
practical training. They have to be thoroughly prepared for what it entails. Once the
student decides on the training, then s/he needs to find out more about the training
opportunities in that field.
The counseling program is a two-year or four-semester master’s level program,
sometimes supplemented by a one-year professional training program. A counselor
has to have earned at least a postgraduate degree in psychology with a specialization
in counseling and guidance. An additional degree such as M Phil or Ph D could be
a further qualification. For a practicing counselor, the former would be sufficient in
India. But higher degrees will give the counselor greater credibility and allow him or
her to work in research, in a field seriously lacking contributions from Indians.
Some diploma courses in the West last over three years involving many hours of
supervised practice. Some diplomas, however, can be obtained by mail order, as also
some degree level courses. This is not to say that they are not equally valid; the Open
University for example works to a high standard, but standards do vary between one
university and another. This also applies to all types of training.
Professional counselors update their knowledge in education and training by
reading professional journals, attending workshops, and various training programs:
or by actively participating in one of the organizations devoted to counseling.
Counseling is a very challenging occupation, requiring a considerable amount of
initiative. So at any time, a given amount of preparation can never be complete and
final. Therefore, counselors have to constantly keep themselves up to date with latest
knowledge and skills.
Counselors have to be ingenious and creative in their outlook. They have to
take responsibility for their decisions about intervention strategies, and also be
accountable for them: to themselves, to their profession and to their clients. Now,
with a growing demand for counselors, attention should be given to their selection
and training. More and more of the urban population is turning to counseling as a
remedy for their minor problems.
Children’s special issues and adolescent issues are becoming acknowledged. The
stigma that existed earlier is slowly decreasing. The complexities of modern-day
living, globalization, and the implosion of the western culture have left children
confused and parents at their wit’s end. Parent–child gap seems to be increasing day
by day. The two are just not able to get along, let alone understand each other.
116 Counseling: Theory, Skills and Practice

The world has become more competitive, both for students and working
adults. Competition has resulted in increase in stress levels. People deal with it in
maladaptive ways. They seek temporary solutions. When that does not work, they
seek the help of a counselor.
Given the complex scenario, changes in the family structure, social structure,
industrial sector, and the political quarter, the counselor has to be very competent.
The counselor has to understand the world of the individual, from a subjective as
well as objective point of view.

Training Levels: Master’s and Doctorate

The master’s degree in counselor education is now considered an entry-level
preparation for qualification as a professional practitioner, whereas, not long ago,
a bachelor’s degree in social work, psychology, or human services was considered
sufficient to secure a job in the field (and still is in some rural areas). Today most
professional positions in schools and agencies require a master’s degree as a minimal
credential. The master’s degree is, in fact, the foundation for national certification
or state licensure as a counselor.
Master’s level training is essentially the counseling practitioner’s degree. It
qualifies them to work and to apply the skills of assessment and clinical intervention
in various settings (schools, agencies, universities) and with different modalities
(individual, group, and family counseling). Most programs require a minimum of 2
years full-time study, or its equivalent.
Doctoral training places as much emphasis on research as it does on practice. This
degree is intended to prepare professionals to function independently as scholars,
supervisors, advanced practitioners, and educators. The additional 3 to 5 years spent
in school are intended to help the student master the knowledge, research, and
skill base of the field. Depending on whether the student’s career aspirations are as
an administrator, supervisor, researcher, or counselor educator, specialty areas are
individually designed. Doctoral-level training is considered a terminal degree, which
means the graduate (after completing internship and licensure requirements) may
function in an independent position as a supervisor.
Because the variety of specific doctoral degrees in counselor education and
counseling psychology fields, choosing to go for a doctorate is not as simple a
decision as it sounds. There are different degree areas (such as counselor education,
counseling psychology, clinical psychology), specializations (such as mental health,
school, business and industry, rehabilitation), and degree designations (such as Ph D,
Ed D, Psy D), and each serve to confuse the student. However, these differences
also serve the purpose of helping one select the program and career path that best
matches them.
 Preparing to be a Counselor 117

Students become knowledgeable about supervisory relationship, supervision

models, evaluation, different teaching formats and interventions, current research,
legal and ethical issues, ethnic and social class issues, gay and lesbian issues, and
women’s issues. Finally, students will become experts on several supervisory
assessment instruments via a class project.

In-house Training
Finding trained counselors and paying them becomes a difficult task for some non-
profit organizations. Thus, when individuals who do not have the necessary training,
but a lot of interest and motivation volunteer, they offer their own training, and
over a period of time, with supervision and ongoing training, it is possible for these
individuals to achieve a high level of competence in the field. Sometimes, over a
substantial period of time, the training offered and the experience gained may equal,
and in some cases exceed, that offered by some colleges. These trained volunteers
then enter the “profession”.
Others have entered counseling via other professions. As part and parcel of
their work and training ministers of religion, nurses, care assistants, social workers,
teachers, occupational health managers, or occupational therapists may all be
taught some basic counseling skills. These are then topped up from time to time
with further seminars or short courses. Members of these professions develop an
increasing counseling-based practice and acquire considerable counseling experience.
Sometimes, almost by default, counseling may become their full-time work; nurses in
palliative counseling units, social workers becoming youth counselors, occupational
health managers becoming occupational counselors for example.

Practical Training
Besides, counseling consists of practices and skills involving several counseling
processes. Interviewing, case taking, choosing and administering tests, interpreting
test results, etc. are important skills to be acquired by the students. These skills
cannot be mastered by mere intellectual learning and didactic understanding.
The acquisition of these skills of empathizing, diagnosing, resolving conflicts,
understanding feelings, ideas, content, and a host of other subtle and sensitive skills
needs to be done through practicum work, stress on supervised counseling sessions,
and verbatim supervision. This constitutes training.
Counseling is a science and an art. It involves theoretical preparation as well as
practical training. Counseling efficiency is closely related to the quality of counselor
preparation and training. The programs must be carefully drawn. This will result
in better counseling service. It is sometimes argued that counseling skills are inborn
118 Counseling: Theory, Skills and Practice

rather than acquired. There is no opposing the fact that counseling is both an art
and a science.
The objectives of counseling can be succinctly stated as follows:
1. To identify the problem areas or difficulties of individuals, their potentialities
and limitations
2. To assist people to understand themselves and their situational factors as
fully as is practicable
3. To help develop the potential of individuals through a greater self-
understanding, to enable them to take full advantage of the environmental
resources
4. To help mitigate suffering, reach appropriate solutions, take responsible
decisions and thus enable clients to become self-actualized individuals.

COUNSELOR CERTIFICATION

The code of ethics does not come down hard on the counselors who make mistakes
or even fail due to ignorance or lack of training. However, society cannot be at the
mercy of ignorant and ill-trained professionals. The public has to be protected against
possible harm done by such persons. This is secured by a system of certification
or licensing. Individuals are granted professional status and permitted to enter the
“occupation” only when the training is adjudged to meet the standards laid down
and the prospective entrants qualify by passing the standards set for them.
This is a very important ethical issue, which concerns the competence of the
counselor to provide the appropriate service. It is a very tricky question; who ought
to be the judge? Once the counselor obtains his certificate after training (and obtains
his license or a certificate of practice where such regulation is statutory), he is free to
accept any client. He is himself under an obligation to determine and judge whether
or not he can provide the necessary help and service to the client. The counselor
may honestly believe that he can, but it may be only his misconception. An outsider
cannot judge the matter. It is entirely for the counselor to take the responsibility. It
should be specifically understood that the counselor must make every effort to correct
any false impressions, which the client may derive concerning his qualifications and
competence. He should, if necessary, make a referral. Occasionally a client may refuse
to accept a referral (such situations are very common and frequent in the field of
medical practice). Should the counselor continue to counsel or should he terminate
the relationship? It is necessary that the counselor should help the client make a
realistic assessment of the situation and act in accordance with his (counselor’s)
professional advice. If this is not heeded, there appears to be no alternative but to
terminate the relationship.
 Preparing to be a Counselor 119

Counselor Certification in the United States

As has been mentioned earlier, different states have different laws of licensure and
certification. First a college or university voluntarily reviews an accrediting body
such as Council for Accreditation of Counseling and Related Educational Programs
(CACREP), Council on Rehabilitation Education (CORE), or the American
Psychological Association (APA) which are professional accrediting bodies that
evaluate graduate education programs in professional counseling, rehabilitation
counseling, and counseling psychology, respectively. This ensures professional
accrediting bodies that evaluate graduate education programs in professional
counseling, rehabilitation counseling, and counseling psychology, respectively.
The government sanctioned credential is called licensure and is based on the legal
concept of the regulatory power of the state (www.counseling.org).
Separate from this process is a process of voluntary individual certification. There
are government sanctioned professional certification organizations for counseling
and a host of specializations within the counseling profession. The two leading
certification organizations for the counseling profession are the National Board for
Certified Counselors (NBCC) and the Commission on Rehabilitation Counselor
Certification (CRCC). This certification attests to the fact that the holder of this
certification has met the standards of the credentialing organization and is therefore
entitled to make the public aware of this as further documentation of his or her
professional competence. .

SELECTION AND TRAINING OF PROFESSIONAL

COUNSELORS

Counseling, like many fields of professional work, draws its principles of practice
from a number of disciplines. In the early decades of the present century, the
ebullient enthusiasm, which marked the counseling movement, tended to emphasize
the need for appropriate methods from a pragmatic standpoint, to the neglect of the
development of conceptual models, which could form a sound theoretical basis for
practice. The counseling movement grew out of the vocational guidance movement,
which explains why it did not have a clear theoretical bias. Therefore, it largely
tended to be technique-oriented and was less concerned with theory building.
It is being increasingly recognized in any professional field that entrants have to
be carefully selected. It is not sufficient to only take into account the intellectual
factors or the professed interest in the service to the client. A number of studies
have shown that personality characteristics have great significance. Further, the
effectiveness of counselors is said to depend on the goals which they may be trying
to achieve. No useful purpose is served by listing a string of personality traits which
120 Counseling: Theory, Skills and Practice

would supposedly characterize a successful counselor. A more suitable criterion

would be for a counselor to evince interest in helping people. He should be sensitive
to the situation around him and the needs of the people and above all he should be
sincere and genuine.
In the past, attention was focused on helping the client, without understanding
the integrated nature of the human organism and the dynamics of problem appraisal.
The resolution of the problem from a psychological point of view did not receive
sufficient attention.
This relatively unsophisticated approach to counseling has undergone several
decisive changes over the years leading to the emergence of counseling as a
professional service.
Individuals who are engaged in professional activities have to face three basic issues
concerning (1) the procedures of selection and the training of prospective entrants,
(2) academic preparation to reach a level of professional standing with regard to
the necessary knowledge and the understanding of the principles and dynamics of
human growth, motivation, adjustment and coping mechanisms, and (3) methods
of analysis and synthesis and the appropriate application of the acquired skills.
The first and foremost of the professional considerations, therefore, consists of
equipping prospective counselors with necessary skills and adequate knowledge.
With the progressive growth of knowledge and an increasing understanding of
natural phenomena, what is known and acclaimed as the latest is likely to become
obsolete as soon as new knowledge and techniques are known. Professional training
and skills by their very nature are in need of constant revision and updating.
This brings home the related issue, namely, the question of differential service or
different kinds of services to be provided to clients who differ in age, sex, experience
occupation, etc. Similarly, clients could differ with regard to the type of problems
they have and the kind of service they apparently require. Consideration of these
issues suggests that training should not be of an omnibus type. Perhaps there could
be different levels of training:
1. A basic or general type of training.
2. Training for different specializations depending on the areas or groups or
situations in which the trainees will be called upon to serve.
Counselors vary in the quality of help they can provide. Those who are highly
competent and skilled are able to produce better results. Therefore, it is the primary
obligation of the profession to provide the expertise to produce desirable results in
the clients.
All professional fields attach considerable importance to the selection of suitable
persons to be trained to become members of a profession, for example, medicine,
engineering, etc. For proper criteria to be laid out it is necessary for the different
functions of counselors to be identified. Primarily counseling is a helping function.
Therefore, it is closely related to the needs and characteristics of the social system
 Preparing to be a Counselor 121

in which it is to function and operate, and also to the resources; personnel and
material; available to the system. For example, counseling services are comparatively
highly developed in the United States. They are almost nonexistent in India. With
rapid industrialization and urbanization, the traditional modes of functioning
and the characteristics of the Indian society are fast breaking down, necessitating
the increasing provision for counseling services. Demographic growth, income
distribution, and educational access among others, determine the nature of services
required by the society.
In the developing countries, the following limitations have prevented and
sometimes distorted the development of counseling:
1. Lack of proper understanding of what counseling is, leading to confusion
and false expectations.
2. Lack of financial support owing to the general poverty of the developing
countries.
3. ∑ Introduction of unrealistic models of functioning. For instance,
imitation and emulation of the kind of services available on the
campuses of US universities, such as student personnel services, by the
Indian universities. Such services are too expensive to be of value in the
Indian context.
∑ Emphasis on models of help unsuited to the milieu. For example,
the average Indian, or for that matter the average oriental, is largely
conventional in his outlook, while in the West, and more especially in
United States, people are unconventional and individualistic.
4. Lack of proper coordination between the available agencies of assistance
leading to wastefulness and duplication of effort.
5. Absence of educational and employment avenues to serve as the primary
source for counseling activity.
6. Social and economic means of a large part of the population falling below
the poverty line, making counseling an unrealistic exercise.
Most social systems are committed to achieving human well-being. The leaders of
such systems recognize the need for counseling but do not give it the kind of priority
it deserves owing to lack of personnel and material resources. More often than not
there exists an attitude that we can solve our problems ourselves. We do not need a
third party solution. We know more about the issues related to our problem than
a stranger. But we fail to understand that standing outside the problem can lend a
clarity that being in the problem situation cannot.
Now people are beginning to value and therefore seek counselors for their
institutions and organizations. But I feel that this is more out of the fact that people in
authority feel that they do not have time for problem-solving, rather than confessing
an inability to problem solve. However, counselors are being sought after, and this
122 Counseling: Theory, Skills and Practice

is good news. With the growth and recognition of the profession, the ethical code
will also be standardized in India. Then, all counselors will be made responsible and
held accountable for their professional behavior.

COUNSELOR SUPERVISION

Counselor supervision can be defined as ‘a distinct intervention that is provided

by a senior member of a profession to a junior member or members of that same
profession. This relationship is evaluative, extends over time, and has several
purposes:
∑ enhancing the professional functioning of the junior members,
∑ monitoring the quality of professional services offered to the clients he/she/
they see(s) and
∑ serving as a gatekeeper for those who are to enter the particular
profession.
(Bernard & Goodyear, 1992, p. 4).

Supervision is the construction of individualized learning plans for supervisees

working with clients. The systematic manner in which supervision is applied is
called a “model.” The Standards for Supervision (1990) and the Curriculum Guide
for Counseling Supervision (Borders et al., 1991) identify knowledge of models as
fundamental to ethical practice.
Supervision routines, beliefs, and practices began emerging as soon as therapists
wished to train others (Leddick & Bernard, 1980). The focus of early training,
however, was on the efficacy of the particular theory and then spread to attitude and
skills of counseling.
Supervision of counselors involves an evaluative, long-term relationship between
a “more senior member of a profession” and “a more junior member or members
of that same profession” (Bernard & Goodyear, 1998, p. 5). The supportive and
educative process of supervision is aimed at assisting supervisees in the application
of counseling theory and techniques to client concerns (Association for Counselor
Education and Supervision, 1993).
Supervision provides a means to support counselors and to address clients’ needs,
at the same time upholding the professional practice of counseling around the
globe. Counseling supervision is a relatively new area in the developed world, and
experiences and concepts from developing countries are only in the interim stages
of implementation. Therefore, there is a continuing need, especially in developing
countries, for “learning by doing” and for documenting how well different concepts
 Preparing to be a Counselor 123

and practices translate across cultures and settings. As was observed in relation to
an effective response to the AIDS epidemic, all counselors require ongoing support,
training and skills development in order to prevent or reduce the impact of burnout,
as well as to uphold ethical practices in counseling.
Burnout is the gradual process by which a person, in response to prolonged
stress and/or physical, mental and emotional strain, detaches from work and other
meaningful relationships. The result is lowered productivity, cynicism, confusion, a
feeling of being drained, and a sense of having nothing more to give (Mark Gorkin,
stressdoc.com).
Ethical practices and policies are designed to ensure that counselors conduct
themselves and provide services in a professional manner. They also help to ensure
that both the counselor and the client are protected by establishing guidelines for
counselors on issues such as responsibility, anti-discriminatory practices, contracts,
setting boundaries, confidentiality, and competency.
Success in counseling depends on counselors receiving the education, skills, and
support required to adequately meet the needs of their communities and clients.
This can be achieved by providing effective counseling supervision mechanisms.
In many countries, there are no individuals trained in counseling supervision, and
some countries also have limited numbers of adequately trained psychologists and/
or social workers to take on a role as counseling supervisors.
Numerous developmental models of supervision have been proffered in an
attempt to further advance the sound application of supervisory services (Littrell,
Lee-Borden, & Lorenz; 1979; Loganbill, Hardy, & Delworth, 1982; Rodenhauser,
1994; Stoltenberg & Delworth, 1987; Watkins, 1995a). Developmental models of
supervision have a common, focus on supervisee change from novice to experienced
clinician, through a delineated stage process with representative challenges facing
supervisees at each level. The characteristics of each stage provides the supervisors
with the opportunity to enhance effectiveness through interventions aimed at
facilitating further supervisee development (Rando).
In the past two decades, models of psychotherapy supervision, particularly
developmental models, have increasingly been proposed; these efforts have provided
us with a useful meta-perspective on the supervisory process, stimulated some
valuable thought about intervention, stimulated much research about therapist
development and supervision, and substantially advanced supervision theory far
beyond anything that therapy-based supervision models have contributed (Watkins
1997, p.13) .
The research in this area focuses on “discovering what supervisory interventions
work best for which level of trainees, with which characteristics when used by
supervisors with what type of experience and which characteristics at what point
in time”.
124 Counseling: Theory, Skills and Practice

What is Supervisory Training?

Supervisory training is field training for the supervisor so as to increase and improve
supervisory competency areas. Whether in an administrative or a clinical setting,
supervisory training is needed. Experience alone cannot qualify for supervision.
Border et al., (1991) described supervisory training as the development of a
curriculum guide that utilizes three phases of the current professional standards:
Self-awareness
Theoretical and a conceptual knowledge
Skills and techniques.
They also outlined seven core curriculum areas that compose effective supervisory
education. These areas are as follows:
Models of supervision
Counselor development
Methods and techniques
Supervisory relationship
Ethical, legal, and professional regulatory issues
Evaluation
Executive and administrative skills
This model of supervisory training incorporates conceptual, integrated, and
experiential elements.

Initial Planning
Prior to the initial supervisory training session, a meeting is needed with the supervisor
to provide an overview of the supervisory training sessions. During this initial
meeting, background information should be obtained to ensure that the supervisor
has the requisite background and interest to participate in the training sessions.
The supervisor should be informed of the anticipated structure and format of the
training sessions. Additionally, the supervisor should understand the expectations
and the requirements for successful completion of the supervision training. The
following topics should be discussed:
The amount of time anticipated for completing the supervisory training
Information about who is responsible for the training sessions
Responsibilities for the supervisor in training
Overview of evaluation procedures
Clarification of how satisfactorily and unsatisfactory performance will be
determined
Confidentiality issues
 Preparing to be a Counselor 125

Goals
Four major goals guide the planning of supervision training:
to provide a theory or knowledge base relevant to supervisory functioning
to develop and a refine supervisory skills
to integrate the theory and skills into a working supervisory style
to develop and enhance the professional identity of the supervisor.

Need for Supervised Training

Qualities of professional reflectivity are necessary for trainees to adopt conceptual
and interactive skills. Counseling trainees progress through a sequence of definitive
stages while experiencing increased levels of emotional and cognitive dissonance.
In order to transform dissonant counselor-training experiences into meaningful
guides for practice it is necessary to increase conceptual complexity, and articulate
the difference between novice and advanced trainees. A trusting and supportive
supervisory relationship is a prerequisite for advanced supervisee development
Counselors often find that they experience tension and while coping with
complexity, integrating theory into practice, taking on the evaluative role, and
increasing awareness of liability and ethical concerns. A comprehensive program of
counselor education should include an intensive supervision curriculum in order to
avoid some of the problems. Supervised counseling always helps the future counselor
to get a reality check on what is in store in the future. Thus there are many counselor
supervision models developed to improve the quality of the trainee, as well as the
supervisors themselves.
Today’s counselors deal routinely with complicated counseling needs, including
cases of severe depression and suicidal ideation, unwanted pregnancy, substance
abuse, violence, family problems, problems at work, career issues, personal conflict
situations, sexual identity and child abuse. To respond adequately to these needs,
counselors must have strong clinical skills and a keen awareness of the legal and
ethical ramifications of any actions they may take or fail to take (Barbara Herlihy).
Counselors in these situations may feel stressed and overworked and could experience
professional burnout. As a consequence, they may become unsure of their abilities
and effectiveness and may experience erosion in their skills and competence. This
process runs counter to their ethical responsibility to maintain and increase their
competence (Crutchfield and Borders, 1997).
Supervision can be an effective means of assisting counselors to maintain and
enhance their competence. Supervision can provide opportunities for continuing
clinical skill development, ongoing consultation regarding legal and ethical issues,
and a professional support system that can mitigate stress and burnout (Barbara
126 Counseling: Theory, Skills and Practice

Herlihy). The primary purpose of supervision is to enhance competence and increase

counseling skills of the counselor who is being supervised.
The need for clinical supervision in counseling has gone largely unmet.
Nonetheless, it has been observed that supervision enhances effectiveness and
accountability, improves counseling skills, encourages professional development,
and increases confidence and job comfort.
One reason due to which clinical supervision has been a neglected issue in
counseling may be a perception that counselors do not have the same level of need
for supervision as do clinical mental health counselors. In the following section we
will understand some models, which are popular educational programs.

Counselor Supervision Models

Supervision norms were typically conveyed indirectly during the rituals of an
apprenticeship. As supervision became more purposeful, three types of models
emerged. These were: (1) developmental models, (2) integrated models, and (3)
orientation-specific models.

Developmental models
Developmental models are based on the notion that people grow in fits and starts,
spurts and patterns. Development of strength and growth areas happens through
the combination of experience and hereditary disposition. The object is to maximize
and identify growth needed for the future. Continuously identifying new areas of
growth is typical of a life-long growth process.
Worthington (1987) reviewed many studies on developmental supervision models
and noted that there appeared to be a scientific basis for developmental trends and
patterns in supervision. The studies revealed that the behavior of supervisors changed
as supervisees gained experience, and the supervisory relationship also changed.
The developmental model of Stoltenberg and De lworth (1987)
Their model had three levels of supervisees: Within each level the authors noted a
trend to begin in a rigid, shallow, imitative way and move towards more competence,
self-assurance, and self-reliance for each level. Particular attention is paid to (1) self-
and-other awareness, (2) motivation, and (3) autonomy. They also highlight eight
growth areas––intervention, skills competence, assessment techniques, interpersonal
assessment, client conceptualization, individual differences, theoretical orientation,
treatment goals and plans, and professional ethics. The supervisees are helped to
identify their strengths and growth areas enabling them to be responsible for their
life-long development as both interventionists and supervisors.
1. Beginning: Where the supervisees are dependent on their supervisors to
diagnose/understand/explain client behaviors and attitudes and establish
plans for intervention.
 Preparing to be a Counselor 127

2. Intermediate: Where supervisees depend on supervisors for an understanding

of difficult clients, but would be annoyed at suggestions about others.
Resistance, avoidance, or conflict is typical of this stage, because supervisee
self-concept is easily threatened.
3. Advanced where supervisees function independently, seek consultation
when appropriate, and feel responsible for their correct and incorrect
decisions.

Integrated models
Eclectic counselors and therapists integrate several theories into consistent practice.
Some models of supervision were designed to be employed with multiple therapeutic
orientations. Bernard’s (Bernard and Goodyear, 1992). The Discrimination Model
combines three supervisory roles:
1. Teacher: When they directly lecture, instruct, and inform.
2. Counselors: When they assist supervisees in noticing their own “blind
spots” or the manner in which they are unconsciously “hooked” by a
client’s issue.
3. Colleague (co-therapy situation): They might don a “consultant” role …
with three areas of focus for skill building:
1. Process issues examine how the supervisee is making use of the skills of
counseling; is communication being conveyed. For e.g., is the supervisee
responding to the client’s emotions, is he paraphrasing/reframing well
enough, is his attitude helping the client be less resistant?
2. Conceptualization issues include how well supervisees can explain their
application of a specific theory to a particular case––how well they see
the big picture––as well as what reasons supervisees may have for what
to do next.
3. Personalization issues pertain to counselors’ use of their persons in
therapy, in order that all involved are non-defensively present in the
relationship, for e.g., awareness of the effect of their body language on
the clients, whether their client is attracted to them, etc.
This model is primarily a training model assuming that each counselor trainee/
supervisee has certain skills, attitude and philosophical orientation. When these are
identified the supervisor can gear the interventions to the needs of the supervisee
instead of supervisor’s own preferences and learning style.

Orientation-specific models
Counselors who adopt a particular brand of therapy often believe that the best
supervision is analysis of practice for true adherence to the “brand” of intervention.
Different theoretical orientations offer different styles for supervision. Eckstein and
128 Counseling: Theory, Skills and Practice

Wallerstein described psychoanalytic supervision as occurring in stages such as the

following: (1) The supervisee and supervisor eye each other for signs of expertise and
weakness. (2) The mid-stage is characterized by conflict, defensiveness, avoiding, or
attacking. (3) The last stage is characterized by a more silent supervisor encouraging
supervisees in their tendency toward independence. Behavioral supervision views
client problems as learning problems; therefore counseling requires two skills:
(1) identification of the problem, and (2) selection of the appropriate learning
technique. Carl Rogers felt that group therapy and a practicum were the core of
supervision. The most important aspect of supervision was modeling of the necessary
and sufficient conditions of empathy, genuineness, and unconditional positive
regard (Leddick and Bernard, 1980)
Bernard and Goodyear (1992) summarized advantages and disadvantages of
psychotherapy-based supervision models. When the supervisee and supervisor
share the same orientation, modeling is maximized and theory is more integrated
into training. When orientations clash, conflict or parallel process issues may
predominate.
Some specific models of counseling supervision:

1. Adaptive supervision in counselor training

Adaptive Supervision in Counselor Training (ASiCT) is based upon Howard,
Nance, and Myers’ (1986) adaptive counseling and therapy (ACT) model. This
model provides a means for supervisors to match supervisee task readiness with the
goal of moving them to the next skill and developmental level.

Supervisee readiness: Supervisee readiness is the supervisee’s willingness,

ability, and confidence in addressing a task related to their role as counselor
or supervisee. For example, a supervisee may have a great deal of experience in
addressing drug abuse or teenage pregnancy in crisis counseling situations. And
thus, this supervisee will have a high degree of readiness when dealing with that
situation. However, this supervisee may not have a great deal of experience in dealing
with rape or incest victimization. Then the supervisee would have a lesser degree of
willingness, ability, and confidence in addressing the client concern.

The supervisory styles: In order that the efficiency of process of counseling

supervision is maximized the supervisors need to match their methods/interventions
to supervisee readiness on a specific issue or cluster of issues and move that supervi-
see to increased readiness to address those issues in the future.
There are four supervisory styles identified within the ASiCT model which are
differentiated by the degree of support and direction given by the supervisor to the
supervisee, based upon supervisee readiness. The four styles are as follows:
 Preparing to be a Counselor 129

1. Supportive mentor: When the supervisee is moderately high in readiness

the supervisor provides low direction and high support.
2. Teaching mentor: When the supervisee is moderately low in readiness the
supervisor provides high direction and maximum support.
3. The delegating colleague: When the supervisee is high in readiness the
supervisor provides low direction and low support.
4. Technical director: When the supervisee is low in readiness the supervisor
provides less direction and less support.

2. Interpersonal process recall model

Some recent models of counseling supervision have tended to be task oriented,
emphasizing such competencies as case conceptualization and the attending skills
of the counselor (Craig S. Cashwell). However, attention is also needed to increase
counselor self-awareness regarding the therapeutic relationship. Interpersonal process
recall (IPR) is a supervision strategy developed by Norman Kagan and colleagues.
This strategy empowers counselors to understand and act upon perceptions to which
they may otherwise not attend, e.g., covert thoughts and feelings of client and self
and practice expressing them in the here and now without negative consequences,
in order to deepen the counselor/client relationship.
In IPR, counselors (and sometimes clients) re-experience the counseling session
via videotape or audiotape in a supervision session that can be characterized by
a supportive and nonthreatening environment. The supervisor functions as a
consultant, taking on the role of inquirer during the IPR session.
The following steps are intended as a guideline for conducting a recall session:
1. The supervisor creates a non-threatening environment, by emphasizing
that the purpose of the session is to reflect on thoughts and feelings of
the client and the counselor during the session that will be reviewed and
that there is more material in any counseling session than a counselor can
possibly attend to.
2. Begin playing the tape; at appropriate points, either person stops the tape
and asks a relevant lead to influence the discovery process. If the supervisee
stops the tape, he/she will speak first about thoughts or feelings that were
occurring at that time in the counseling session.
3. During the recall session the supervisee is allowed to explore thoughts and
feelings to some resolution (Bernard & Goodyear, 1992).

Inquirer leads: Questions can be worded to enhance supervisees’ awareness of

their blind spots at their own level of readiness and capability (Borders & Leddick,
1987). (e.g., focus on client non-verbals versus counselor’s internal reaction to the
client). To further an understanding of the inquirer role, the following inquirer
130 Counseling: Theory, Skills and Practice

leads are provided from various sources (Bernard & Goodyear, 1992; Borders &
Leddick, 1987; Kagan, 1980):
1. What do you wish you had said to him/her?
2. How do you think he/she would have reacted if you had said that?
3. What would have been the risk in saying what you wanted to say?
4. If you had the chance now, how might you tell him/her what you are
thinking and feeling?
5. Were there any other thoughts going through your mind?
6. How did you want the other person to perceive you?
7. Were those feelings located physically in some part of your body?
8. Were you aware of any feelings? Does that feeling have any special meaning
for you?
9. What did you want him/her to tell you?
10. What do you think he/she wanted from you?
11. Did he/she remind you of anyone in your life?

3. Use of technology in counseling supervision (Watson)

Computer technology has become an important part of our society. It provides
users with applications that can simplify several tasks. Counseling professionals
can also use this new medium to facilitate their practice. Counselor educators are
beginning to acknowledge the value of computer-based applications in the delivery
of counseling supervision. The internet is becoming increasingly popular and the use
of online, computer-based approaches are becoming more favorable. The counseling
profession is beginning to realize the effectiveness of this approach in facilitating the
delivery of their services. Researchers have shown that computer usage is becoming
an integral part of counseling and counselor training (Lee and Pulvino, 1988).
The use of computers in counselor training is not a totally new concept. Computer
applications for training mental health professionals first appeared during the 1960s
and were primarily designed to assist in psychiatric interview training (Bellman,
Friend, and Kurland, 1966; Starkweather, 1967). In the 1970s and 1980s, counselor
educators began to show an interest in computerized training applications. More
recently, computers have been used to aid in the delivery of counseling supervision,
helping counselor educators train new generations of counseling professionals
(Watson). Froehle, (1984) looked at ways computers could be used to monitor
student progress in practicum courses which sparked the beginning of supervisors
using computer-based applications, to create a more multidimensional approach to
their supervision sessions.
Technology can be used at both the practicum and internship stage of counselor
development. It can be used to deliver supervision both live and delayed. They can
also be used to facilitate more efficient internship communication when proximity
 Preparing to be a Counselor 131

is an issue computer-based technologies offer several possibilities for supervisors

today (Watson) including:
(a) Computer-assisted live supervision: Where immediate feedback is offered.
Supervisors position themselves behind a two-way mirror and observe a
session. There is a computer screen in the therapy room which can be seen
by the counselor and the supervisor, but not the client, Counselors-in-
training can receive immediate feedback and suggestions. The supervisors
type their comments on the keyboard, which the student can view and
integrate into their counseling repertoire. This can be very useful when the
supervisor and supervisee are not in the same location.
(b) Electronic mail (e-mail): Allows for regular contact between clinical
supervisors and counselor educators (Casey, et al., 1994; Myrick and
Sabella, 1995). The supervisor and supervisee can converse regularly
without the constraints of physical proximity thus allowing for a more
continuous supervisory experience for the supervisee. The use of e-mail is
not restricted to academic settings. Counselors in the field can also access
this technology and seek out the supervision they may need (Watson). Here
the supervisees give a brief description of the client (while maintaining his or
her anonymity), the presenting problem, behaviors or thoughts associated
with that problem and any interventions already attempted. They then list
questions or concerns they have about this case.
(c) Chat rooms provide real-time communication; Allows individuals to
post comments and questions to others in a group and receive feedback
or suggestions. Supervisors establish a listing of all group members and
their assigned/chosen screen names. And they all meet in a designated
chatroom. A real-time discussion forum takes place between supervisor and
supervisees. Supervisees are also able to communicate with one another.
A variation of this is the instant messenger services of Yahoo, Google,
MSN, etc.
(d) Cybersupervision provides supervisors with the most flexibility in working
with their supervisees. Audio, video equipments provide supervisors and
supervisees the opportunity to interact in real time even when they are in
different locations. A real-time discussion forum can take place between
supervisor and supervisees. Supervisees are also able to communicate with
one another and can share written, voice, and image messages. Supervisors
can watch video of counseling sessions and offer instant feedback.
Videoconferencing, the key element in cyber supervision, is more secure than
e-mail or chat room transcripts that are considered public record and are used
extensively in counselor supervision (Casey, et al., 1994; Myrick & Sabella,
1995). Videoconferencing is more secure because it utilizes a closed point-to-point
communication system and occurs in real time (Roblyer, 1997).
132 Counseling: Theory, Skills and Practice

Ethical considerations for the cyber field of counseling: The National

Board of Certified Counselors (NBCC) and the American Counseling Association
(ACA) have developed sets of ethical guidelines for web-based counseling. Issues that
may come up include confidentiality, informed consent, and emergency contact/
response issues. Supervisors and supervisees need to be familiar with the ethical
guidelines of these approaches.

4. Systems approach model

The systems approach model is built on seven dimensions, including the institution,
the supervisor, the functions of supervision, the supervision relationship, the client,
the trainee, and the tasks of supervision. The supervision must always be vigilant,
fair, and thorough, with supervisors always staying in contact with their supervisees,
lest the pressure and drama associated with a myriad of client personality types take
the supervisees into an unreal situation regarding therapy.
In the book, Clinical Supervision: A Systems Approach (Holloway, 1995), the
author lays out the fact that “supervision is among the most complex of all activities
associated with the practice of psychology.” he asserts that “clinical supervision
which concentrates on developing the supervisee’s skills, offers support for and helps
frame the vision of the supervisee “ goes deeper to the heart of the needs of the
counselor than administrative supervision which is about paperwork, recruiting,
delegating and “acting as a change agent within the organization.”

5. Multicultural counseling supervision: A four-step model

This was a model developed by Robinson. Bradley and Hendricks (2000) felt that
multicultural elements and issues though being a vital part of effective counseling
supervision were not addressed by the traditional counseling supervision models. They
then went on to provide a four-step model for the development of multiculturally
competent counselors. The four-step model includes the following:
1. Developing cultural awareness of the counseling supervisor
2. Exploring the cultural dynamics of the counseling supervisory relationships
3. Examining the cultural assumptions of the traditional counseling theories
4. Integrating multicultural issues into existing models of counseling.

Counselor Training in Supervision

Training methods
The course curriculum should emphasize experiential learning while also presenting
frameworks for counseling supervision. Training activities should include, but
 Preparing to be a Counselor 133

not be limited to, practicum (fieldwork), role-plays, games, presentations by

participants, case studies, use of transcripts, action planning, small group discussions,
brainstorming, and self-awareness exercises. Students taking the course should be
expected to fully participate in all activities, and all participants must be aware that
if they miss a module, they must make it up and satisfactorily complete it to meet
the course requirements to receive a certificate.
At the beginning of the course, trainers should identify the needs and assess
the skill levels of participants and shape the training accordingly. For example,
trainers should add activities where they see a need for additional skills development
or remove activities that are not necessary or not appropriate for the group of
participants. Scheduled breaks and timeframes should be flexible and should be
determined by the trainer and participants.
The ideal number of participants for the course is 10 to 12, but the course can
be designed to accommodate a minimum of 8 or a maximum of 15. Smaller groups
allow for greater participation and more practice of new skills, and also allow trainers
to better assess and aid the skill development of participants. At the end of each day,
a reporter should be selected (by the trainer or by the participants) from among
the group to recap the lessons learned and to give a brief presentation (about five
minutes) the following morning.
Participants should also fill out on a daily basis the daily evaluation form, which
the trainer should hand out every morning. At the end of each module, there is a
take-home task that the trainer can give to participants at his/her discretion. The
take-home tasks should be completed overnight and handed over the following
morning. The take-home tasks will help the trainer monitor the progress of the
trainees, that is, how well they have understood and conceptualized the material in
each module.

Selection criteria for trainers

Selection criteria for trainers include the following:
Essential:
Experience facilitating experiential training
Minimum two years of counseling (preferably with diverse clientele)
Understanding of counseling theory and how it applies in practice
Strong verbal and written communication skills in the required language
Desirable:
Should have been supervised in counseling practice (past and/or
presently)
Should be supervising a case load of counselors at present
Have experience participating in a counselor support group and/or
network
134 Counseling: Theory, Skills and Practice

Have one of the following professional backgrounds: psychology, social

work, nursing, be a clinical officer, psychiatry, teaching or theology

Selection criteria for participants

Selection criteria for participants include the following:
Minimum six months of counseling experience with clients from diverse
backgrounds
Counseling qualification (i.e., completion of a minimum of one month
of training from a recognized agency/training institution; this is desirable,
though in some countries this may not be possible)
Strong verbal and written communication skills in the required language
Support of management or the sponsoring agency to undertake the course
(as demonstrated in letter of support)
In a position to supervise counselors upon course completion (as
demonstrated in letter of support)

Recruitment process for participants

Individuals can apply to the training institution individually and/or be nominated by
a sponsoring agency. Suitability for entry into the course is based on the application
form, letter of support and interview.
Individuals applying or being nominated should complete a standard
application form and submit it to the training institution.
Individuals applying or being nominated must attach to the application
form a letter of support from their place of work/sponsoring agency (e.g.,
in the case of volunteers) demonstrating that the agency supports their
attendance and that upon course completion, the participant will have
supervisory responsibility within the agency.
Individuals must attend a screening interview at the training institution to
determine their suitability for attending the course. The interviews must
use a standardized procedure, including general open-ended questions, a
values- and-attitudes-based question and a hypothetical scenario.
Following are the programs for training counselors and supervisors.

CHOOSING A GRADUATE PROGRAM

Personal and professional aspirations

Like so many important transitions in life, choice of education becomes a series
of often-serendipitous events as people influence us often in contradictory ways,
 Preparing to be a Counselor 135

selecting courses because of convenience, people pressure, and sometimes simply

the path of least resistance.
But one cannot count on serendipity. Today we know that it is important to
find answers to the following questions: Will the counseling profession suit you and
your life style? What factors ought to be considered in choosing a graduate program?
What type of graduate training is most likely to meet your needs? What will help
you get into the program you choose?
When one is considering counseling as a career for a number of reasons, including
some that are universal and others that are unique, generally altruism is tempered
with intensely personal motives in choosing counseling as a career. The feelings of
power and control, as well as the opportunities to work through one’s own issues,
are among the most frequently cited reasons. These underlying reasons mean that
the counseling profession can be a source of tremendous satisfaction; but it can
also become major blocks to professional effectiveness. You can even do great
harm to others if you meet your own needs, or act out your own unresolved issues,
during sessions. It is for this reason that quality counselor training programs offer
components that emphasize personal development as well as skill and knowledge
acquisition.

Program factors to consider

There is considerable variation among graduate programs as to their faculty,
philosophy, and specialty areas. These factors, as well as training levels, accreditation,
and location, need to be considered.

1. Faculty
One of the best ways these programs may be observed is to look at how well faculty
work together as a unit. What is the diversity of instructors in terms of their theoretical
orientations, clinical experiences, teaching methods, cultural backgrounds, gender
balance, and personality styles? How well do they get along as colleagues?
Some programs have faculty who are cooperative, supportive, and respectful of
one another, making it safe for student to find their own paths to learning. Other
programs can have faculty who are unduly competitive, threatened, or perturbed.
Sometimes students are caught in the middle of these struggles.
The answers to these questions can be found by speaking to other students about
how well they perceive faculty are getting along, how disagreements are handled,
and how conflicts are managed. Expect a reasonable amount of intellectual strife.
The strength of a faculty is based on much more than how well they get along,
however. Other things to look for include racial, gender, and ethnic diversity; time
availability; and diversity in functioning.
136 Counseling: Theory, Skills and Practice

2. Ethnic and racial backgrounds

The mandate of our profession is to reach out to those who need our services the
most: the disadvantaged and those who are not part of the power base that controls
things. One of the ways we help prepare counselors to work with people of diverse
cultures, religions, and ethnic and racial backgrounds is to provide models of
successful professionals representing diverse cultures.

3. Time availability
Who is available? Are students available who are interested in talking to and
working with their instructors? Is there a faculty that is interested in talking to their
students? Who is available when needed is a barometer that can be used to assess the
commitment of faculty to students.

4. Diversity in functioning
The best way to do counseling and the best way to develop counselors are the
subject of a heated debate, but it is generally agreed that it is advisable to be get
exposure to many theoretical approaches and teaching styles during one’s tenure
as a student. By learning in a variety of settings, content focused, experientially
based, interactive, introspective, supportive, controversial, informal, and highly
structured, one can select features that best fit one’s personality, career goals, and
preferences. This exposure to many different models also prepares you better for the
variety of employment, organization, and peer styles that will present themselves
after graduation.

5. Philosophy
Training programs were once easily identifiable as subscribing to the tenets of a
single theoretical base, such as psychoanalytic, humanistic, or behavioral. It is now
quite rare to find allegiance among all staff members to a particular counseling
approach; but even then there are methods of instruction among faculty which are
likely to be more similar than different. One of the joys of the profession is that each
of us is permitted to discover ways of helping others that suit us best, as long as we
maintain ethical and competence standards established by our peers.
Nevertheless, in spite of the variations in methods of instruction, approaches to
counseling, and even personality styles of faculty, many departments do espouse
a particular philosophy of counselor education. This mission statement may be
simply the requirement of an accredition standard, or in many cases, it represents a
well-thought-out summary of what the program intends to do and how these goals
are to be carried out.
 Preparing to be a Counselor 137

6. Polarities in counselor training

Competency based Experience based
Emphasis on courses Emphasis on learning experiences
Emphasis on content and skill Emphasis on process and skill development
development on moral and emotional development
Lecture and discussion Interaction and group experience, and self-
reflective activities
Evaluation by exam Self-evaluation and evaluation by writing
papers
Reliance on the technology of Reliance on the human dimension
systematic instruction

Few programs are as pure as those described in the table. However, the emphasis
today is on integration and synthesis. The best features of competency- and
experience-based approaches are combined into programs that include (1) content
and information acquisition, (2) skill development through systematic modeling
and supervision, (3) process interaction in small groups, (4) emotional/personal
development through group and self-reflective assignments, (5) evolution of a
personal style of practice through supervised experience, and (6) refinement of
counseling interventions through feedback on videotapes.

7. Specialty areas
One of the keys to securing employment is developing an area of expertise that
is both interesting to you and in demand by others. The function of program
specialization is to compensate for the increasingly complex circumstances in which
counselors are asked to work. Having specialized training in a given area increases
the likelihood that the counselor is insensitive to unique client needs and unaware
of the most current thinking on dealing with those issues.
All counselors receive exposure to the core knowledge base of our profession,
including developmental theory, career development, assessment, multicultural
awareness, and individual and group interventions as well as training in the skills
of helping. However, most practitioners also choose to concentrate in a particular
professional area that requires specialized training. This choice of a specialty may
be based on a deliberate personal decision. Such a decision may also be based on
expediency, such as a surplus of specialized jobs in a given geographic area.
Most counseling programs emphasize on several distinct specialties rather than
one general program. Typically all students take a core set of courses together. These
include foundation classes in human development, research methods, assessment
techniques, counseling theory, multicultural issues, vocational development, and
other subjects considered to be part of necessary training for all practitioners,
138 Counseling: Theory, Skills and Practice

regardless of the specialty. Then, depending on such factors as faculty interests and
qualifications, program accreditation, the institution’s historical precedents, and the
area’s political climate, particular specialty areas may be developed.
How can you choose the best specialty for you? Several factors should be
considered when making a tentative specialty choice:
1. What you are qualified for (for example, attaching certificate may be
required for school counseling)
2. The population you prefer to work with (young children, adolescents,
adults, older adults)
3. The job opportunities available in your preferred geographic region
4. The drive and passion you feel toward a particular kind of professional
identity
5. The relative strength of the faculty, resources, and support within the
various specialties available
6. The match between your personal strengths and weaknesses and those of
a particular specialty (for example, crisis intervention versus longer term
counseling relationships)

Counseling Faculty
Counseling discipline in any university ensures professional education and training
at the master’s level, leading to appropriate counseling knowledge, competencies,
and skills.
The student population is vastly different in terms of their educational social and
cultural diversity, hence counseling faculty needs to address the student’s academic
as well as counseling needs. They need to play an important and a significant
role in providing support to the students. Thus, the counseling faculty needs to
be trained in counseling skills and be familiar with the entire curriculum. Quality
counseling programs staffed by professional counseling faculty are critical to ensure
that students achieve their educational and career goals. Today’s students face a
myriad of complex academic and personal issues and concerns. Counseling faculty
helps students identify these issues and deal effectively with them through academic,
career and personal counseling, and help students to be successful both academically
and personally.
It is the responsibility of the faculty to provide every student the opportunity
to realize his or her intellectual, emotional, and vocational potential. The student’s
goals and aspirations which often change during the educational experience should
be understood and dealt with accordingly. The faculty must assist students in
identifying their talents and ability, direct them to specializations that meet their
needs, and maintain standards designed to ensure their success.
 Preparing to be a Counselor 139

The students of today tend to think more about the future than the present.
They appear to be more interested in their jobs and placements and less in their
studies. Hence, they do not do very well in their examinations. Counseling faculty
must help the students of the university. This can deter the students from disastrous
self-placements and impossible workloads and help students to develop hope,
confidence, and commitment to realistic aspirations. They can also help the students
whose academic abilities do not match their aspirations. Counseling faculty have
the obligation to provide counseling programs to help students decide what they
want from higher education, plan their route through the system to achieve these
goals, and help them overcome the barriers that may impede progress towards those
goals.

Counseling Faculty: Qualifications, their Roles and Activities

Counseling faculty is professionally trained to diagnose the difficulties students face
in the educational arena, to prescribe solution, and to support students during their
struggle to success. In order to do this effectively the faculty needs to understand
the students’ stated goals in the context of human development and the inevitable
changes that occur as they undertake college education. Even when students initially
present clear goals, counseling faculty understand that students change as the result
of their unfolding education or personal situations. This requires careful attention
to cues that suggests students need assistance in reevaluating their goals.
In these tasks, the role of counseling faculty is unique among the faculty of
colleges and universities. The counselor’s role is even more crucial to students’
success when we consider that it is not just likely that students at colleges will
encounter difficulties—it is almost inevitable.
The minimum qualifications as prescribed by UGC are masters in counseling,
rehabilitation counseling, clinical psychology, guidance counseling, educational
counseling, or their equivalent. The professional education and training required
of a college counseling faculty enable them to play a variety of roles and offer a
range of activities to meet students’ counseling needs. They are needed to assist
the individual in decisions which affect educational, vocational and personal goals,
and provide appropriate support and instruction which will enable the individual
to implement these decisions. The implementation may include selection of
appropriate institutions, academic planning, and dealing with learning handicap-,
making the transition from college to work, or to an appropriate higher level college
or university, and assistance in handling personal, family or social problems which
may interfere with educational goal attainment.
The student should also be assisted in assessing, planning, and implementing his
or her immediate as well as long-term academic goals. Career counseling, in which
the student is assisted in understanding his or her attitudes, abilities, and interest
140 Counseling: Theory, Skills and Practice

and is advised concerning the current and future employment trends, is done by the
counseling faculty, including programs for students with special needs, skills testing
programs, financial assistance programs, and job placement services. This work is
usually undertaken by the counseling department in many universities.
Career counseling helps students figure out what they really want to do and how
to get there. Otherwise they put in more effort in unnecessarily wrestling with career
decisions. They may take up unwanted courses, and finally, lose motivation and
drop-out. A counselor’s help through this natural struggle could be quite effective.
Many students experience some form or educational or occupational uncertainty
during the course of their college careers, and uncertainty for a new student increases
rather than decreases during the first two years of college. Personal counseling is
critical to ensure the success of the students. Students with psychological disabilities,
and students who experienced crisis situations while on campus need to be assisted
with sensitive counseling. Personal counseling benefits many students and helps
them manage their difficult life situations while they progress in college. Young
students experiencing the stress of transition into adulthood are bound to face these
kinds of conflict and confusion, their goals becoming undermined by their personal
conflicts.
Counseling discipline in any university involves professional education and
training at the Masters level leading to appropriate counseling knowledge,
competencies and skills. But there is no definition of or the limitations on the
role of the counseling/ advising para-professionals, and in some places the role of
professional counseling faculty and para-professionals are blurred.
The student population is vastly different in terms of their educational, social and
cultural diversity. The counseling faculty needs to address the student’s academic
as well as counseling needs. They need to play an important and significant role in
providing support to the students. Thus the counseling faculty needs to be trained
in counseling skills and be familiar with the entire curriculum.
It is the responsibility of the faculty to provide every student the opportunity
to realize his or her intellectual, emotional, and vocational potential. The student’s
goals and aspirations, which often change during the educational experience, should
be understood and dealt with accordingly.

v Summary v
It is important for students of counseling to familiarize themselves with
problems concerning ethical behavior, which invariably accompanies the
development of a profession. Counselors should be aware of certain legal
and ethical issues related to practice of counseling. Confidentiality is an
ethical term that refers to the client’s right to privacy, guiding counselors
 Preparing to be a Counselor 141

to disclose information only with the informed consent of the client.

It includes the clinical or counseling practice of psychology, research,
teaching, supervision of trainees, development of assessment instruments,
conducting assessments, educational counseling, organizational consulting,
social intervention, administration, and other activities as well. Psychologists
work to develop a valid and reliable body of scientific knowledge based on
research. This Ethics Code provides a common set of values upon which
psychologists build their professional and scientific work.
Counseling discipline in any University ensures professional education and
training at the masters level leading to appropriate counseling knowledge,
competencies and skills. The counseling faculty needed to address the
student’s academic as well as counseling needs. Quality counseling
programs staffed by professionals counseling faculty are critical to assure
that students achieve their educational and career goals. Today’s students
face a myriad of complex academic and personal issues and concerns. By
helping students identify those issues and deal effectively with them through
academic, career and personal counseling, counseling faculty provide a
means for students to be successful both academically and personally.
The counseling faculty must help the students of the University. This can
deter the students from disastrous self-placements and impossible workloads
and they can help students develop hope, confidence, and commitment
to realistic aspirations. Counseling faculties have the obligation to provide
counseling programs to help students decide what they want from higher
education, plan their route through the system to achieve these goals, and
help them overcome the barriers that mere impede progress toward those
goals.
Counseling faculty is professionally trained to diagnose the difficulties
students face in the educational arena, to prescribe solution in difficulties,
and to support students during their struggle to success. The minimum
qualifications as prescribed by UGC are masters in counseling, rehabilitation
counseling, clinical psychology, guidance counseling, educational
counseling, or the equivalent.
The counseling faculty needs to address the student’s academic as well
as counseling needs. Quality counseling programs staffed by professionals
counseling faculty are critical to ensure that students achieve their
educational and career goals. Today’s students face a myriad of complex
academic and personal issues and concerns. By helping students identify
those issues and deal effectively with them through academic, career and
personal counseling, counseling faculty provide a means for students to be
successful both academically and personally.
An applicant for Professional Counselor certification receives the
professional supervision required by subsection (A) from a Certified
Behavioral Health Professional Counselor or an individual eligible for such
certification. Under Laws 1991, Ch. 253, §4(c), an applicant for Professional
142 Counseling: Theory, Skills and Practice

Counselor certification who meets all other requirements may submit a

written request to the Counseling Credentialing Committee for waiver of
the requirement that professional supervision be provided by a Certified
Behavioral Health Professional Counselor or an individual eligible for such
certification. The Counseling Credentialing Committee shall grant the
waiver if it determines the applicant was supervised by a certified or licensed
behavioral health professional or other behavioral health professional who
has education, supervision, and experience acceptable to the Counseling
Credentialing Committee.
Counseling, like many fields of professional work, draws its principles of
practice from a number of disciplines. Thus, the relatively unsophisticated
approach to counseling has undergone several decisive changes over the
years leading to the emergence of counseling as a professional service.
The supportive and educative process of supervision is aimed toward
assisting supervisees in the application of counseling theory and techniques
to client concerns (Association for Counselor Education and Supervision,
1993).
Supervision provides a way to support counselors and to address clients’
needs while at the same time upholding the professional practice of
counseling around the globe. Success in counseling depends on counselors
receiving the education, skills and support required to adequately meet the
needs of their communities and clients. This can be achieved by providing
effective counseling supervision mechanisms. In many countries there are
no individuals trained in counseling supervision, and some countries also
have limited numbers of adequately trained psychologists and/or social
workers to take on a role as counseling supervisors.
The characteristics of each developmental stage afford supervisors
the opportunity to enhance effectiveness through interventions aimed at
facilitating further supervisee development.
Supervising training is training for the supervisor in the field so as to
increase and improve supervisory competency areas. Experience alone
cannot qualify for supervision. Prior to the initial supervisory training
session, a meeting is needed with the supervisor to provide an overview of
the supervisory training sessions. The supervisor should be informed of the
anticipated structure and format of the training sessions. Additionally, the
supervisor should understand the expectations and the requirements for
successful completion of the supervision training.
Supervision can be an effective means of assisting counselors to maintain
and enhance their competence. The primary purpose of supervision is to
enhance the competence and increase the counseling skills of the counselor
who is being supervised.
The need for clinical supervision in counseling has gone largely unmet.
Nonetheless, it has been observed that supervision enhances effectiveness
 Preparing to be a Counselor 143

and accountability, improves counseling skills, and encourages professional

development, and increases confidence and job comfort.
One reason clinical supervision has been a neglected issue in counseling
may be a perception that counselors do not have the same level of need for
supervision as do clinical mental health counselors.
Counseling supervision models are basically of three types––
developmental, integrated and orientation specific. Some counselor
supervision models are:
• Adaptive supervision in counselor training (ASiCT)
• Interpersonal process recall
• Use of technology in counseling supervision
• Systems approach model
• Multicultural counseling supervision: a four-step model
Counselor training in supervision is very important. The course curriculum
should emphasize experiential learning while also presenting frameworks
for counseling supervision. Choosing a graduate program requires a lot
of thought and introspection. Quality counselor training programs offer
components that emphasize personal development as well as skill and
knowledge acquisition. Master’s-level training is essentially counseling
practitioner’s degree. This degree is intended to prepare professionals to
function independently as scholars, supervisors, advanced practitioners,
and educators.

References
Association for Counselor Education and Supervision. 1990. Standards for counseling supervisors.
Journal of Counseling and Development, 69, pp. 30–32.
Barbara Herlihy “Legal and ethical issues in school counselor supervision - Special issue: legal and
ethical issues in school counseling”. Professional School Counseling. FindArticles.com.
17 Jul, 2010. http://findarticles.com/p/articles/mi_m0KOC/is_1_6/ai_93700940/
Bellman, R., M. B. Friend and , L. Kurland. 1966. ‘Simulation of the initial psychiatric interview’.
Behavioral Science, 11, pp. 389–399.
Bernard, J. M. and R. K. Goodyear. 1992. Fundamentals of clinical supervision. Boston, MA: Allyn
& Bacon.
Bernard, J. M., and R. K. Goodyear. 1998. Fundamentals of clinical supervision (2nd ed.). Boston:
Allyn and Bacon.
Borders, L. D. 1991. ‘A systematic approach to peer group supervision’. Journal of Counseling and
Development, 69, pp.248–252.
Borders, L. D., and G. R. Leddick. 1987. Handbook of counseling supervision. Alexandria, VA:
Association for Counselor Education and Supervision.
Borders, L. D., J. M. Bernard, H. A. Dye, M. L. Fong, , P. Henderson and D. W. Nance.1991.
Curriculum guide for training counselor supervisors: Rationale, Development and
Implementation; 31, 58–80 <Au: I added the journal volume and page range from the
Web>.
144 Counseling: Theory, Skills and Practice

Casey, J. A.,J. W., Bloom and E. R. Moan. 1994. Use of technology in counselor supervision (Report
No. EDO-CG-94-25).
Crutchfield, L. B. and L. D. Borders. 1997. ‘Impact of two clinical peer supervision models on
practicing school counselors’. Journal of Counseling and Development, 75, pp. 219–230.
Froehle, T. C. 1984. ‘Computer-assisted feedback in counseling supervision’, Counselor Education
and Supervision, 24, pp. 168–175.
Goodyear, R. K. 1982. Psychotherapy supervision by major theorists.
Hersey, P. and K. H. Blanchard. 1977. Management of organizational behavior: Utilizing human
resources (3rd ed.). Englewood Cliffs, NJ: Prentice-Hall.
Howard, G. S., D. W. Nance and P. Myers. 1986. ‘Adaptive counseling and therapy: An
integrative, eclectic model’, The Counseling Psychologist, 14, pp. 363–442.
http://www.counseling.org/counselors/LicensureAndCert.aspx.
Watson, Joshua C at http://jtc.colstate.edu/vol3_1/Watson/Watson.htm.
Lee, J. L. and C. J. Pulvino. 1988. ‘Computer competency: A means for learning to be a better
counselor’. Counselor Education and Supervision, 28, pp. 110–115.
Littrell, J. M., N. Lee-Borden and J. A. Lorenz. 1979. ‘A developmental framework for counseling
supervision’, Counselor Education and Supervision, 19, pp. 119–136.
Loganbill, C., E. Hardy and , U. Delworth. 1982. ‘Supervision: A conceptual model’, The
Counseling Psychologist, 10, pp. 3–42.
Mark Gorkin in http://www.stressdoc.com/four_stages_burnbout.htm
Myrick, R. D., and R. A. Sabella. 1995. ‘Cyberspace: New place for counselor
Supervision’. Elementary School Guidance and Counseling, 30, pp. 35–44.
Roblyer, M. D. 1997. Videoconferencing. Learning and Leading with Technology, 24, pp. 58–61.
Robinson, Beth, Loretta J. Bradley and , Bret C. Hendricks. 2000. ‘Multicultural counselling
supervision: A four-step model toward competency’, International Journal for the
Advancement of Counseling. Volume 22, Number 2.
Rando, A.Robert. ‘Adaptive Supervision in Counselor Training’ in http://ccvillage.buffalo.edu/
Village/ElecProj/Rando.htm.
Watkins, C. E. 1997. ‘Reflections on contemporary psychotherapy practice, research, and
training’, Journal of Contemporary Psychotherapy, 27, pp. 5–22.
Craig S. Cashwell at http://www.cyc-net.org/cyc-online/cycol-1001-supervision.html.
 6
The Counselor
and the Counselee

Chapter Overview
The Counselor
Philosophy and attitude of the professional counselor
Personality of effective counselors
Skills of counselor
Values in counseling
Ethical considerations for a counselor
The Counselee
The counselee characteristics and variables
Characteristics of a successful counselee
Counselee expectations
Counselee perceptions

THE COUNSELOR

W
hy do People become Counselors?
Most believe they can really help people.
Some have a desire to help those who are less fortunate.
Some want to help prevent people from having difficulties in the
first place.
Some want to help people reach their full potential.
Some believe that it is a very rewarding and uplifting experience.
There are many reasons why a person chooses to become a counselor. The
association between the counselor characteristics and the efficacy of the counseling
process cannot be undermined. Along with the rigorous training required for a
student of counseling, his or her personal qualities go a long way in supplementing
146 Counseling: Theory, Skills and Practice

that training. Counseling usually helps people but also can harm them. “Good”
counselors have unique and identifiable personal characteristics. Clients react
differentially to counselor characteristics and that those reactions are important
components of counseling outcomes. Today, the study of counselor characteristics
is getting a renewed focus and is intended to facilitate “matching” of counselors
and clients. Many counselor characteristics are being investigated; however, Hiebert
(1984) has suggested this effort would be better invested in defending the worth of
counseling services.

PHILOSOPHY AND ATTITUDE OF A PROFESSIONAL

COUNSELOR

The counselor is a trained professional who should manifest the following personal
and professional characteristics:
The belief that counselees are unique individuals of significant value
The knowledge of how an effective individual functions
The belief that counselees are capable of change
That their knowledge and skills are necessary to help individuals overcome
functional limitations
The willingness to become involved in this interpersonal process
The understanding of oneself and one’s own skills and limitations
Non-judgmental acceptance of people
Belief that people are basically good
Acceptance of and positive use of transference
Helping the person see reality, encourage objectivity
The purpose is to remove the veil of ignorance

Belief that Counselees are Unique Individuals

of Significant Value
All human beings are worthwhile, valuable, and unique. This is an essential
conviction that every counselor must have in order to relate to each counselee in a
positive and constructive manner. Moreover, this acceptance of, and a sincere belief
in the counselee, must be felt as an experience and not an abstract philosophical
concept. It means that the counselor must have a genuine interest in the counselee
and the presenting issues. It does not mean that one must not approve or disapprove
of a particular act or like or dislike a particular trait manifested by a counselee;
but rather that, in spite of these, the counselor should have a genuine interest in
the counselee, and respect the counselee as an important, valuable, and worthwhile
human being. This is what Carl Rogers called “unconditional positive regard”.
 The Counselor and the Counselee 147

The counselor must understand that a counselee’s perceptions about self, and
perceptions of the world constitute reality for that person. The counselee’s problem
should be approached from that frame of reference. The socioeconomic, religious
and cultural background, education, and family factors of the counselee are of
utmost importance when we try to understand where he or she is coming from. The
beliefs, attitudes, feelings, and impressions that the counselee has about self and of
the environment strongly influence the way the person behaves. A counselor needs
to focus on understanding these perceptions and comprehending the meaning of
the counselee’s behavior. Understanding where the counselee is coming from, his or
her internal frame of reference, will give valuable clues to his or her problem.
The counselee’s sense of worth and uniqueness has to be appreciated and
encouraged. This will create a feeling of trust between the counselor and the
counselee. The counselor’s belief in the counselee and in his sense of self-worth
is expressed verbally, paraverbally, and non-verbally. Nonverbal expressions are
promptness, posture, and facial expressions. Paraverbal expressions are tonal quality.
And verbal expressions are responses that are sensitive to the feelings and attitudes
of the counselee.

Belief that counselees are capable of change

When someone asked me, “Do you think he will change?” My answer was, “I wouldn’t
be in this business if I did not believe that.” It is true. We are all capable of change.
We will have to make that decision on our own. It only requires determination to do
so. A counselor’s theoretical orientation and basic assumptions about the nature of
human beings strongly influences the counselor’s belief regarding the kind of change
and amount or degree of change possible for any individual counselee. Counselors
may hold distinct and varied opinions on the kinds of change that they believe are
possible. But it is important for all counselors to believe that counselees are capable
of change.
A counselor has to be optimistic. The belief that all counselees can, at least to
some extent, modify their feelings, attitudes, cognitive structure, and behavior is
imperative to all counselors if they have to prove themselves helpful to the process.
Change is never easy. They need to recognize that it is not easy to help people
change. And it is not possible to help all people to change. Sometimes a counselee
may just not be ready; he or she may not be willing to change. There may not be any
necessity for the counselee to change, rather it may be the counselee’s surroundings
that need to change or be changed.
As a counselor one must communicate to the counselee this belief that he or
she can change. Without the counselee’s cooperation it would not be possible to
achieve a change. Thus it is not enough if the counselor believes that the counselee
can change, it is equally important that the counselee believes that he or she can
change.
148 Counseling: Theory, Skills and Practice

The knowledge of how individuals function

All counselors must understand the psychological principles that guide human
behavior and the environmental factors that influence behavior. The counselor’s
education in psychology courses at the undergraduate and postgraduate level is
therefore imperative. This knowledge will help the counselor see the counselee as an
individual as well as a member of the society. The unique ways of the individual and
of his or her functioning in the world out side should be very carefully understood
by the counselors. Knowledge of how individuals function within the framework of
the self and in relation to the outer surroundings is essential to the entire counseling
process. This will form the foundation of a trust in a working relationship, which
attempts to explore and understand the factors that are delimiting the counselees
behaviors, deciding upon a particular treatment program, working on it in a sound
and appropriate manner, and deciding when to terminate a case, and also when to
refer.

Knowledge of how to assist individuals

Counselors must provide assistance to individuals in pain. They must have
appropriate clinical skills in order to do that. It requires a high level of sensitivity
born out of training to find the impediments that block the counselee’s ability to
undergo changes and functions at a more effective or higher level. A large variety of
approaches, methods, and theoretical analysis must be employed by the counselors.
Every individual is unique. The counselors must make tailor-made intervention
strategies to suit this particular counselee.
Students of counseling can undergo supervised training and practice to experiment
with various approaches, and then gradually find their own style of functioning.
Assisting the individual in overcoming her functional limitations and moving
towards personal growth is a time-consuming process. Actually it is a two-step
process: one is to work upon the present maladaptive behavior and to reduce that;
and then to work toward personal growth. Students can try to emulate the behavior
of their supervisor in the beginning and eventually they will find their comfortable
level of working.
Counseling should not only be seen as an analgesic which helps alleviate pain, but
also as a vitamin to enhance growth and prevent pain. Understanding of individuals
not only helps counselors in intervention strategies, but also keeps the focus on
prevention as well as growth.

Willingness to become involved

The counselor must be prepared to commit her time and energy to assist the
counselee. That apart, the counselor’s interaction with the counselee is also important.
One must go beyond a merely giving time and energy. One must demonstrate
 The Counselor and the Counselee 149

a willingness to become involved in this interpersonal process called counseling.

It involves the ability to communicate one’s understanding of the counselee, the
willingness to listen patiently to the counselee, and the total commitment to the
process. Concentrating on the counselee’s internal frame of reference and reaching
out to the counselees needs are all very important in the counseling process. This
approach has many advantages. First of all it gives the counselee an impression that
the process cannot be taken lightly, helps to build a rapport with the counselee, and
then build up the trust in their relationship. It also gives the counselee a sense of
importance and raises the self-worth of the counselee. Furthermore, this motivates
the counselee to engage more actively in the process and finally motivates him or her
to change. Commitment is infectious. And that is what the counselee sees when the
counselor exhibits a deep willingness to become involved in the counselee’s life.

Knowledge of self
Counselors must have a very good knowledge about themselves. They must be
aware of their feelings, thoughts, and behavior, must have understood and processed
their own attitudes, values and motivations for working with others, and must be
constantly in search of personal growth. They must be aware of their strengths and
limitations and must realize that they cannot help everyone. Sometimes they may
not be comfortable with a particular counselee or a particular type of problem.
In such a situation, they need to be confident enough to refer this counselee to
somebody who could be more helpful. This requires a great deal of honesty and
integrity. It also requires a high degree of understanding and appreciation of one’s
own feelings, thought, and behavior.
Counselors who have a good sense of self-esteem, adequacy, and self-discipline
transcend their own limitations and are free to give the necessary attention to
their counselees and focus on ways to assist them. These counselors are warm,
understanding, sincere, and generally interested in the counselee’s health.

Prayerful
The role of spirituality in the healing profession is being increasingly recognized.
Counselors are starting to realize that emotional problems can be alleviated through
spiritual counseling. Counselors can be most effective in helping counselees who suffer
from helplessness and hopelessness related to anxiety and stress by recommending
a prayers to alleviate their fears and concerns. Prayers may not eliminate the
circumstances causing the stress, but will sparkle hope and instantly relax the mind,
and thus bring the symptoms under control. It is with the combination of prayer,
support of the counselor, and the counselee’s own effort that the counselee will have
the best chance of overcoming his or her distress.
150 Counseling: Theory, Skills and Practice

PERSONALITY OF EFFECTIVE COUNSELORS

Numerous studies have demonstrated the significance of the therapeutic relationship

in determining effective counseling (e.g., Martin, Garske, & Davis, 2000). Moreover,
the quality of the relationship is partially determined by the personal qualities of
the counselor, which have been shown to be more important to counselees than
particular techniques or interventions (Lambert & Cattani-Thompson, 1996;
Sperry, Carlson, & Kjos, 2003). Empathy, warmth, and positive regard are also
interrelated with the therapeutic relationship and the counselor’s attributes.
Several studies have attempted to determine the personality characteristics of
counselors, which are basic to effective counseling. Counselors are interested in
helping people. They have a “social service need.” Many researchers have found
that this is necessary for success and satisfaction with a counseling job. Counselors
generally like people and are interested in helping. This attitude makes the counselees
feel comfortable in their presence.
Perceptual sensitivity is also an important characteristic of the counselor. The
counselor should perceive and understand the thoughts and feelings of the counselee
and should be sensitive to the clues given by him or her.
It is important for the counselor to be well-adjusted, not necessarily perfectly
adjusted. Counselors must be able to cope with their problems in a constructive
manner, and not attempt to try and solve the problems of the counselees when they
are themselves facing acute problems.
A feeling of personal security is another very important factor. Internal security
will give the required clarity required to effectively help the counselee, which would
help not only in the counseling process, but in all life situations.
Genuineness is a personality trait that is of utmost importance in any relationship,
including counseling relationship. Counselees can very easily pick up a fake, put on
warmth, which can harm the process. The counselor should establish a genuine
relationship with the counselee, and should be “real” to the counselees.
Counselors are abstract in thought and speech, cooperative in reaching their
goals, and directive and introverted in their interpersonal roles. They focus on
human potentials and think deeply in terms of ethical and human values. They have
an unusually strong desire to contribute to the welfare of others and genuinely enjoy
helping their companions. They find great personal fulfillment in guiding people to
realize their human potential.
Although counselors tend to be private, sensitive people, they make effective
leaders and work quite intensely with those close to them, quietly exerting their
influence behind the scenes with their families, friends, and colleagues. They have
great depth of personality; they are themselves complicated, and can understand and
deal with complex issues and people.
 The Counselor and the Counselee 151

Counselors have an unusually rich inner life. They are not reluctant to express
their feelings of love and appreciation, as well as the difficult ones of hurt and
pain. Thus, they have a strong ability to understand the feelings of others. They
have strong empathic abilities. They can become aware of another’s emotions or
intentions sometimes even before that person is conscious of them. They have this
ablity to feel the hidden distress or illnesses of others to an extent, which is difficult
for others to comprehend. Counselors are able to understand and deal with complex
ethical issues and with deeply troubled individuals.
They find it relatively easy to get in touch with their counselees’ innermost
thoughts and feelings. Their personal warmth, their enthusiasm, their insight,
their devotion, their originality, and their interpretive skills help them a lot in their
profession.
Counselors are both kind and positive in their handling of others; they are great
listeners and seem naturally interested in helping people with their problems. They
understand and use human systems creatively, and are adept at consulting and
cooperating with others. They enjoy pleasing others and they find argument or
debate disagreeable and destructive. They use approval as a means of motivating
others.
Counselors are warm, exceptionally loving parents, deeply concerned about the
comfort, physical health, and emotional well-being of their children. A counselor
mother will naturally try to form a special mental and emotional connection with
her children, sometimes wanting to bond so closely that it can be unhealthy for both
of them. More often, however, counselors are content to be good friends with their
children, wanting to treat them as much as possible as adults, while still keeping a
firm hand on discipline.

SKILLS OF A COUNSELOR

Counseling is a skilful activity, albeit that its skills are grounded in the practitioner’s
personal development. Counseling approaches vary in their conception of skill
development. Some hold to a reductionist emphasis whereby skilful behavior is
subdivided into smaller units of discrete skills. Training exercises are then developed
for each discrete skill with feedback and assessment available to the course member.
Once discreet skills are practiced and developed, they can then be built upon each
other once more to create integrated skilful behavior.
Other approaches hold to a holistic emphasis whereby skilful behavior is recognized
but there is a reluctance to break it into smaller units lest the integrated quality be
lost. The view taken here is that the whole is more than the sum of its parts and
cannot be assembled from those parts. Another presumption within this emphasis
152 Counseling: Theory, Skills and Practice

is that the skilful behavior is inextricably tied to the personal development of the
counselor and to try to separate specific skills would be to encourage incongruence.
“Skills training” proceeds, but in a holistic fashion. Rather than discrete skills being
practiced, the emphasis is on conducting whole interviews or parts of interviews
and monitoring the experience of those involved as well as the development the
counselor is making.
It is probably fair to say that no counseling approach is exclusively reductionist
or holistic in its emphasis. However, approaches vary considerably in their leanings
towards the reductionist or the holistic. For example, Egan’s skilled helper approach
leans heavily toward the reductionist while psychodynamic and person-centered
counseling favor the holistic.
Carl Rogers always maintained a holistic conception of skill development but
his encouragement of research, particularly research of a reductionist character,
inevitably created products, which could be viewed, in a reductionist fashion. Truax
and Carkhuff (1967) and Carkhuff (1969) fruitfully employed a fairly reductionist
perspective to the core conditions and offered much by way of operational definition
of these conditions, though that work has not survived into present day training
methodology, which is more holistic in character.

Broad skills in the counseling process

Releasing empathic sensitivity
Responding in a range of ways that assist the counselee’s focusing
Releasing a widening portfolio of ways of communicating warmth
Releasing congruent responsiveness
Communicating clearly and openly
Addressing difficult issues, even underlying issues, directly
Expressing confusion where that persists
Challenging the counselee in ways that encourage the counselee’s congruent
response
Developing ways of tapping the counselee’s experience of the process and
the relationship
Maintaining empathy across a range of “difficult” counselees
Experiencing a consistent congruent non-judgmental attitude across a
range of counselees
Establishing psychological “contact” with counselees who are “difficult to
reach”
Establishing psychological “contact” with different parts of the counselee’s
self (where such boundaries have already been symbolized by the
counselee)
Relating unself-consciously with the counselee
Achieving “stillness” to meet the counselee
 The Counselor and the Counselee 153

Entering the counselee’s world with willingness, confidence and noninvasive

respect
Comprehending and responding to a range of counselee’s “personal
languages”
Focusing on self to identify personal issues that may be projected into the
counselee material
Remembering important matters of fact about the counselee
Remembering key personality dynamics, conditions of worth, introjections,
discovered denials and other constituents of the counselee’s self-structure
Remembering precisely the words used by the counselee to describe aspects
of his self-structure and elements of his experience
Remembering the changes and development in nomenclature used by the
counselee to denote aspects of his self-structure and experiences
Becoming aware of the degree of externalization or internalization of the
counselee’s locus of evaluation
Developing an ability to stay close to the counselee’s expression where
relevant (for example, in the case of a counselee whose locus of evaluation
is highly externalized)
Counseling is a complex process based on knowledge of psychological aspects of
human growth and human adjustment to a changing society. Effective counseling
requires knowledge of many sources of information about individuals, and a deep
conviction that these individuals do have a capacity for self-understanding and self
direction.
The single most important goal of any counseling skills training course is to
improve the quality of students’ listening. Even experienced counselors have to
monitor the quality of their listening all the time. Listening skills play a crucial role
in building positive relationships with both counselees and their families. Listening
(active listening) is very important in communication and in building healthy
relationships.
This set of skills is not intended as a “bag of tricks” for the counselor.
Memorization of the leads will provide no magic powers for any counselor. There
is no intent to oversimplify the counseling process, for the mere use of the skills or
leads or techniques do not constitute counseling. Counselees soon lose respect for
a counselor whose outward approach to the counseling process seems inconsistent
with his or her attitudes and value orientation. Counseling is not an act, a role to be
played, it is a process based on sincerity, empathy, and a deep appreciation of the
values of both the individual and the process.
The understanding of the basic techniques and relationships to basic facts and
basic assumptions is one of the many ways in which the professional counselor can
improve his or her capacity for constructive service.
154 Counseling: Theory, Skills and Practice

Effective use of the techniques will be determined to a large extent by the

self-concept and self-value of the counselor and by understanding of personality
structure and of psychological growth and development. The counselors would
be wise in selecting the techniques that are consistent with their personality and
training. That will make the counselor more confident and hence more genuine.
Otherwise there will be incongruence and a lack of integrity in the process.
Prominent counseling skills trainers like Gerard Egan advocate the microskills
approach. This approach developed out of the microskills approach to teaching,
where single communication skills units of the process were identified and taught
sequentially as separate units. Illustrative counseling microskills include attending
behavior, open and closed questions, and reflection of feeling.
Training in these microskills involves the following:
1. Warm-up and introduction to the skill
2. Example of the skill in operation
3. Practice
4. Feedback from the supervisor
5. Self-assessment
6. Back into practice

Basic communication skills for counselors

Attending: The counselor’s posture, gestures, facial expression and voice send
out non-verbal messages to the counselee. Gerard Egan, in his book The Skilled
Helper talks about the SOLER attending model.
S– Face your counselees squarely. This says that the counselor is available fully
for the counselee.
O– Adopt an open posture. This says that you are open to your counselees and
non-defensive.
L– Lean toward the counselee at times. This underscores your attentiveness
and lets the counselee know that you’re with them.
E– Maintain good eye contact without staring. This tells your counselee of
your interest in them.
R– Remain relatively relaxed with counselees. This indicates your confidence
in what you are doing and also helps counselees relax.

Listening and responding: Listening is about focusing on the person who

is speaking. An active listener needs to focus full attention on the person who is
speaking. Listening and responding well are skills that require practice. In order to
get the information you need to help a counselee, you must listen attentively. This
technique involves communicating, without words, your interest in the needs the
counselee expresses. You can open up communication by using silence. You can
let the counselee know that you are listening by maintaining eye contact, leaning
 The Counselor and the Counselee 155

forward, occasionally saying words like “yes,” “uh-huh,” and “please continue” —
these are signs of respect and generate a feeling of well-being in the person who
is being heard. There are good listening skills, and there are bad listening skills.
Good listening is active listening. Active listening involves listening to feelings and
facts, the verbal and nonverbal communication of the counselee. It involves certain
microskills, such as the following:
Desire to listen: Want to listen to the information being delivered.
Note taking: Always being prepared to take notes when necessary. That
means having writing tools readily available.
Clarification: Repeating the information you heard by saying, “I hear you
saying ... Is that correct? If the speaker does not agree, repeat the process to
ensure understanding.
Probing: Remain curious and ask questions to determine if you accurately
understand the speaker. Most of the time, ask open-ended questions in
order give the counselee more scope to answer clearly and accurately.
Active-listening questions intend to do the following:
ã Clarify meanings: “I hear you saying you are frustrated with Johnny, is
that right?”
ã Learn about others thoughts, feelings, and wants: “Tell me more about
your ideas for the project.”
ã Encourage elaboration: “What happened next?” or “How did that
make you feel?”
ã Encourage discovery: “What do you feel your options are at this point?”
Gather more facts and details: “What happened before this fight took
place?”
Listening by using the ears to hear the message, the eyes to read body
language (when listening in person), the mind to visualize the person
speaking (when on the telephone), and intuition to determine what the
speaker is actually saying.
Paraphrasing: Repeating in your own words what the counselee is saying,
tentatively; almost like a question. Paraphrasing is a tool you can use to
make sure that you understand the message that you think your counselee
is sending. It is restating the information you just received to make sure
you understand it. For example, your counselee says, “I hate math and
the teacher because she never lets us do anything cool!” You might say,
“It sounds like you’re having a hard time with math and that makes you
feel frustrated and bored.” This technique helps counselors and counselees
communicate in several ways.
ã First, it helps counselors make sure they understood the message
correctly.
156 Counseling: Theory, Skills and Practice

ã Second, by restating or paraphrasing, counselors draw further

information from their counselee.
ã Third, paraphrasing allows the counselee to know that the counselor
has heard them and is interested in what he or she has to say.
ã Fourth, it allows the counselee an opportunity to correct any
misunderstanding immediately.
Being silent: Silence is the technique by which the counselor encourages the
counselee to comment by remaining completely silent and waiting for the
counselee to go on.
Acceptance or non-judgmental listening: This is the non-directive technique
through which you try to indicate that you are interested in what the
counselee is saying. It is important not to interrupt the continuity of
thought of the counselee.
Simple reflection: It is the technique of acting as a mirror for verbal expression.
In this technique, the counselor restates the last words of the counselee.
Showing the counselee how s/he sounds encourages the counselee to clarify
and expand on her remarks.
Reflection of feeling: In this technique, the counselor tries to express verbally
the attitudes of the counselee. This is an extremely important lead used to
bring feelings to the surface and to get more verbalization by the counselee.
It serves to bring problems into focus without the counselee feeling that he
or she is being probed or pushed by the counselor. Reflective listening can
be a powerful tool of communication. In reflective listening, you simply
reflect to the counselee what you think you heard, making sign to reflect
their feelings.
Thinking and mentally summarizing: Weighing the evidence, listening
between the lines to tones of voice and evidence.
Paraphrasing, summarizing, and clarifying: This technique involves
repeating, synthesizing, or summarizing in other words what the counselee
has told you. This helps the provider clarify what the counselee is saying,
and helps the counselee to feel that he or she has been heard.
Reflecting and validating feelings: This technique involves clarifying the feelings
the counselee expresses in order to help understand his or her emotions. It
is helpful to counselees to let them know that their reactions to a situation
are normal, and that those feelings are common to other people in similar
situations. You can communicate that the feelings are valid.
Giving clear information: Before you give any information, it is helpful
to ask questions to determine how much the counselee already knows. It
is important to provide information using words that the counselee can
understand. Ask counselees to repeat the information you have given them
to verify that they understood.
 The Counselor and the Counselee 157

Arriving at agreement: This technique involves clarifying and summarizing

the decisions that a counselee has made during the counseling session.
Power of reflective listening: The power of reflective listening lies in three
distinct forces:
1. As the counselor processes what the counselee is saying through the
counselor’s own experience and reflects it to the counselee in the
counselor’s own words, it lets the counselee know that the counselor
has not only heard the counselee but has understood what has been
said.
2. The counselor is telling the counselee what he or she is saying in
an accurate way, it is clear the counselor has been listening and not
distorting what the counselee has told the counselor.
3. As the counselor reflects to the counselee what the counselor’s
understanding is, the counselee has an opportunity to hear him or
herself in a new way.
Establish rapport by following the counselee.
ã Match the momentum, tone of voice, body language, and words used
by the speaker.
ã Please use common sense when matching. If the speaker is yelling,
don’t do the same because it will make a bad situation worse.

Poor listening skills: A poor listener—

May be abrupt and/or give one-word answers such as no, yes, and maybe.
Will be easily distracted looking around the room as opposed to focusing
on the speaker’s face.
Constantly interrupts, making the speaker feel that what he or she has to
say is not important.
Finishes the counselee’s sentences, implying that the listener already knows
what the speaker is about to say.
Changes the subject without even realizing it.
Looks at the watch, signaling that the counselee is wasting time.

Results from active listening: Active listening takes time and practice and does
not produce results overnight. Usually, each time the counselor and the counselee talk,
the conversation will get easier and will include more active listening, not just from the
counselor but from the counselee too. The counselor has to lead the way.

Empathy
“Empathy is the counselor’s ability to sense the counselee’s world the way the counselee
does and to convey that understanding.”
—Frank A. Nugent
158 Counseling: Theory, Skills and Practice

“Empathy is the skill of reflecting back to another person the emotions he or she is
expressing so that he or she feels heard and understood.”
— Opendoors.com
“Empathy involves listening to counselees, understanding them and communicating this
understanding to them so that they might understand themselves more fully ad act on
their understanding.”
—Eagan (1994)

The word was first used in English in the early twentieth century to translate the
German psychoanalytic term Einfühlung, meaning “to feel as one with”, though in
practice more closely translating the German Mitgefühl, “to feel with” someone.
The word “empathy” is actually a poor and misleading translation of the German
word “einfuhlung.” The correct translation would be “in feeling” or “feeling into
something” according to Judy Harrow (1996):
It is easy to know when you are being empathic because
your body language and tone match
your tone and your feelings match
you are focused on what your counselee is saying and meaning
You are trying to see things from your counselee’s point of view, which requires
that you do the following:
you do not impose your feelings, thoughts, and ideas any time throughout
the conversation.
you refrain from immediately giving advice.
you are tired after listening because it takes a great deal of energy.
you ask yourself if you would make that same statement to an adult. If not
then think twice about making it.
Decisions are processed logically, but made emotionally. Counselors help
counselees make decisions. And decision-making involves emotions. Empathy is
not a trait, but a skill. It is not something that the counselor is or has, but does. It is
the active process of feeling into the inner world of another.
The first step to empathy is listening openly, without judgment or expectation. This
brings out the objectivity in the counselor. An effective counselor not only conveys
accurate empathy, but also recognizes whether the empathic responses will indeed
be experienced with equal accuracy by the counselee. Research has demonstrated
that empathy increases when counselors modify their empathic response style to fit
the counselee’s definition of helpful, empathic responses (Lambert & Barley, 2001);
the ability to do so corresponds to counselor sensitivity to individual and cultural
differences, which is also a determinant of a quality therapeutic relationship and
effective counseling (Sperry et al., 2003).
 The Counselor and the Counselee 159

Effective understanding, communication, and relationships emerge from

empathy and trust. Part of the “empathy process” is establishing trust and rapport.
Establishing trust is about listening and understanding—not necessarily agreeing
(which is different)—to the other person. It is important to know that the counselee
is not the counselor. So it cannot be a state of total identification with another’s
situation, condition, and thoughts. The counselee comes with his or her own
formative experience which can be very different from the counselors’. The action
of understanding, being aware of, being sensitive to and appreciation of another
person’s problems and feelings needs to be restricted to the cognitive level without
experiencing the same emotional reaction. This is where it is distinguishable from
sympathy, which is usually nonobjective and non-critical. Sympathy is feeling with
the person whereas empathy is feeling for the person.
Carl Rogers emphasized that integral to the counseling process is a special kind
of relationship, focused on the counselee’s feelings and needs, while the counselor
offers consistent empathy, warmth, and respect. Given these “core conditions,”
people seem able to explore their issues, not just the easy ones but those that go
deep, perhaps hurt bad, and potentially release real change.
Commitment and sincerity to the process of counseling cannot be faked or forced.
No one can fake empathy, warmth, or respect which are the essential conditions of
the counseling relationship. Genuineness is one of the most requisite attitudes which
needs to be nurtured and developed over time by the counselors. So it is best to be
honest about one’s limits and only attempt to enter into counseling relationships
where genuine empathy, warmth, and respect are really possible. Where theory and
practice can meet together and agree there is congruence Judy Harrow.

Empathy involves two major skills: Perceiving and

communicating

Carl Rogers on empathy: “The therapist is sensing the feelings and personal
meanings which the counselee is experiencing in each moment, when he can
perceive these from the inside, as they seem to the counselee, and when he can
communicate that understanding to his counselee, and then the third condition has
been fulfilled.”
The counselor needs to ask himself or herself some of the following questions:
Will it be possible for me to step into the counselee’s world so completely
that I lose all desire to evaluate and judge it?
Can I allow myself to enter the counselee’s world and see his or her personal
meanings and feelings as he does?
Can I be sensitive enough to move freely in the counselee’s world without
trampling on meanings that are precious to him?
Can I extend this understanding without limit?
160 Counseling: Theory, Skills and Practice

Can I sense it so accurately that I can catch both the obvious meanings as
well as those which are implicit and expressed as confusion?

Empathic listening techniques

Encouragers
These are “continuers”. They communicate listening, the willingness to listen
and the desire to understand more about the counselee’s experience.”
They can be verbal (giving permission, requesting additional information,
and providing direction), nonverbal (include nodding of head, leaning
forward, making sounds like “umm, ahh,” etc., and facial expressions like
smiles and grimaces) or a mixture.

Reflections
Reflective listening is a powerful tool of communication. When the counselor simply
reflects to the counselee what he or she thinks they have heard in terms of content
and feeling, it helps the client hear himself in a new way, it lets him know that the
counselor has not only heard but has also understood what has been said, and also
lets the counselor clarify whether he has his facts right.

Empathic comments
Through the empathic comment the counselor sends the message to the
counselee that the latter has been heard and understood.
Rogers (1995) wrote: “To be with another in this way (empathetic) means
that for the time being you lay aside the views and values you hold for
yourself in order to enter another’s world without prejudice. In some ways
it means you lay aside your self.’
Empathic comments include using encouragers and reflective listening,
parroting or repeating word for word what the counselee said, summarize
with reflective statements, etc.

Barriers to empathic listening

Any ongoing personal issues or preoccupations that tend to distract the
counselor
Cultural differences
Gender
Counter transference and therefore role confusion
The counselor’s inner-world (inscape)
The counselor’s preconceived ideas and beliefs
Discomfort in the presence of the counselee’s strong emotions––grief,
anger or pain
 The Counselor and the Counselee 161

VALUES IN COUNSELING

Counseling is not a value-free human endeavor. All counseling is intimately involved

with cultural, moral, and ethical values related to the three major spheres of life:
the educational/vocational dimension, the marital and family dimension, and the
social/cultural dimension. Both counselors and counselees bring to the counseling
relationship deeply cherished values concerning education, work, marriage and family
issues, and the individual’s obligations and responsibilities to those in his or her
immediate environment as well as those incumbent upon him or her as a citizen.
Generally speaking, value issues become critical in the counseling process when
one of the following situations occurs.
The values of the counselee and the counselor are different.
The values of the counselee are causing some difficulty in his or her environ-
ment.
The only value that may appear overtly in a counseling session is the dignity and
respect that both participants reveal in their treatment of one another. However,
other values are usually implicit in the relationship and are not obvious, principally
because both the counselee and the counselor are working under the same value
system and do not need to discuss them.

Awareness of his/her own cultural values and biases

The earlier segment told us how it is important for the counselor to be aware of
his or her self, feelings, and thinking patterns. This awareness is a vital element in
learning to work with culturally different students whose backgrounds differ from
that of the counselor. It is important for counselors to be aware of their own socio-
cultural backgrounds, assumptions, biases, values, and perspectives with regard to
culturally different students. Only then will the counselor be able to work effectively
with them. Issues such as racism, sexism, casteism, economic and social classes, and
other realities have to be understood in depth if they want to understand diversity
and the experiences of counselees from diverse backgrounds.
Critical self-examination may sometimes be threatening to the counselors
because it involves their beliefs, biases, and feelings related to cultural differences.
As counselors are products of their own culture. they are conditioned by it and
operate from that worldview. They should recognize the impact of their beliefs on
their ability to respect others different from themselves.
It then becomes very important for counselors to look into their inscape and
explore their own values, beliefs, and assumptions about culturally different
individuals, their behaviors, and lifestyles. Counselors need to learn to respect the
cultural differences of their counselees. If not there is more likelihood of counselors
imposing their values and standards on culturally different counselees. Skilled
162 Counseling: Theory, Skills and Practice

counselors are sensitive and actively engaged in avoiding discrimination, prejudices,

and stereotyping.
Counseling in an educational institution may bring the counselor face-to-face
with his or her own value biases. If this is not identified and taken care of in the
initial stages, she may find that the chances for successful interactions are majorly
compromised. If she needs to help in broadbasing the use of counseling services by
the students in various educational institutions, she will have to pay serious attention
to her own values and belief systems.
When one begins to understand the world, one will start with the history,
experiences, values, and lifestyles of culturally different counselees. An awareness
of the counselees’ historical and cultural background should be understood in
the current social context relating to perceived racial, gender, cultural, and other
differences. It is crucial that the counselor relates first to the interpretations of
experiences that the student provides in terms of the counselees’ background, the
frame of reference, and norms of social behavior (Chandras, 1997).
The counselee needs to experience a sense of freedom in order to express and
then explore his or her feelings and other sensitive issues surrounding a problem.
For effective counseling, a suitable psychological climate should be established
where both the counselor and the counselee are able to appropriately and accurately
send and receive both verbal and non verbal messages (Chandras, 1997; Sue & Sue,
2003) , it is then that the culturally different counselee will experience the freedom
that is necessary to initiate a productive counseling relationship. Only through
accurate empathic understanding of the counselees’ world can the counselor create
a positive psychological climate.
Difficulty communicating with others due to a language barrier, style of dress,
skin color, and physical appearance, all are factors which contribute to the counselee’s
stress and inability to involve him or herself in the counseling process. The counselor
needs to be sensitive to that; and if necessary, refer the counselee to someone who
can provide the necessary help.
Special attention should be given in order to develop a constructive and empathic
relationship when dealing with culturally different counselees. This means not only
fostering the relevant necessary attitudes and behaviors, but also avoiding those that
will foster a negative or destructive relationship with the counselee. A counselor who
continually shows behaviors that are judgmental, non-empathic, defensive, sexist, or
argumentative is not fostering a positive trusting relationship. The counselor should
avoid these characteristics and behaviors and exhibit other qualities that will foster a
positive relationship with students.
Building a positive trusting relationship with culturally different counselees
require the counselor to have certain characteristics:
Empathy
 The Counselor and the Counselee 163

Openness
Pragmatism
High internal reality
Good emotional health
Awareness of and keeping abreast of current world issues
Nonjudgmental nature
Warmth
Acceptance
Competence
When dealing with a such a counselee, a counselor will do well do follow the
rules of interaction so as to not frighten away the counselee or make him or her feel
uncomfortable in the situation (Chandras, 2000):
1. The counselor must only ask the most relevant question. This will not
threaten the counselee. Too many personal questions asked initially will
deter the counselee from feeling free to self-disclose.
2. The counselor’s preparation of the counselee is of utmost importance in the
Indian situation. As the field of counseling is not very well established, the
counselees may come to the counselor for “prescription.” If the counselor
is from a different cultural or religious background the counselee may be
frightened. Therefore, she must be readied for the process. The counselor
should explain the stages of counseling, what happens during counseling,
and the need for verbal disclosure.
3. The counselor should focus on the specific problem brought in by the
counselee and help develop his or her own goals for counseling. These goals
should reflect the counselor’s understanding of the counselee’s culture
and value system. Any goal that requires one to abandon their cultural
background could be perceived as a very threatening event. If the goal
is to be pursued at all, the counselor must tread very carefully, and help
the counselee process her feelings and thoughts regarding the goal with
sensitivity. For example, it would be very difficult for an abused woman in
the Indian setting, and that too from lower socioeconomic strata to leave
her husband who abuses her.
4. In India, the counselor should play an active or direct role because most
culturally different counselees have an external locus of control. Due to
historical and cultural reasons, compliance is valued more than cooperation.
Most people are trained to obey the rules rather than understand them.
Thus, when a counselee seeks help, it is likely that she seeks more of advice
and direction rather than help in independently processing her feelings and
situation.
164 Counseling: Theory, Skills and Practice

5. The counselor should fully analyze the environmental concerns of the

counselee. Any process that goes against her views of the world will be
resisted. And the entire counseling process will be nullified. The counselor
should go with the flow of the counselee and then seek to help make
changes. The counselee my perceive drastic changes as very threatening and
see them as impossible. This will result in the counselee losing confidence
in the process or even in the counselor herself.

Cultural issues in India that counselors need to be aware of

In India we are passing through an unenviable phase of transition. There is a
tendency to cling to past values and simultaneously crave for things, which are not
consonant with the past values. This has resulted in an identity crisis, particularly
in the youth. The changes in our social systems, the forceful advent of the western
media in our lives, and the world getting reduced to a global village is making the
people very anxious, especially today’s youth. They are torn between the values they
are presented with in society and the values that they have been taught to uphold
by their parents. This has resulted in uncertainty as to what values to hold and what
to follow. Parents are their wit’s end. They are confused as to how to help their
children; they are finding it more and more difficult to compete with the outside
forces in influencing their children. This creates the parent–child gap that is tearing
several families apart.
Another issue that is causing a rift in family relationships is the breakdown of the
joint family system, known traditionally to provide social and economic security to
its individual members. The unit families are confronted with problems that they
had not bargained for. This has meant for many people an increase in anxiety and
stress resulting from uncertainty and isolation. The wisdom of the elders is no longer
counted as one of our assets. It is a very sad situation. Thus, those problems that can
be easily resolved by the intervention of our family elders now seek resolution in the
courts or counselor’s offices.
Social change has affected not only family life but also several other things, for
example, the status of women. This issue involves a change in several other types
of relationships as well. These include parent–child and husband–wife relations.
Many families today are characterized by a lack of understanding even when there
is no open conflict between the generations. Sexual relation is another area which
is not easy for the counselor to advise those families in which the parents have one
set of standards and the children another. An interesting phenomenon increasingly
becoming apparent is “ascending education” in which the young become teachers of
the old. It is not uncommon to hear from the young that adults do not know about
new things and that they have to learn from them.
One aspect that is becoming increasingly important is our concern and anxiety
for modernization. We are engaged in a drastic movement from traditional to the
 The Counselor and the Counselee 165

modern form of living, and by “modern” we tacitly mean westernized technological

modes of living. Many aspects of this movement are of considerable concern to
the counselor. What are the effects of this thrust? Is it true that the effects of rapid
industrialization are the disruption of interpersonal relations, an increase in crime,
alienation of the youth, disrespect for elders, sharp increase in delinquent behavior
and other maladjustments? How should the counselor deal with this situation?
With advances in the field of medicine, environmental hygiene and better
nutrition, man’s longevity has increased. Again, the breakdown of the joint family
system has a great impact on the role and status of these older people in society.
Retirement from positions of authority and prestige can be a very devastating
experience. How can the “retirement-shock” be assuaged? The counselor’s role
should be to assist the “senior citizens” to make optimum adjustment.
The tremendous technological progress has created problems for youth seeking
employment as well as for the older people in employment. While the youth pass
out from their education that has the latest technological advances incorporated
into their curriculum, the older people have no idea of it. For example, the use of
computers. They feel lost when asked to use a computer in their work. The youth
on the other hand prove themselves very useful. But we cannot do away with the
experience and wisdom of the older people. The management has a tough job when
their offices are modernized with computers. They have to provide training for the
people working there, which is expensive and time-consuming. The counselor will,
therefore, have to play the role of a cultural mediator and help individuals adjust
themselves to the new conditions of living.
The next issue concerns decision-making. In the western culture, autonomy
and independence and the ability to stand on one’s own feet and make one’s own
decisions are stressed upon. Even if the student decides to take a year off his or her
studies, the individual makes it on his own. But in oriental cultures in general, and
India in particular, decision-making is to a certain extent culturally determined.
A young man or a woman is expected to consult the adult members of the family
in matters, such as choosing a course of study, entering a specific occupation or
choosing a life partner. The counselor should remember to include the parents
and/or other significant members of the family when the counselee has to make a
decision.
The counselor has to be mature enough to strike an appropriate balance and
help the youth to have sound values. The counselor could have problems with his
counselees who may be struggling with the new values and trying to cling to the
past values. This may lead to a clash between loyalty to old values and the desire to
pursue new values. The counselee’s value structures are thus of a crucial nature and
the counselor has to work in terms of his own value structure, which may not be
similar to that of the counselees.
166 Counseling: Theory, Skills and Practice

As has been mentioned earlier, the attitude toward women has undergone a
considerable change. They are no longer confined to their homes but are taking
up careers, which earlier were exclusive only to men. The counselor, therefore,
should not look askance at a female counselee who does not propose to enter into
matrimony or one who proposes to enter such fields as mountaineering, forestry,
and the like. The counselor would do well to present the facts in full and not try to
influence the counselee.
The Indian attitude toward sex has been that it is looked upon as something
intimate, precious, and sacred. It is not identified with the fulfillment of carnal
desire. Premarital sex is considered a sin. Women are not expected to freely mix with
men and they are expected to maintain a certain distance. Questions, such as what
should be done about premarital sex, sex outside marriage, bigamous relations, etc.,
loom large. The bias in the favor of males in this regard is still upheld in most Indian
societies. The man is virile but a woman is promiscuous. Though one should admit,
this attitude is fast disappearing in urban, educated societies. Different standards for
men and women create avoidable confusion, conflict, and also crisis.
The counselor must of necessity widen his field of work to include the new
problems, which are surfacing as a result of rapid change. If the counselor, is
understood to be a culture interpreter, culture mediator, and an agent for culture
change, he must of necessity move into a wider area (of human life) and make it the
canvas for his work.
When the counselee and the counselor have different values regarding an issue
that is relevant to the counseling relationship, the counselor needs to remain aware
of these differences and respect the counselee’s right to his or her own values about a
particular issue. India is a pluralistic society, and counselors must work within that
system.
Because the goal of any counseling relationship is to help the counselee resolve his
or her own problem, you should, if at all possible, try to work within the counselee’s
frame of reference and value system to find a solution. However, sometimes you
may find that it is impossible to do this. When this occurs, the conflict should be
discussed openly with the counselee, and if further counseling proves impossible, a
referral to another counselor is mandated.
When the counselor’s value system is causing the counselee difficulty, the counsel-
ing is clearly value dominated. Again the counselor must remember that the overall
goal of the process is to help the counselee help himself or herself. Therefore, you
need to help the counselee discuss his or her values in the counselee’s own environ-
ment, and help the counselee resolve the difficulty or cope with the situation in a
more effective way.
 The Counselor and the Counselee 167

ETHICAL CONSIDERATIONS FOR A COUNSELOR

It is important for students of counseling to familiarize themselves with problems

concerning ethical behavior, which invariably accompanies the development
of a profession. Since the counseling relationship is a highly personal one, there
is a danger of its abuse. Although few counselors would deliberately misuse the
counselor–counselee relationship, we cannot be complacent and content. A
profession is greater and wider than most of its members, either taken individually
or collectively. It is, therefore, essential that professional rules or ethics be laid out
or spelled out in no ambiguous terms. This will create public trust and confidence
in the profession.
The American Psychological Association has drawn up quite an exhaustive list
of rules and regulations to be followed by practitioners and academicians alike.
They have attempted to set down the ethical and legal standards for psychologists,
violation of which will hold them legally accountable.
It is known that India does not have any governing authority for psychologists.
This has been mentioned in more than one section in this book. Psychologists in
India neither have a body to who we are accountable, nor do they have a grievance
forum to whom they can address their grievances. There are many small counseling
organizations that are attempting to gather counselors together from various fields,
holding seminars and workshops to improve their knowledge in the field, and
providing a platform for them to meet one another, and discuss professional issues.
Schwebel (1955) explains unethical practice as arising from (1) ignorance, (2)
inadequate training, and (3) self-interest. Though a counselor may fail owing to
ignorance or lack of proper training it is termed unethical only if he or she acts out
of self-interest.
Ethics is a difficult concept to define, however it must be done in order to provide,
to the maximum extent possible, some concrete guidelines for the members of the
profession to follow in their everyday professional activities. It must be noted that
these guideline are professional and not personal guidelines. This issue of ethics is
of utmost importance in any profession. They provide the bridge of confidence and
trust between the counselor and the counselee.
For example, the Medical Council, the Bar Council, and other such bodies have
spelled out rules of conduct for their members. Likewise, in the field of counseling,
the American Counseling Association has published a code of ethics to which the
members are required to conform. This code can be accessed at www.counseling.
org/files/fd.ashx?guid=ab7c1272-71c4-46cf-848c, it can be downloaded as a PDF
file.
The code frames guidelines for the entrant into the professional field and he cannot
claim ignorance as a legitimate defense for his perversion or noncompliance. The
168 Counseling: Theory, Skills and Practice

codes of conduct formulated by professional bodies can only be recommendatory

and not mandatory. For strict enforcement of the code of ethics, they should
have legal binding, that is, they should be made statutory either by an Act of the
Parliament or by an Act of the State Legislature. The former is preferable to secure
uniformity throughout the country (the US).
The code clearly outlines the mission and purpose of the code of ethics. The
contents are:
Section A – The Counseling Relationship
Section B – Confidentiality, Privileged; Communication, and Privacy
Section C – Professional Responsibility
Section D – Relationships With Other Professionals
Section E – Evaluation, Assessment, and Interpretation
Section F – Supervision, Training, and Teaching
Section G – Research and Publication
Section H – Resolving Ethical Issues
A code of ethics, however exhaustive, is not enough. There is a need for arousing
the ethical sense in the professional practitioner. It should become a part of his or
her professional self-concept. In fact there are so many dilemmas and delicate issues,
which may come up in everyday practice, for which the code of ethics may not have
answers. It is not possible to foresee, or even spot all the problem situations in the
field of counseling.
As in any profession, the counselor has a primary responsibility to his counselee.
This may sometimes clash with the interest of the institution, which employs the
counselee or clash with the interests of the counselee’s family or those of another
individual. Yet the counselor’s responsibility cannot be compromised. His or her
responsibility is to the counselee. The second is the counselor’s responsibility to the
society, in as much as all citizens are responsible to the society to which they belong
and in a wider sense to humanity as a whole.
The counselor has a responsibility to the profession. He or she should work for
the progress of the profession and strive at all times and in all situations to further
its interests. Next, the counselor has a responsibility to self, as an individual, as a
member of his or her family and as a member of this community.
Usually, the several responsibilities and most of the life situations are compatible
with one another. Occasionally there may arise situations in which the counselor is
confronted with dilemmas and conflicting situations. In such situations, the ethical
codes may not be of much value to the counselor, who has to fall back upon his
or her “own sense of values” or value system, self-concept, and sense of self-regard.
This would help in arriving at and relying on his or her judgment.
 The Counselor and the Counselee 169

THE COUNSELEE

THE COUNSELEE CHARACTERISTICS AND VARIABLES

The importance of counselee variables cannot be overemphasized in any discussion

on counseling. Counselee variables have both a direct as well as indirect impact on
the process and outcome of the intervention efforts. They are highly relevant to the
various intervention models that stress the importance of matching therapy with
relevant characteristics of the counselee. Based on extensive reviews of counseling
outcome research, Lambert (1992) concluded that the counselor’s techniques
account for only 15 percent of the total therapeutic outcome. Another 15 percent
is attributable to expectancy and placebo effects, which relate to counselees’ belief
that their counseling will result in desired changes. The therapeutic relationship,
interpersonal variables of the counselor, and core conditions of empathy, warmth,
and positive regard account for 30 percent of a positive counseling outcome. The
greatest proportion, 40 percent, is estimated to be due to counselee variables.
A large portion of a positive counseling outcome is determined by the counselee
(Lambert, 1992: Lambert & Barley, 2001; Lambert & Cattani-Thompson, 1996).
The counselee’s level of pathology, motivation for change, expectations from
treatment, coping skills, personal history, and other external resources all influence
how effective the counseling experience will be (Lambert, 1992; Lambert & Cattani-
Thompson, 1996). Counselees clearly benefit by actively participating in the
counseling process. The more collaborative, motivated, and engaged counselees are,
the more they tend to be involved, which results in effective counseling (Sperry et al.,
2003). Variables relating to the counselee contribute to outcome much more than the
counselor (Lambert, 1992). Counselee characteristics, such as help-seeking attitudes
and attachment style have been found to be related to counselee’s use of counseling,
as well as expectations and outcome. Stigma against mental illness can keep people
from acknowledging problems and seeking help. Public stigma has been found to
be related to self-stigma, attitudes towards counseling, and willingness to seek help
(Vogel, D. L., Wade, N. G., & Hackler, A. H., 2007). In terms of attachment style,
counselees with avoidance styles have been perceived to face greater risks and fewer
benefits, and are less likely to seek professional help, compared to counselees who
are more secure. Those with anxious attachment styles are perceived to face greater
benefits as well as risks to counseling. Educating counselees about expectations from
counseling can improve counselee satisfaction, treatment duration and outcomes,
and is an efficient and cost-effective intervention.
170 Counseling: Theory, Skills and Practice

The counselee characteristics that strongly influence counseling and the

intervention approach include the following:
The kind of problem or nature of pathology
The scope of the problem
The historical and idiosyncratic pattern employed to solve problems and
resolve issues
Demographic characteristics such as socioeconomic status race, gender, and
developmental level. Meta-analyses have identified that gender is a potential
moderating factor in the therapy–outcome link, with some support for the
hypothesis that girls respond better to counseling than boys
Personality characteristics
Intelligence
Reading ability
Cognitive style
Temperament
Level of motivation
Counselee’s degree of functioning
Strengths and resources of the counselee
Reluctance and resistance
Values and beliefs of the counselee
Cultural background and experiences

CHARACTERISTICS OF A SUCCESSFUL COUNSELEE

Openness to new experiences, willing to do something new or different

Responsive, willing to listen to other people, to accept negative as well as
positive feedback, to take instructions, and to do what is expected
Assertive, willing to ask for help, clarification, or additional instruction or
guidance
Communicates expectations clearly
Understands the process of counseling and allows a reasonable amount of
time for progress
Goal-oriented, focused on producing results or changes
Enthusiastic, eager to learn
Attending sessions regularly and being on time
Working diligently on all the homework that they might be required to
do
Knowing that they are responsible for their own success
 The Counselor and the Counselee 171

COUNSELEE EXPECTATIONS

Both theoreticians and practicing counselors have long been in agreement that
counselees bring expectations and beliefs to counseling situations. It is believed that
these expectations can influence both the counseling process and its outcome.
Counselees’ expectations affect many aspects of counseling, including the length
of their stay in counseling, their satisfaction with the counseling, and how much and
how rapidly they improve. Counselee expectations need to be recognized and taken
into account in order to enhance the efficacy of counseling. Despite the significance
of these expectations, the bases of counselees’ expectations have rarely been studied.
Expectations might be mediated by counselees’ specific types of disorders, such as
depression, or by specific constructs related to disorders, such as hopelessness or
negative self-view (Goldfarb, 2002).
The counselees’ trust in the counselor and the counseling process is established
and later enhanced by the counselor’s attitudes and behaviors (genuineness and
acceptance), or the counselor’s ability to help people in general (expertise). Many
potential counselees never seek counseling because of their low expectation of
being helped. Considerable research has been done on the relationship between
the counselee’s expectation of gain and the counseling outcome. The expectation
of gain is a powerful determinant of counseling effectiveness. These expectations
may be important determinants of where the person turns for help (Snyder, Hill, &
Derksen, 1972; Ziemelis, 1974), whether the person discontinues counseling after
the initial interview (Heilbrun, 1970, 1972), and the effectiveness of counseling
(Frank, 1968; Goldstein, 1962).
It has been found that the counselees’ strongest expectation is to see an experienced,
genuine, expert, and acceptable counselor they could trust. It is widely believed that
persons enter counseling with expectations about what it will be like (Bordin, 1955;
Frank, 1968; Goldstein, Heller, & Sechrest, 1966). The counselee’s experience of
feeling empathically understood has been shown to be a primary component of
effective counseling and the best predictor of a successful outcome (Lambert &
Barley, 2001; Lafferty, Beutler, and Crago, 1989).
The counselor is expected to be warmly interested in each counselee, to be
highly trained and experienced, and to be confident of his or her ability to help the
counselee. The counselor is expected to be problem-centered on a personal level,
thoroughly prepared for each interview, to be at ease with the counselee and his or
her individual problem, and to maintain confidentiality.
172 Counseling: Theory, Skills and Practice

COUNSELEE PERCEPTIONS

Counselees enter into counseling with an idea of “what counseling will be like.”
They form an “ideal picture” of the method they want and will respond (Hoch,
1955). Thus, the helping process and its outcome are influenced by counselee’s
perceptions. All counselors at some point or other in their career have come into
contact with counselees who are negatively biased toward the process and hence have
made no progress, causing immense frustration. There are other instances where the
counselee had come in with very low expectations and a negative attitude, but had
started actively participating in the process owing to the skill and knowledge of the
counselor.
This is perhaps the first lesson that a student of counseling has to learn. Not all
counselees come in with a resolve to change or even accept the process. They may
be here due to pressure from others, or as a last resort, or even to prove to others
that this is not a good idea. Such counselees have to be dealt with very carefully.
These counselees can be very demanding as well as extremely frustrating for the
new counselor. It is important to know how much leeway to give before one starts
to confront the counselee regarding his/her attitude and the damage it is doing to
the process. Also, it is vital to know that though the counselor can help in changing
the attitude of the counselee, there may be times when it cannot be done. At these
times, the counselor will do good to not doubt her skills and training. A 100 percent
success rate is not only unrealistic, but actually impossible.
Losing patients is a very traumatic experience for a new counselor. Self-doubt
immediately emerges causing anxiety, guilt and even depression. If the counselor is
satisfied that she/he has done his or her best in the situation, and honestly tried to
work with the counselee, then she/he must learn to let it go.
The counselees’ perceptions of type of problems that require counseling becomes
all important when seeking out counselors. Bachelor (1988) underscored the central
importance of counselee perceptions of what therapists think they are offering. His
study indicates significant variation between counselees in terms of what is perceived
as meaningful therapist empathy. Around 44 percent of counselees specifically
valued a cognitive type of empathic response, whereby the therapist indicates an
understanding of the counselee’s subjective state or motivation. About 30 percent
valued an affective-style response, whereby the therapist indicates that they are
themselves participating in the same feeling the counselee is expressing. Finally,
about one quarter took empathy to be either a sharing of personal information
via relevant self-disclosure or the offering of a particularly nurturing or supportive
response. The bottom line is that there is no single form of empathy and what is an
effective style of empathic response for one counselee may not be empathy at all for
another counselee.
 The Counselor and the Counselee 173

Some things that the Counselor can Encourage the

Counselee to think, Expect and/or Do
It is important that the counselor encourages the counselee to do the following:
Talk about their expectations and needs. Just like any other relationship,
the more one knows and can communicate what they want and need,
the better chance they will have of receiving it and speeding the process.
The counselor does not have a crystal ball, neither can she/he mind read.
Thus, they will not know the counselees needs or thoughts without them
communicating it. If people feel more comfortable with writing than
actually saying aloud they can do so. It is likely that the counselee is entering
therapy for the first time and has no idea of what will happen, other than
the expectation of feeling better than they currently do. This expressing
of feelings, thoughts, hopes and fears the start to can very helpful to the
counseling environment if progress is to be made.
Good therapy is not something done to or for the counselee; it is a
living process within which both the counselor and counselee play active
parts. Counseling works best when it is an honest two-way process of
communication, and both have an equal responsibility.
The counselee can also be told that it takes time to establish a trusting
relationship, so expect it to take a few sessions before she/he feels
comfortable.
The counselee can be reminded that it is important that she/he goes at their
own pace and not be pressurized to overwhelm themselves. It cannot be
stressed enough to not try to rush things for a quick fix.
The process of counseling is a journey towards change. Everyone resists
change, and the counselee can be warned not to be l surprised if she/he is
tempted to quit therapy just before some real changes or breakthroughs are
about to happen.
Therapy is very often hard work, and can be emotionally draining at
times. Sometimes, therapy can release emotions and memories that have
been “locked in time” for many years. After an intense therapy session the
counselee can be told to expect to feel exhausted and emotionally drained
for a while.
If during therapy you feel that you are unable to get on with your therapist,
it is first worth considering that the reason you may feel the way you do
might have something to do with the way you relate to others; and the
very issues you need to resolve. The therapeutic relationship can often
be a reflection of outside relationships, and the difficulties you similarly
experience in therapy, are then important opportunities that can lead to
insight and resolution. It may also be that you are becoming afraid of the
174 Counseling: Theory, Skills and Practice

change that is happening. It is wise to talk to your therapist about all these
normal feelings; the way your therapist reacts can be very informative.
Ultimately however, therapy is your responsibility, and if you really are
unhappy with your therapist or the style you must consider looking for
something new.

v Summary v
This chapter has dealt with the essential characteristics of the professional
counselor proceeding from the knowledge that the characteristics of the
ideal counselor must match the roles, responsibilities, and identity of the
counseling profession. The chapter elucidates the characteristics of the
professional counselor, with specific reference to communication skills,
empathy, cognitive abilities, professional knowledge base, values, ethics,
and a social-cultural understanding.
Counseling involves working with a variety of individuals and their
everyday problems in individual, family, or group settings. Counseling
psychologists typically work helping clients with a variety of problems,
which are not usually severe disturbances. Counseling psychologists would
assist their clients in the healing process.
Characteristics of the professional counselor include the belief that clients
are unique individuals of significant value, the belief that clients are capable
of change, the knowledge and skills necessary to help individuals overcome
functional limitations, the willingness to become involved in this interpersonal
process, the willingness to become involved in this interpersonal process
and The knowledge of oneself and one’s own skills and limitations.
Personal characteristics of the counselor are as important to the counseling
process as their professional ones. They include the following: They focus
on human potentials and think deeply in terms of ethical and human values.
Work quite intensely with those close to them they have strong empathic
abilities and can become aware of another’s emotions or intentions—good
or evil—even before that person is conscious of them. Counselors are both
kind and positive in their handling of others; they are great listeners and
seem naturally interested in helping people with their problems. They
understand and use human systems creatively, and are adept at consulting
and cooperating with others.
When the counselor’s value system is causing the client difficulty, the
counseling is clearly value dominated. Again, the counselor must remember
that the overall goal of the process is to help the client help herself.
Therefore, the counselor needs to help the client discuss her values in the
client’s own environment, and help the client resolve the difficulty or cope
with the situation in a more effective way. It is important not to impose the
counselor’s values on to the client.
 The Counselor and the Counselee 175

Certain personality variables are associated with, or are the cause of, the
different degrees of counselor competence. It has been shown that some
students of counseling appear to be readily adapt to the role of counseling,
whereas others struggle, are confused and in conflict, and generally ill-
suited to the counseling education.
Whatever the type of counseling being carried on, whatever the setting
in which the counselor works, many of the important decisions which may
decide the eventual success or failure in helping the counselee depend
on the characteristics of the counselor as well as the characteristics of the
counselee.
The client expectations and perceptions of counseling as well as the
counselor determine the difficulty value of the counseling process. The
counselor needs to be aware of them and tailor his or her counseling
approach, skills and techniques to the specific individual client.

References
Bachelor, A. 1988. ‘How Clients Perceive Therapist Empathy: A Content Analysis of ‘Received’
Empathy’, Psychotherapy: Theory’, Research and Practice: 25: pp. 227–40.
Bordin, E. S. 1955. ‘The implications of client expectations for the counseling process’. Journal of
Counseling Psychology, 2, pp. 17–21.
Chandras, K. V. 1997. ‘Training multiculturally competent counselors to work with Asian Indian
Americans’. Counselor Education and Supervision, 37, pp. 50–59.
Chandras, K. V., J. P Eddy,.and D. J. Spaulding. 2000. ‘Counseling Asian Americans: Implications
for training’. Education, 120, pp. 239–246.
Frank, J. D. 1968. ‘The influence of patients’ and therapists’ expectations on the outcome of
psychotherapy’. British Journal of Medical Psychology, 4,349–356.
Goldfarb, Dori E. 2002. ‘College counseling center clients’ expectations about counseling: how
they relate to depression, hopelessness, and actual-ideal self-discrepancies’. Journal of
College Counseling |September 22, 2002| (http://www.accessmylibrary.com/article-1G1-
93453768/college-counseling-center-clients.html.)
Goldstein, A. P. 1962. Therapist-patient expectancies in psychotherapy. New York: Macmillan.
Goldstein, A. P., K. Heller and L. B. Sechrest. Psychotherapy and the psychology of behavior change.
New York: Wiley. 1966.
Harrow, Judy. 1996. Empathy: the spirituality of counseling. http://www.proteuscoven.org/proteus/
empathy.htm
Harrow, Judy. 1996. Congruence: getting real about counseling. http://www.proteuscoven.org/
proteus/congruence.htm.
Heilbrun, A. B. ‘Toward resolution of the dependency-premature termination paradox for females
in psychotherapy’. Journal of Consulting and Clinical Psychology, 1970, 34, pp. 382–386.
Hoch, P.H. 1955. ‘Aims and limitations of psychotherapy’, American Journal of Psychiatry, 112,
pp. 321–327.
Hiebert, B. 1984. ‘Counselor Effectiveness: An Instructional Approach’. Personnel and Guidance
Journal, 62(10), pp. 597–601. (EJ 302 610).
 176 Counseling: Theory, Skills and Practice

Lafferty, P., L. E., Beutler and M. Crago. 1989. ‘Differences between more and less effective
psychotherapists: A study of select therapist variables’. Journal of Consulting and Clinical
Psychology, 57, 76–80.
Lambert, M. 1992. ‘Implications for outcome research for psychotherapy integration’, in J. C.
Norcross and M. R. Goldstein (Eds.), Handbook of psychotherapy integration (pp. 94–
129). New York: Basic Books.
Lambert, M., and , K. Cattani-Thompson. 1996. ‘Current findings regarding the effectiveness
of counseling: Implications for practice’. Journal of Counseling & Development, 74, pp.
601–608.
Lambert, M., and D. Barley. 2001. ‘Research summary on the therapeutic relationship and
psychotherapy outcome’. Psychotherapy, 38(4), pp. 357–361.
Martin, D., J. Garske, and M. Davis. 2000. ‘Relation of therapeutic alliance with outcome and
other variables: A meta-analytic review’. Journal of Consulting and Clinical Psychology, 68,
pp. 438–450.
Perkins, Daniel F and Kate Fogarty. 1999. Active Listening: A Communication Tool; http://edis.
ifas.ufl.edu/he361.
Sperry, L., J. Carlson, and , D. Kjos. 2003. Becoming an effective therapist. Boston: Allyn &
Bacon.
Rogers, Carl. 1995. On becoming a person: a therapist’s view of psychotherapy. Houghton Mifflin
Company, New York.
Schwebel, M.1955. ‘Why unethical practice’? Journal of Counseling Psychology, Volume 2, pp.
122–128.
Sperry, L., J., Carlson and D. Kjos. 2003. Becoming an effective therapist. Boston: Allyn &
Bacon.
Snyder, J. F., C. E., Hill and T. P. Derksen. 1972. ‘Why some students do not use university
counseling facilities’? Journal of Counseling Psychology, 9, 263–268.
Sue, D. W., and D. Sue. 2003. Counseling the culturally diverse: Theory and practice (4th ed.). NY:
John Wiley & Sons, Inc.
Vogel, D. L., N. G. Wade and A. H. Hackler. 2007. ‘Perceived public stigma and the willingness
to seek counseling: The mediating roles of self-stigma and attitudes towards counseling’.
Journal of Counseling Psychology, 54, pp. 40–50.
 7
Counselor Database

Chapter Overview
Role of communication in the process of counseling
Stages in the counseling process
Evaluation of the process
An indigenous model of counseling

C
ounseling as a professional field is just emerging in India. Students attend
counseling for allotment of courses, a talk show host with no training at all
counsels her guests, and a manager in the industry counsels his subordinate.
The functions of a counselor are not very well defined. Only of late, the family courts,
educational institutions, and industrial organizations are realizing the importance of
counselors and the counseling profession. The aim of counseling and psychotherapy
is to assist one’s increasing awareness by mastering conflicts and patterns that have
previously determined one’s thoughts, feelings, actions, and decision-making skills.
Helping clients become more effective, fully functional, and more independent
is the ultimate goal of any counseling process and is implicit in all counseling
approaches (Doyle, Robert E, 1992). They all describe how a person functions
effectively or ineffectively in one or more of the following dimensions of life:
satisfaction of needs, stress and the coping processes, developmental task attainment,
social contact, and interpersonal relationship skills, other personal or characteristic
attributes, and discusses the major problems that can impede the effective functioning
of individuals. They illustrate at length that individuals who are functioning
effectively usually (1) satisfy their needs in appropriate ways, (2) deal with pressure
efficiently, (3) handle their emotions as well as emotional reactions effectively,
(4) learn tasks that are appropriate to their developmental stage, (5) have meaningful
social interactions and interpersonal relationships, and (6) display other positive
attributes.
178 Counseling: Theory, Skills and Practice

Counseling skills are basic communication skills. The only difference is that
counselors work under the canopy of their understanding of human behavior and
relationships. There are various theoretical orientations to counseling. Any counselor
tilts toward one, or receives training in one area of therapy. Whatever orientation
the counselor majors in, whatever type of therapy he/she provides, training in soft
skills, or communication skills is essential.
Communication skills training forms the very core of person-centered approach
to counseling. Communication is the most important component of counseling.
Apart from theories regarding human nature and behavior, counseling involves the
skills of effective communication.

ROLE OF COMMUNICATION IN THE PROCESS OF

COUNSELING

We engage in communication and conversation everyday. In order to accomplish

tasks, communication and conversation are employed. At work we must
communicate with our employers as to the status of our work, or as employers, we
must communicate with our employees regarding responsibilities and expectations.
We must communicate with our children’s teachers in order to help them to be
at their best in school and we must communicate with our friends and family
members. Most importantly, we must communicate our feelings, our expectations,
our sorrows and our joys with our significant other.
Without effective communication and conversation skills, relationships can
be intimidating and overwhelming. Gatherings involving groups can be utterly
devastating, causing individuals to avoid social situations.
Helping relationships involve connections between individuals who need help
and individuals who provide that help. This connection is the essential characteristic
of any relationship. The helpers use counseling skills to assist clients in alleviating
their pain and suffering.
Counseling skills are basic communication skills. The only difference is that
counselors work under the canopy of their understanding of human behavior and
relationships. They have a sound foundation in the theories relating to human
behavior, pain and its source, and the various intervention strategies that can be
employed to help clients through that pain.

Definition of communication
Communication may be broadly defined as the transmission of information and the
exchange of ideas. Communication skills include ability to initiate conversations,
 Counselor Database 179

maintain social interactions, express one’s thoughts and feelings to others, and
accurately comprehend the expression of others.
Communication skills training forms the core of person-centered approach to
counseling. Carl Rogers also stressed the counselor’s attitudinal qualities lest the
whole approach be reduced to a mechanistic skill. Thus, person-centered counselors
identified attitudes, such as empathy, nonpossessive warmth, genuineness,
congruence, and respect.
Communication is the most important component of counseling. Apart from
theories regarding human nature and behavior, counseling involves the skills
of effective communication. A counselor can be effective only when he/she is an
effective communicator. Let us see how these communication skills can be instilled
and improved.

Why communications skills are so important?

Clarity and unambiguity in getting the message across to others define the purpose
of communication. This involves effort from both the sender of the message and the
receiver. And it’s a process that could be fraught with error. Messages can often be
misinterpreted by the recipient causing tremendous confusion, wasted effort, and
perhaps missed opportunity.
When the receiver understands the information sent just as it was meant to be
understood, then, and only then is it successful communication. There is no error
or misunderstanding. By successfully getting a message across, thoughts and ideas
can be conveyed effectively. When communication is not successful, the thoughts
and ideas that one sends do not necessarily reflect one’s own feelings, causing a
communication breakdown.
Effective communication, though stressed upon in all walks of life, especially
in the helping professions, many continue to struggle. Progress in any relationship
is achieved by getting the message across the way it was meant. In order to do this
one needs to understand what their message is, have the knowledge of the target
audience, and how it will be perceived. Situational and cultural context surrounding
the communications should also be taken into serious consideration.
To understand the process of communication clearly it needs to be broken down
into different components. These are:
1. Sender: The sender needs to be clear about the what and why of the particular
communication. Also, she/he needs to be assured that information is useful
and accurate.
2. Receiver: The receiver is the audience. When communicating, the receiver’s
actions and reactions need to be objectively anticipated. The cognitive,
emotional and behavioral responses of the receiver upon receiving the
information needs to be considered before communicating, and should be
acted upon accordingly.
180 Counseling: Theory, Skills and Practice

3. Channel: The channels are many––verbal face-to-face meetings, telephone

and videoconferencing; and written channels including letters, emails,
memos and reports. Different channels have different strengths and
weaknesses.
4. Message: The message is the information that one wants to communicate.
5. Feedback: The best and most honest feedback about our skills are those
that are provided by the client: verbal and nonverbal reactions to the
processes provide an important insight on how the process is being received.
Depending on the feedback the counselor can continue doing the same or
change his/her communication methodology.
6. Context: It is the situation (surrounding environment or broader culture)
in which counseling takes place. The counselor would do well to recognize
the sensitivities and sensibilities surrounding the client issues.
The process takes place as follows:

Msg Msg Msg Msg

Source Encoding Channel Decoding Receiver

Feedback
Context

Source: (http://www.mindtools.com/CommSkll/CommunicationIntro.htm)

Encoding: This is the skill of changing the information into a form that
can be sent and correctly decoded. The success of this process depends on how
accurately the sender has perceived the reception by the receiver, personally as well
as contextually.
Decoding: depends a lot on the receiver’s readiness to receive the information,
knowledge of the information, mental state (pre occupations, etc).
It then is quite obvious that problems can arise at every stage of the process and
have the potential to create misunderstandings and confusion. To be an effective
communicator one’s goal should be to lessen the frequency of these problems at each
stage of this process with clear, concise, accurate, well-planned communications
(www.mindtools.com).

Making a great first impression

This is very important in the counseling process. It ensures the client’s commitment
to the process. Or in other words, it decides whether the client is going to be back or
not. It takes just a quick glance, maybe three seconds, for someone to evaluate you
 Counselor Database 181

when you meet for the first time. In this short time, the other person forms an opinion
about you based on your appearance, your body language, your demeanor, your
mannerisms, and how you are dressed. With every new encounter, you are evaluated
and yet another person’s impression of you is formed. These first impressions can
be nearly impossible to reverse or undo, making those first encounters extremely
important, for they set the tone for the all the relationships that follow (mindtools.
com).
1. Be on time
2. Be yourself, be at ease
3. Present yourself appropriately
4. Total conformity or losing one’s individuality is not at all necessary.
5. A winning smile
6. Show openness and confidence through body language
7. Be courteous and attentive

Communication in a group setting

Counselors are not only trained to deal with individual clients but also group
counseling. The Johari window is a very good concept for the counselors to be
trained in, in order to start handling a group.

The Johari Window

Creating better understanding between individuals and groups
The Johari Window is a communication model used to help people to understand
their interpersonal communications and relationships better. This is a cognitive
psychological tool developed by Joseph Luft and Harry Ingram in the US in 1955.
The Johari Window can be used as a heuristic exercise to improve understanding
between individuals within a team or in a group setting. Using the Johari model,
each person is represented by his or her own four-quadrant, or four-pane window.
Each of these contains and represents personal information––feelings, motivation—
about the person, and shows whether the information is known or not known by
themselves or other people.
The four quadrants are as follows:
Quadrant 1: Open Area
What is known by the person about him/herself and is also known by others.
Quadrant 2: Blind Area, or “Blind Spot”
What is unknown by the person about him/herself but which others know.
This can be simple information, or can involve deep issues (for example, feelings
of inadequacy, incompetence, unworthiness, rejection) which are difficult for
individuals to face directly, and yet can be seen by others.
182 Counseling: Theory, Skills and Practice

Quadrant 3: Hidden or Avoided Area

What the person knows about him/her that others do not.
Quadrant 4: Unknown Area
What is unknown by the person about him/herself and is also unknown by
others.
SELF
Solicits Feedback
Things I know Things I Don’t know

ARENA BLIND SPOT

Things
They
Gives Feedback
Self-Disclosure

Know
GROUP

IN
or

SI
G
H
T

Things
They
Don’t
Know FACADE UNKNOWN

UNCONSCIOUS

The Johari Window is a communication model that can be used to improve

understanding between individuals. Individuals can build trust between themselves
by disclosing information pertaining to them. It is also a tool for self-discovery.
They can learn about themselves and come to terms with personal issues with the
help of feedback from others.
There are three main processes which are explored by the Johari Window:
1. Feedback
2. Self-disclosure
3. Insight
The Johari Window maintains that for a person to be very comfortable with
himself or herself, when alone or in the company of others, the first quadrant must
be the biggest. And constant efforts must be directed towards this. For people to
build up trust and form a deeper relationship they need to know more about each
other. The diagram shows that in order to do that individuals need to make the
‘hidden’ quadrant smaller. This can be done by self-disclosure. And in order to gain
more self knowledge the ‘blind’ quadrant needs to reduce in size. This can be done
by soliciting feedback from others.
 Counselor Database 183

These processes are relatively simple compared to the process of reducing the
‘unknown’ quadrant. This consists of information unknown to both the self and
others. Hence, neither soliciting feedback, nor self-disclosure will do any good.
Insight, interactions, introspection or contemplation during therapy are the only
things that will help. This can neither be forced nor pushed. It has to happen on its
own. And this is only possible if one constantly raises the bar on self-awareness; to
catch that glimpse of sudden fractional information and convert it into full-fledged
knowledge.

STAGES IN THE COUNSELING PROCESS

(Radhika Soundararajan, 2010)

The counseling process always starts with the emergence of a problem. Therefore,
the discussion should begin with the understanding of various types of problems,
and then later on to recommend remedies.

The Problem
Problems or conflicts are reduced to means and end. No matter how unpleasant or
distracting, there is the clarity that there are two ways to approach the solution:
1. Knowing the end and thus to adopt the appropriate means; or
2. Knowing the nature of the problem and thereby to know the nature of the
solution.
The first situation is definitely easier to handle and execute. It may or may not
require very intense external help. It is the second situation that becomes very
stressful and difficult to handle. When one does not know what is wrong, and is just
aware that something is wrong, that is when self-enquiry should begin—to ascertain
the nature of the problem that is to be solved. That in turn will reveal the nature of
the solution. It is from this very simple viewpoint that counseling operates.
All of man’s problems and seeking originate in his mind. When he is in deep
sleep he is not conscious of any struggle. There is nothing he wants to do, nothing
he wants to change. But when awake or dreaming his peace of mind is constantly
challenged by thoughts and situations. And his urge is to resolve all disturbances, to
make things better.
Problems can be categorized in the following manner:
1. According to the source: There are two sources.
Problem for which the solution is external; for example, the first three
levels of Maslow’s hierarchy of needs. There are many problems of this
kind in individual and social life.
184 Counseling: Theory, Skills and Practice

And then there are problems for which the solutions are within the
problem itself. Problems due to attitude, perceptions, thinking,
memory and motivation require the individual to look within for the
answer.
2. According to the level: There are two levels.
The first level is that of a situational or topical problem. The problems
of the here and now. These are problems which can be solved by
planning and effort, taking into account the resources at our disposal.
But as we will see in the following sections these are but band-aid
solutions. Solution to the topical problems lies elsewhere and one has
to seek where the problem lies.
The second level is that of a fundamental problem. This problem
ironically stems from the glory of the human mind; its unique capacity
to inquire into the nature and meaning of things, to reason out, to
analyze, to appreciate subtleties, to imagine, to conceptualize, to come
to conclusions, and to make choices. Man has an intellect, a thinking
faculty, and mere bodily survival does not make his life. He not only
wants to go on living, but to live in a particular way as well. The mind
of a person makes him self-conscious and self-aware. Being self-aware
he cannot but be a desirer, a seeker. At any moment in a person’s life
we find that the life he leads is but an expression of his desires. While
the specific want varies from person to person and from time to time,
what doesn’t vary is “I want.” What a person really wants is to be free
of want. To say “I want” is really to say, “I don’t want to have any
want”. And that is the fundamental problem; the constant desiring
and moving to achieve it. And counseling should help the individual
solve this fundamental problem, and thereby solve all his situational
problems.
3. According to the nature of the problem: There are basically six dimensions
of psychological functioning:
1. Need satisfaction
2. Developmental task attainment
3. Managing stress – developing coping strategies
4. Interpersonal relationship skills
5. Developing emotional maturity
6. Developing spirituality
Difficulties in one or many of the above areas may instigate the client to seek
counseling. The major goals of counseling are then twofold:
1. Helping them get through the present problem situations and
2. Educating them to handle future situations.
 Counselor Database 185

Process
The actual process of counseling starts much before the counselor–counselee
interaction. It proceeds in the stages described below.

Stage 1: The awareness of the problem

Having a mind that is self-conscious, the individual is appreciative of a lack,
something that he misses in himself. His mind being an instrument of reason, he
looks into this constant tendency to desire and according to his knowledge and
values, he tries to achieve it. Being acutely aware of his anxieties and lack of peace
within, he tries to overcome it through the resources available to him. This awareness
has three dimensions:
1. Awareness of the intensity of the problem depending on how unpleasant it
makes one feel
2. Awareness of the consequences of the problem, how bad they are
3. Awareness of the depth of the urge to come out of the problem

Stage 2: Recognition and acknowledgement of helplessness

When one recognizes his helplessness, uncertainty, and incapacity to order things
as he wants; that there is uncertainty with reference to the fulfillment of wishes
and desires; that there are limitations of strength in terms of will and the capacity
to make the necessary effort; that there are also limitations in terms knowledge
and resources; that there is an absence of freedom in one’s mental life; there is the
acknowledgment of one’s helplessness.

Stage 3: Recognition of the need for an external guide

When one acknowledges that he feels helpless, one seeks external help. That external
help is often first in the form of prayer. Ancient Indian wisdom says “Effort,
initiative, courage, intelligence, resourcefulness, and perseverance. Where these six
qualities exist, there the Lord will always be helpful.” But, even when one has every
one of the six qualities, still there will be some unknown factor that can cause a
problem. Any number of things can happen. Thus one requires the grace of God to
help one through problems.
Thus, one seeks the help of an external guide, be it a spiritual teacher, or a
professional counselor. In seeking help from the spiritual teacher, the gain is self-
knowledge (which is the remedy for all problems, be it worldly or cosmic).

Stage 4: Providing emotional support

The counselor then provides the emotional support to help release the thinking
faculty of the individual to a functioning mode. Thinking is the operating skill
with which intelligence acts upon experience (Edward de Bono). When one is in
186 Counseling: Theory, Skills and Practice

the throes of emotion this thinking is de-capacitated. Only when the emotion is
explored and processed does it allow the thinking to emerge and assess and evaluate
the situation. Only then the solution comes to the forefront. Ancient Indian wisdom
says that the solution is always there within each and every one of us. For it to be
seen the intellect has to function effectively.

Stage 5: Education/guidance from the counselor

The counselor then works with the client to sort out the different dimensions of
the problem, and provide guidance with various available solutions. The counselor
plays the very important role of a psycho-educationist. He or she not only helps the
client identify and understand the cause and the nature of the problem, but also
educates the client regarding the nature of his personality and the role of perception,
thinking, attitude, beliefs and values in contributing to problems in general.

Stage 6: The learning process

The client/student learns by following the three step process.
1. The client pays close attention to the words of the counselor. Asking
questions and clarifying doubts, the client not only hears the words but
also listens to their meaning, both direct as well as inferred.
2. Once the client understands the concepts, he/she assimilates them internally
by reflecting on them over and over again, going back to the counselor who
is ever ready to help remove uncertainties, fears, misgivings, and conflicts.
This continues until the client is absolutely sure of the subject matter.
3. Profound and repeated meditation on what has been taught.

EVALUATION OF THE PROCESS

(Swami Paramarthananda Saraswati)

Any problem, situational or fundamental, can be solved through the psycho-

educational process of counseling. When one understands the nature of the self all
kinds of problems see the light of solution. Some of the major benefits of this type
of counseling process are:
1. Intellectual satisfaction. Human beings, at some point in their lives develop
a natural curiosity to know who they are and where they are heading.
Mystery is a pain for the intellect. It cannot stand doubt of any kind. Every
thinking individual has the natural urge to quench curiosity about the Self,
goal, purpose, destination and direction of living.
2. Fulfillment. The joy of understanding the self. This lifts the insecurities,
fears and anxieties. Peace of mind and ultimately joy descends upon the
client.
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3. Freedom from dependence. When one discovers that one is actually not
dependent on anything, anyone, or any situation in which to be happy or
secure, there is emotional freedom.
4. Freedom from pain. Self knowledge and the resulting joy serve as an
emotional cushion when the going is tough. When there is no dependence,
then there is peace of mind. Life is unpredictable, future is uncertain,
past cannot be changed: all this knowledge is very helpful in modifying,
reducing as well as avoiding pain.
5. Achieving a poised mind (emotional maturity). A poised mind is an efficient
mind. An emotionally disturbed mind is inefficient. It cannot tap on
intellectual resources. A poised mind has the capacity to remain balanced
when things are going haywire. It is an emotionally mature mind which is
intellectually available.

AN INDIGENOUS MODEL OF COUNSELING

Counseling and Spirituality

1. There is a paradigm shift in the healing profession today. From being
dogmatically scientific, focusing only on the tangible, the observable and
the measurable, therapists are steadily moving towards the intangible, the
higher order, the spiritual. Spirituality and religion are significant bases
of strength for many clients; they are the core values for finding meaning
in life, and can be instrumental in promoting healing and well-being.
Transpersonal psychology is gaining more and more significance and
acceptance, both among the practitioners as well as the people on whom
they are practiced. Spiritual and religious values can play a major part in
human life, hence spiritual values should be viewed as a potential resource
in therapy. Increasingly, therapists are realizing that religion and spirituality
are often part of the client’s problem. Ergo, rather than as something to be
ignored, they should also be part of the client’s solution. In this scenario, it
would be foolish, if not suicidal, for counselors to ignore the trend. Thus
counseling in India as well should open itself to this. As spirituality and
religion are region-specific, the author has made an attempt to extract a
theory of counseling from the ancient Indian philosophy Vedanta. Vedanta
says that the goal of human life is to live and grow into an emotionally
mature person. The journey to emotional maturity starts with one’s
philosophy. This decides one’s perceptions. It is well known that emotions
follow perceptions and result in action/behavior. The more objective the
perception the higher the level of emotional maturity. Counseling can
188 Counseling: Theory, Skills and Practice

help clients gain insight into the ways their fundamental beliefs and values
are reflected through their emotions in their behavior, and make use of
the spiritual and religious beliefs of their clients to help them explore and
resolve their problems.
The search for the meaning of life has nagged man from time immemorial. Every
man, subject to his working knowledge of the dynamics of human behavior, has
formed his own theory of how best to live. There are scientists who try to make some
sense of this seemingly chaotic world around us. And in order to give meaning to
all this, there are ideas generated, theories formulated, and laws set down, ensuring
that the mechanism of life is well oiled. Yet, in spite of all the efforts, both at the
micro and macro level, the concepts of individual and global psychology seems to
have yielded little towards alleviating human problems with permanent solutions.
People are still struggling with their anxieties, conflicts, and confusion. Any joy
or happiness experienced is transient. Peace of mind and contentment seem just a
little further away at best, or a pipe dream at worst. Where do we find that? More
importantly, what can we DO to find that? Or should we ask—what do we have to
BE to find that!
Counseling is a psycho-educational process providing help to clients who are in
pain and are not able to help themselves. This encompasses life skills for personal
growth as well as coping skills for problem solving.

Counseling for Personal Growth

Smith and White, as quoted by Allen, Mehal, Palmateer and Sluser (1995), say
that in a Life Skills group, responsibility for personal growth rests with the client.
“The coach’s task is to help them learn” (p. 11). Coaches act as facilitators, guides,
role-models, trainers, teachers and counselors (Allen et al., 1995). “… Counseling
is directed towards helping clients deal with their immediate problems and improve
their life situations. And the attitude of the counselor is that of one individual
interacting with another, on a more-or-less equal footing” (Belkin, 1988, p. 24).
Coaches (…and counselors) encourage students to “develop belief systems which
support their rights and the rights of others” (Allen et al., 1995, p.39). Personal
growth, counseling and developing belief systems are all part of encouraging
psychological growth. Psychological growth must be considered a primary goal of
life skills.
Psychological growth and spiritual growth are interrelated and intertwined.
More and more professionals from all arenas are recognizing and acknowledging
this. Wolman (2001) considers the drive for spiritual self-improvement to be
the same thing as the desire for self-actualization. Self-actualizing people provide
Maslow with his benchmark for psychological health. Counseling, in its support and
 Counselor Database 189

encouragement of personal growth, is involved with supporting and encouraging

spiritual growth.

Counseling as Problem Solving

In his work on identifying and defining intelligences, Gardner (1993) states “An
intelligence is the ability to solve problems, or to create products, that are valued
within one or more cultural settings (p. x). He has since clarified with “I now
conceptualize intelligence as a bio-psychological potential to process information
that can be activated in a cultural setting to solve problems or create products that
are of value in a culture (Gardner, 1999, pp. 33–34).
Building on Gardner’s work, Bowling (1999) and Emmons (1999, 2000a) have
proposed the concept of spiritual intelligence. Emmons (2000b) identifies a minimum
of four core components of spiritual intelligence: (a) the capacity for transcendence;
(b) the ability to enter into heightened spiritual states of consciousness; (c) the
ability to invest everyday activities, events, and relationships with a sense of the
sacred or divine; and (d) the ability to utilize spiritual resources to solve problems
in living (p. 63).
Zohar and Marshall (2000) call spiritual intelligence “our ultimate intelligence”
(p. 4). They define it as

“… the intelligence with which we address and solve problems of meaning and value,
the intelligence with which we can place our actions and our lives in a wider, richer,
meaning-giving context, the intelligence with which we can assess that one course of
action or one life-path is more meaningful that another” (pp. 3–4).

Wolman (2001) defines spiritual intelligence as “ . . . the human capacity to ask

ultimate questions about the meaning of life, and to simultaneously experience the
seamless connection between each of us and the world in which we live” (pp. 84–85).
He sees spiritual intelligence as “the ground on which morality stands” (p. 115) and
as being applied in making moral choices and solving moral problems.
Counseling on matters of problem-solving and effective behavior change through
choices of action invokes the exercise of spiritual intelligence when problems of
right and wrong are focused on; and when decisions about moral courses of action
are made.

The Theory behind the Indigenous Model

In light of the above issues the author has made an attempt to study the ancient
scriptures called Vedanta and extract a theory of counseling from them. Vedanta
is a serious study of oneself, one’s goal in life and its achievement. It says that the
190 Counseling: Theory, Skills and Practice

fundamental problem of human life is subjective perception of the self and the
world. This subjectivity causes pain and anguish. The solution is objectivity with
respect to the same. The goal of counseling is to help the clients effect change within
themselves with respect to the problems they face within and without, and knowledge
of the Vedantic principles will help them do just that. The goal of counseling is to
help the client process his/her emotions in a way that he/she begins to understand
and discern the underlying issues causing the problem; and then to educate the
client in the ways to resolve it.
There are as many problems as there are clients. The spectrum is wide and varied.
It can be mind boggling to the counselor sometimes, even to the most experienced
one. Vedanta simplifies the whole helping process. It brings to light the fundamental
problem, the problem beneath all its manifestations, and teaches how to get to the
solution.

Maturity and human life (Swami Dayananda Saraswati)

What is the goal of life? Living is the aim of life. What is living? To live is to grow.
When an organism is born, it is not adequately mature to begin living. The physical
body has to grow, to metamorphose into an adult for which one need not do
anything special. Nature takes care of it. The very nature that brought the body into
being also takes care of its growth. The body should just keep living. But maturity is
not merely biological, physical maturity. There must be emotional maturity.
We are our emotions. No matter what your learning or understanding is, it does
not seem to have any bearing on your day to day responses to the world. This gap
between one’s understanding of, and the actual day to day living is a problem. Life is
about living; living is about experiencing; experiencing is about emoting; and emoting,
is about perceiving/interpretation.
According to Ellis, we experience activating events (A) everyday that prompts us
to look at, interpret, or otherwise think about what is occurring. Our interpretation
of these events results in specific beliefs (B) about the event, the world and our role
in the event. Once we develop this belief, we experience emotional consequences
(C) based solely on our belief.

A B C
Activating Belief Emotional
Event Consequence

Consider the following diagram (adapted from Ellis, 1962):

Event —————> Interpretation —————> Emotional Response
Here the author would like to present the flow chart as extracted from Vedanta.
Philosophy Objectivity Emotional Maturity
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Vedanta says that the goal of human life is to live and grow into an emotionally
mature person. The journey to emotional maturity starts with one’s philosophy and
personality. These, in combination, decide one’s perceptions. It is well known that
emotions follow perceptions and result in action/behavior. The more objective the
perception the higher the level of emotional maturity. Counseling can help clients
gain insight into the ways their fundamental beliefs and values are reflected through
their emotions in their behavior, and make use of the spiritual and religious beliefs of
their clients to help them explore and resolve their (client’s) problems. Whenever an
individual encounters a particular situation his/her personality as well as philosophy
comes into play. Together they influence the extent of objectivity with which the
individual perceives the situation.
The Objectivity Emotional Maturity equation works both ways; one
constantly reinforcing the other. The higher the level of objectivity, the higher the
level of emotional maturity. And the more one becomes emotionally mature, the
more objective one becomes. Thus, in order to achieve more accuracy, the flow
chart can be modified as:
Philosophy Objectivity Emotional Maturity

Emotional Maturity is the Final Goal

The final destination for a human being is inner freedom; freedom from all types
of dependence on external factors. Dependence on external factors for security
or pleasure or satisfaction. One should discover security in oneself, not in people
around or in the materials one possesses.
Moksha is freedom from bondage. An individual is said to be attached when the
presence of any person, situation, object or relationship is a burden weighing him
down; and alternatively, the absence of any person, object, situation or relationship
creates a vacuum in his mind (2000, Swami Paramarthananda Saraswati). A mature
human being is one who is free from bondage or attachment.
Bondage is when the mind longs for something, grieves about something,
rejects something, holds on to something, and is pleased about something
or displeased about something.
Liberation is when the mind does not long for anything, grieve about
anything, reject anything, or hold on to anything, and is not pleased about
anything or displeased about anything.
Bondage is when the mind is tangled in one of the senses, and liberation is
when the mind is not tangled in any of the senses.
Liberation is achieved when one is not unduly moved by events, people,
relationships or things around. This leads one to that state of mind which is peaceful
and serene, not without pain causing incidents, but in spite of them. That is the goal
of any person.
192 Counseling: Theory, Skills and Practice

Emotional maturity is inner freedom achieved through a balanced state of

emotions, which in turn is a direct consequence of objectivity. Human beings can
never achieve perfection. Yet the striving for it is never given up. It should not be
given up. Any behavior involves a goal. The goal is the one that is seen first. And
then the mind works out the means. Vedanta talks not only about the goal but also
the means.

Components of Emotional Immaturity

Dependence
Dissatisfaction
Helplessness
Insecurity
Insignificance
Emotional instability

Qualities of an Emotionally Mature Person

The following qualities describe an emotionally mature person:
1. Discrimination: Discrimination is the ability of the intellect to see
through a situation and distinguish between the permanent, the relatively
permanent, and the impermanent; and act according to what is appropriate
for the situation. Discriminative knowledge or clarity of thinking is born
out of objectivity; it is also the first step towards objectivity, as opposed to
muddled, conflicted thinking.
2. Dispassion: This is the freedom from all types of dependence or attachment.
It means perceiving both pleasure and pain with an unruffled mind in
equanimity. An individual is said to be attached when the presence of any
person, situation, object or relationship is a burden weighing him down;
and alternatively, the absence of any person, object, situation or relationship
creates a vacuum in his mind. Dispassion is born out of discrimination.
Dispassion also fosters objectivity.
3. Desire for liberation: A person with the above faculties realizes very quickly
and easily that all his pursuits are basically directed at bringing about a
subjective state of freedom and fulfillment. He realizes that every pursuit is
motivated and prompted by a ‘sense of lack’ within. It is this insufficiency
which makes one go on trips endlessly. The moment he realizes that he
is not driving, but is being helplessly driven, and cannot stop even if he
wants, there is realization of bondage. Only when we feel bondage, we
know the exact nature of bondage, that we will have this clear goal of
desiring for liberation from it. To be emotionally mature means to diagnose
 Counselor Database 193

our fundamental problem, and thereafter with single-pointed application

direct all our energies to handle or solve it.
4. Six-fold qualities:
i. A calm, undisturbed mind: It means a peaceful, poised, tranquil mind
which is not very easily perturbed; a quiet disposition, ability to
concentrate on the work at hand, greater enthusiasm to attain our goal,
better memory, ability to feel what the intellect is thinking, etc, it is this
quality to turn back one’s mind from thoughtless preoccupations using
just proper understanding and logic, and turn his attention thoroughly
to ones goal once again.
ii. To be in command of senses or external sense organs, the external faculties
of perception: The said faculty is under direct control of the intellect.
The ability to live and work as per the directions and convictions of
the intellect without bringing into its own whims and fancies is called
control. There is no question or implication of suppression here. It is
simply acceptance of the hierarchy of intellect.
iii. Maintaining the peace and tranquility that has been acquired: It involves
preventing stress and disturbance to bother the individual. The
Kathopanishad in this regards presents a beautiful and an appropriate
simile of a chariot, where the self is the chariot, the intellect is compared
to a charioteer, the mind with reins and the sense organs with horses.
The most ideal condition is that when the reins and the horses are in
full control and command of the driver. Thereafter, any great journey
is not only possible but enjoyable too. What is basically required is an
integrated personality, where all faculties work in unison; otherwise
the person becomes his or her own enemy.
iv. Endurance (both physical as well as emotional): This implies that
irrespective of the situation outside our mind does not get disturbed.
We should be able to remain undisturbed by small pinpricks of life, as
though nothing has happened. Acceptance but that also without any
grudge or helplessness. With the ability to retain our balance we can
not only observe a situation properly but also go deep into it.
v. The ability to fix one’s mind on some thing: In this both our emotions
and understanding are involved and thus, it results in bringing about
greater joy and better understanding of the “object” of our attention.
The mind is quiet and at peace, yet fully awake and dynamic. It is
brought about by a combined effort of “having clarity of our goal”,
“having love for our goal”, and practice.
vi. Faith: It implies a faith in God and his teachings. It is a positive and
respectful attitude that they are basically right, coupled with concerted
efforts to understand whatever we believe in. It is about respect and
194 Counseling: Theory, Skills and Practice

humility. This humility is a direct consequence of a very healthy sense

of self-esteem and self-respect. It takes a great mind to acknowledge
the greatness of another. Arrogance is the manifestation of an inner
sense of inferiority. Arrogance is a poor attempt to cover the feeling of
self- insufficiency. It is a poor defense. It can be understood as a state
of denial of perception of oneself as being not good enough.

Emotional maturity is developed through achieving spiritual

maturity
Spiritual maturity is an assimilation of a working philosophy of life. Philosophy aids
in gaining objectivity about the situation in hand. Objectivity leads to an alternative
perception which effectively results in alleviation of the pain.
Counseling is a learning-oriented process, in which a counselor seeks to assist the
client to discover and understand the self with regard to interpersonal relationships,
explore what one wants out of life, figure out one’s likes and dislikes and/or one’s
best abilities and learn to make better decisions, and solve problems effectively.
Vedanta says that the solution to the problem always lies within the problem. If
subjectivity is caused by preferences and perceptions, and judgments and beliefs;
then objectivity should also be caused by the same, but in the opposite direction.
The study of problem-solving should start with the knowledge and understanding
of five concepts or principles of living, which the author names The Five Laws,
which encompass most of the wisdom necessary to lead a healthy life. These laws are
actually universal. They are:
1. The law of Free Will
2. The law of Dharma
3. The law of Karma
4. The law of the 3 Cs
5. The law of Perfection

1. The law of free will: Freedom of action

Human life is a privilege, which means that among all living beings, the life of a
human being is scarce indeed. It is a privilege to have this human birth. There are
several features common to human beings and other living beings: eating, sleep,
fear, and love for the perpetuation of one’s own species. The human being alone
is endowed with a great capacity; and that is the capacity to understand and make
choices.
Every problem situation can be dealt with in two ways: either do something
about it, or accept it as it is. Action or acceptance. These are the only two choices
that are available. One may argue that it is so for all living beings. What makes us
humans different? The difference is that humans are (or at least should be made)
aware of it.
 Counselor Database 195

That would be the task of the counselor: to highlight this major truth to the
client. And the solution to the problem, whether it is an action, or acceptance, should
be presented as the choice that the client must make. This course of counseling
empowers the client in that it does not only help the present problem situation, but
gives the client the resource to handle future such situations. Any situation, when it
is seen as born out of our choice, only adds strength to our capacity to endure.
A corollary to this concept of freedom of action is the concept of freedom in
action. The goal of life is to live. Living is to intelligently exercise our choices.
And intelligently exercising choices is to differentiate between actions and reactions.
Actions are the chosen responses, while reactions are mechanical responses to
situations. Emotions and thoughts fall under the latter category. They happen. And
one has no control over them. Whereas the consequential behavior can be chosen
consciously or let occur thoughtlessly, in which instance it will be called a reaction.
Intelligent living would be to maximize the action, and minimize reaction. As choice
is available in behavior, not at the thought or emotion level, one would do well to
concentrate on that rather than to fret over their uncontrollable occurrence.

2. Law of karma
Vedas say that every action produces a result. These results can be tangible and
obvious, or they can be intangible and obscure. Either way, they can bring one joy
or pain. Those are the only two end results. As mentioned earlier, everyone seeks to
avoid pain and seek joy. And the law of action states that this depends on the kind
of behavior we engage ourselves in.
The intricacies in this law must be well appreciated. An action can produce a
tangibly positive result, but may not be joy-producing in the long run (as in the
case of addiction, crime, etc). And the opposite is obviously true (as in the case of
sacrifice). Another aspect to consider is the time frame. One cannot know when the
fructification of the actions as pain or joy will take place. Just as different types of
seeds sprout at different duration, so too the different types of actions have different
fructification times.
It follows from the above discussion that one would do well to remember that
all pain is deserved, and all joy is earned. The decision to act in a particular way is
actually a decision to choose joy or pain.
Understanding and assimilating the law of karma has many advantages (Swami
Paramarthananda Saraswati, 2002):
1. The law explains the differences or disparities in living beings from birth.
2. The second advantage is one can accept pain and suffering even though
they seem disproportionate to the actions performed. Blaming God or fate
then seems like immaturity.
196 Counseling: Theory, Skills and Practice

3. The third advantage is that one can take care of the future. By following
the idiom “good begets good” one can see to it that pain is minimized and
joy is maximized.
4. And finally, this is the law that inculcates and maintains morality and ethics
in the society.
This is the essence of the Law of Action. It says that, at any time, one has control
over one’s actions only, not over the consequence of the actions. That knowledge
should not entice one into inaction. One must act as is required, as is appropriate in
the situation. One cannot do away with action. That would surely be the difference
between being alive and living.
The corollary to this law is that good as well as bad actions can be rated depending
on the attitude with which they are performed. Actions and attitudes can be rated on
three levels: low, medium, and high. And as various permutations and combinations
of the two are possible, the fruits of these actions plus attitude will differ vastly.
Added to that, are the fruits of previous actions plus attitude. Thus, the consequence
of a particular action is not only the direct result of that action, but also of all the
accrued consequences of the past unfructified actions.

3. Law of dharma
To live is to act. And one must act sensibly. Dharma is both a discipline and a life of
discipline. This lifestyle has to be handed over from one generation to the next. The
concept of dharma can be seen from three different vantage points, all three valid,
and mutually non-exclusive.
1. Duty: Duties, as opposed to rights, are to be emphasized. Today’s society
emphasizes rights. Rights cannot exist without responsibilities and
restrictions. They are an integral part of the concept of duty. The idea is that
if duties are performed, the rights are automatically taken care of. Rights
come naturally as an outcome of performing duties. The goal of life is to
live; living is to relate to the world around. It follows that effective living
would be to maintain a world that thrives on symbiosis. Everyone needs
to gain from the process of living. If the balance is not acutely maintained
then there is chaos. Then people start their “rights fight” and the system
falls apart.
For the system to function smoothly and effectively, one fact must be
understood clearly. Intelligent living comes from exercising the faculty of
choice or free will. One has to choose one’s behavior. It closely follows that
one cannot choose another’s behavior. In other words, one has control
over one’s own actions and not that of others. Performing duties, or doing
what is to be done, is in one’s hands. As our rights are dependent on others
giving it to us, we become helpless. When our rights are not given, we feel
frustrated. And an endless fight ensues.
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2. Ethics: The uniqueness of human beings is the faculty of choice. As we can

see around us, this faculty can be used, abused, misused, or even disused.
One has choice over every situation, except in the use of this faculty. As
choice entails responsibility and restriction, there are norms set down by
society to regulate people’s actions and encourage them to follow the right
path. Ethics are all about good and bad, right, and wrong. Even though
one knows that the good and the right is to be followed at all times, there
are times when one falters. This is, again, because of the faculty of choice
as well as the faculty of preferences. Conflicts arise due to the fact that one
wants what is not good or right; or one does not want what is good or
right.
One requires being emotionally mature in order to be able to act
according to one’s convictions. The faculty of choice is controlled by the
intellect, while preferences are controlled by the senses. These conflicts will
remain until the intellect and the senses are at loggerheads with each other.
The solution to this common problem is to bring the senses under the
control of the intellect.
3. Compassion: Empathy and compassion are values. In any treatise they must
be categorized under ethics. But they need to have a separate position.
They mention them specially. This is again because human beings are
unique, not only in their faculty of choice but also in their ability to care,
share, and empathize with the world. It is born out of the understanding
that all behavior is directed toward seeking pleasure and avoiding pain.
Internalizing the value of compassion is actually assimilation of the fact
that this fact is true for all. It is understanding that, as much as we need
help in pain, we do not want to be hurt, so too do the others. It requires
putting the self and others on the same weighing scale. It can even be called
charity or assistance, both material as well as emotional.

5. Law of the three C’s

Most of man’s worries and anxieties, if they are not rooted in guilt and grief about
the past, emanate from concerns about the future. A truly liberated person is not
concerned with what is going to happen in the future. Thus, the Law of the three
C’s states that, as one cannot change the past, nor can one control the future, the only
effective way to live is to concentrate on the present and contribute to it wisely and
appropriately.
1. That man cannot change the past: is given. Experiences are about emotions,
emotions are about perceptions, and perceptions are about thoughts and
beliefs. Unpleasant experiences stay in the mind. Thanks to the faculty of
memory one relives the pain and suffering over and over again. This causes
198 Counseling: Theory, Skills and Practice

one to live in utter misery. The more intense the pain, the more vivid the
memory.
Counselors can assist clients in dealing with regrets and anguish by
helping them accept their past gracefully, through highlighting that there
is no other alternative. There are only two options when dealing with the
past: accept/forgive or continue in agony. The clients have to go through
two stages of processing their pain: first expressing it, and then, when they
are ready, counselors can present this concept gently to them. That the past
cannot be changed nor can it be forgotten. What can be forgotten is the
hurt and pain that the client is reliving time and again.
Thus, the acceptance of the past, along with the understanding that it
cannot be changed, coupled with the power of forgiveness, all go towards
helping the client deal with it in a positive manner.
2. Cannot control the future: life is uncertain, and one has to face that. And
that is because the future is unknown. There is neither certainty nor are
there guarantees for the future. Actions based on predictions are called
risks. While taking risks is frowned upon, taking calculated risks is seen as
being intelligent. That is because the latter is seen as a situation in which
the risk-taker is seen more in control of the consequences. However, there
is no guarantee. One experiences a lot of pain trying to find ways to control
the unknown, the unexpected, and the uncontrollable. This pain can be
alleviated by the acceptance that the future is just that.

“We spend so much of our lives worrying and trying to prevent the bad from
happening in our lives that we forget to enjoy the good! Nowhere has it been
proven that a rich, joyous, abundant life cannot exist in the presence of
uncertainty.”
—(Susan Jeffers, 2003)

Counselors will be well-advised to educate the clients that one can only
conquer uncertainty, or rather the pain of it, by acknowledging it first,
understanding it fully, and then later actively accepting it. Once the client
embraces this reality, the future course of counseling becomes a lot easier.
3. Can only contribute to the present: this fact empowers the human being
no end. It is always important that one separates any given situation into
what can be controlled and what cannot. The present and the self will fall
into the former category; while the past, the future, and anything other
that the self will fall into the latter. Once the sieving is over, counselors can
support the clients in making decisions as to the appropriate behavior to
engage in.
 Counselor Database 199

Law of Perfection: It Does Not Exist!

This is a reverse law. The pursuit of goals is a permanent struggle. That is because
an ideal set-up or perfection is impossible to achieve. Thus, it has many limitations:
pain, dissatisfaction, dependence, emotional instability, helplessness, insecurity, and
insignificance. The only answer to this relentless pursuit of perfection is to know
that it is impossible to achieve, and be free from the strong desire to achieve it.
As human beings we are endowed with this unique quality of being aware of
ourselves. Slowly, through the processes of growth and development, we develop
a sense of self-identity. This self-identity is based on our circumstances, past
experiences, roles, relationships, etc. Founded upon this self-identity are all of our
interactions with ourselves and with the world around us. We act upon the world
to achieve something for ourselves. This action leads to a result, which may be
desirable or undesirable to us. Based on how we label the result, we emote. These
emotions, when unpleasant, inflict pain and suffering on our psyche.
Our interactions are primarily directed toward helping us feel happy and secure
within ourselves. With every interaction and exchange with the world, we constantly
make revisions in our self-image and self-identity. These revisions contribute toward
our apparent inner sense of joy and security. That is because instead of searching
for that identity within ourselves, the journey inward we want our society, culture,
relationships, and perceptions to resolve our crisis. The more we look outward, the
more we feel powerless.
This urge to become something different from what we are is innate. The
journey toward being a self-satisfied human being is constant and continuous. Even
when certain targets are reached, new ones take form. Hence, we may be rid of that
particular goal, but the seeking never ends. Finally, we come to understand that in
this manner we may never reach complete satisfaction. And then we despair.
An emotionally mature person understands that perfection is impossibility. He
thus does not feel the need to become perfect. This understanding gives permanence
to emotional health as well as immunity to pain and sickness, for which we struggle
throughout one’s life.

v Summary v
Counseling skills are basic communication skills. Rather, basic skills in
counseling are amplifications of communication skills. The only difference
is that counselors work under the canopy of their understanding of human
behavior and relationships. There are various theoretical orientations to
counseling. Any counselor tilts towards one, or receives training in one
area of therapy. Whatever orientation the counselor majors in, whatever
type of therapy she provides, she has to have had training in soft skills, or
communication skills.
 200 Counseling: Theory, Skills and Practice

Communication skills training forms the core of person-centered approach

to counseling. It is the most important component of counseling. Apart
from theories regarding human nature and behavior, counseling involves
the skills of effective communication.
Listening and assertive communication are discrete skills that can
be learned, and once learned, can be used to enhance any relationship.
In a professional relationship, basic skills in counseling are hopefully
communicated by a counselor’s enthusiasm, confidence, and belief in the
client’s ability to change. Those counselor behaviors are incredibly important
in client outcomes, perhaps more important than theory or technique. Thus
listening, responding and empathizing form the core skills of the counselor
upon which they can build the higher order counseling skills. This chapter
has given a general idea of how the process of counseling proceeds through
many stages, from the recognition of helplessness by the counselee to
termination of the counseling. An indigenous model of counseling founded
upon the principles derived from Vedic philosophy, has been elucidated.

References
Hiebert, B. 1984. ‘Counselor effectiveness: An instructional approach’, Personnel and Guidance
Journal, 62(10), pp. 597–601. (EJ 302 610).
Martin, D., J., Garske, and M. Davis. 2000. ‘Relation of therapeutic alliance with outcome and
other variables: A meta-analytic review’, Journal of Consulting and Clinical Psychology, 68,
pp.438–450.
Lambert, M., and , K. Cattani-Thompson. 1996. ‘Current findings regarding the effectiveness
of counseling: Implications for practice’, Journal of Counseling and Development, 74,
pp.601–608.
Sperry, L., J., Carlson and D. Kjos. 2003. Becoming an effective therapist. Boston: Allyn and
Bacon.
Perkins, Daniel F and Kate Fogarty. 1999 Active Listening: A Communication Tool: http://edis.
ifas.ufl.edu/he361.
Harrow, Judy. 1996. Empathy: the spirituality of counseling: http://www.proteuscoven.org/proteus/
empathy.htm.
Harrow, Judy. 1996. Congruence: getting real about counseling: http://www.proteuscoven.org/
proteus/congruence.htm.
Rogers, Carl. 1995. On becoming a person: a therapist’s view of psychotherapy. Houghton Mifflin
Company, New York.
Chandras, K. V. 1997. ‘Training multiculturally competent counselors to work with Asian Indian
Americans’, Counselor Education and Supervision, 37, pp.50–59.
Sue, D. W., and D Sue. 2003. Counseling the culturally diverse: Theory and Practice (4th ed.). NY:
John Wiley and Sons, Inc.
Chandras, K. V., J. P. Eddy,and D. J. Spaulding. 2000. ‘Counseling Asian Americans: Implications
for training’. Education, 120, pp.239–246.
Schwebel, M. 1955. ‘Why unethical practice’? Journal of Counseling Psychology, Volume 2,
pp.122–128.
 Counselor Database 201

Lambert, M. 1992. ‘Implications for outcome research for psychotherapy integration’, in J. C.

Norcross and M. R. Goldstein (Eds.), Handbook of Psychotherapy Integration; pp. 94–
129. New York: Basic Books.
Sperry, L., J. Carlson, and , D. Kjos. 2003. Becoming an effective therapist. Boston: Allyn and
Bacon.
Lambert, M., and D. Barley. 2001. ‘Research summary on the therapeutic relationship and
psychotherapy outcome’. Psychotherapy, 38(4), 357–361.
Lambert, M., and K. Cattani-Thompson. 1996. ‘Current findings regarding the effectiveness of
counseling: Implications for practice’. Journal of Counseling & Development, 74, pp.601–
608.
Vogel, D. L., N. G Wade and A. H. Hackler. 2007. ‘Perceived public stigma and the willingness
to seek counseling: The mediating roles of self-stigma and attitudes towards counseling’,
Journal of Counseling Psychology, 54, pp.40–50.
Goldfarb, Dori E. 2002. ‘College counseling center clients’ expectations about counseling: How
they relate to depression, hopelessness, and actual-ideal self-discrepancies’. Journal of
College Counseling | September 22. 2002. | (http://www.accessmylibrary.com/article-
1G1-93453768/college-counseling-center-clients.html.)
Snyder, J. F., C. E. Hill,.and T. P. Derksen. 1972. ‘Why some students do not use university
counseling facilities’ Journal of Counseling Psychology, 9, pp. 263–268.
Heilbrun, A. B. ‘Toward resolution of the dependency-premature termination paradox for females
in psychotherapy’. Journal of Consulting and Clinical Psychology, 1970, 34, pp.382–386.
Frank, J. D. 1968. ‘The influence of patients’ and therapists’ expectations on the outcome of
psychotherapy’. British Journal of Medical Psychology, 4, pp. 349–356.
Goldstein, A. P. 1962. Therapist-patient expectancies in psychotherapy. New York: Macmillan.
Goldstein, A. P., K. Heller,and L. B. Sechrest. Psychotherapy and the psychology of behavior change.
New York: Wiley, 1966.
Bordin, E. S. 1955. ‘The implications of client expectations for the counseling process’. Journal of
Counseling Psychology, 2, 17–21.
Lafferty, P., L. E. Beutler and M. Crago. 1989. ‘Differences between more and less effective
psychotherapists: A study of select therapist variables’. Journal of Consulting and Clinical
Psychology, 57, pp.76–80.
Hoch, P.H. 1955. ‘Aims and limitations of psychotherapy’, American Journal of Psychiatry, 112,
pp. 321–327.
Bachelor, A. 1988. ‘How Clients Perceive Therapist Empathy: A Content Analysis of ‘Received’
Empathy’, Psychotherapy: Theory, Research and Practice 25: pp. 227–40.
Allen, S., M. Mehal, S. Palmateer and R. Sluser. 1995. The new dynamics of life skills coaching.
YWCA of Metropolitan Toronto, Toronto, 267 pp.
Belkin, G. 1988. Introduction to counseling. Wm. C. Brown, Dubuque, Iowa, 630 pp.
Wolman, R. 2001. Thinking with your soul: Spiritual intelligence and why it matters. Harmony
Books, New York, 288 pp.
Bowling, J. 1999. ‘An examination of spirituality based on Howard Gardner’s theory of multiple
intelligences’, Abstract from: PsycINFO File: Dissertation Abstracts Item: 1999-95003-
181.
Gardner, H. 1999. Intelligence reframed: multiple intelligences for the 21st century. Basic Books,
New York.
Gardner, H. 1993. Frames of mind: The theory of multiple intelligences. Basic Books, New York.
Emmons, R. 2000a. ‘Is spirituality an intelligence? Motivation, cognition, and the psychology of
ultimate concern’. International Journal for the Psychology of Religion, 10(1): pp. 3–26.
Emmons, R. 2000b. ‘Spirituality and intelligence: Problems and prospects’. International Journal
for the Psychology of Religion, 10(1): pp. 57–64.
202 Counseling: Theory, Skills and Practice

Zohar, D.,and I. Marshall. 2000. SQ: Connecting with our spiritual intelligence. Bloomsbury
Publishing, New York, p. 324.

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 8
Counseling in the Educational
Setting and Career Counseling

Chapter Overview
Counseling in an educational setting
Who is a school counselor?
System of school counseling—ASCA national model
Counselor’s role and responsibilities in schools
College counseling
Career counseling
Career theories
Campus recruitment training program

C
ounseling psychologists are nowadays sought out by a variety of institutions
and organizations, including universities, hospitals, schools, governmental
organizations, businesses, private practice, and community mental health
centers. The key areas of life that counseling can help vis-à-vis self-esteem, trauma,
relationships, stress /anxiety can affect anyone, anywhere, playing any role. Gone are
the days when counselors were only required by schools, colleges, hospitals, career
guidance centers, and corporate industries. Nevertheless, these areas still remain the
main settings where the services of a counselor play a very significant role. These will
be discussed in detail in the present chapter.

COUNSELING IN AN EDUCATIONAL SETTING

Before embarking on this topic, I would first like to clarify that the following is
what school counseling ought to be. It is definitely not how it is, in many places in
204 Counseling: Theory, Skills and Practice

India. There are many reasons for that. The first that comes to mind is that school
counseling is still a very new area in our country. Thus, there is very little awareness
about the role and responsibilities of a school counselor. For many years now
teachers have been providing counseling to students and their parents, in whatever
way, with whatever knowledge they possess. Owing to their years of experience with
the students, many teachers have become quite good at identifying and finding
solutions to student problems. Hence, there was a lot of resistance in schools to
having student counselors.
But the scenario is changing rapidly. With a lot of emphasis being given to
academic achievement, establishment of many new schools increasing the pressure
on the schools to stay afloat and come up on top, teachers are realizing that they are
unable to find time to help students with their psycho-socio-emotional issues. They
are now increasing the pressure on the managements to have a school counselor who
will help them take forward the process of counseling the students.
That being so, it is still not clear where the role of a teacher ends and that of
a counselor starts, or where the counselor’s ends and the teacher’s begins. Many
counselors who have joined schools are being given the additional responsibilities
of taking certain classes, substituting for teachers who are absent, or are bogged
down with administrative duties. This is because the students are discouraged, or
not allowed to leave the room during class hours to seek the help of the counselor.
The only time that is left for the counselor to see students is during the break (when
the students would rather play) or after school hours (when the student has to leave
as s/he is attending some other evening classes). With all the schools promoting
more and more extracurricular activities within the curriculum, there does not seem
to be much time for character education or personality development.
School counseling programs are collaborate efforts benefiting students, parents,
teachers, administrators and the overall community. School counseling programs
should be an integral part of students’ daily educational environment, and school
counselors should be partners in student achievement (ascanationalmodel.org). It
is important for the managements to recognize and utilize the counselor’s wisdom,
training and experience for augmenting positive emotional climate of their school.
The role of a counselor has undergone a big shift in the West. Today’s school
counselors are vital members of the education team. They help all students in the areas
of academic achievement, personal/social development, and career development,
ensuring today’s students become the productive, well-adjusted adults of tomorrow
(http://www.schoolcounselor.org/).
This is the view of the counselor that would be presented in this chapter.
 Counseling in the Educational Setting and Career Counseling 205

WHO IS A SCHOOL COUNSELOR?

A school counselor is a counselor and an educator. The professional school counselors

are certified/licensed educators with a minimum of a master’s degree in school
counseling, making them uniquely qualified to address all students’ academic,
personal/social and career development needs by designing, implementing,
evaluating, and enhancing a comprehensive school counseling program that
promotes and enhances student success (schoolcounselor.org).
She/he provides academic, career, college access, and personal/social competencies
to the students. The counselor develops school counseling curriculum lessons
and does annual planning for every student. The interventions include culturally
competent group, and individual counseling. School counselors use specific skills in
advocacy, leadership, systemic change, technology integration, equity assessment, and
teaming and collaboration with other stakeholders in a data-driven comprehensive
developmental school counseling program (ASCA, 2005 http://en.wikipedia.org).
Professional school counselors serve a vital role in maximizing student success
(Lapan, Gysbers, and Kayson, 2007; Stone and Dahir, 2006). Through leadership,
advocacy, and collaboration, professional school counselors promote equity and access
to rigorous educational experiences for all students. Professional school counselors
support a safe learning environment and work to safeguard the human rights of all
members of the school community (Sandhu, 2000), and address the needs of all
students through culturally relevant prevention and intervention programs that are
a part of a comprehensive school counseling program (Lee, 2001). The American
School Counselor Association recommends a counselor-to-student ratio of 1:250.

SYSTEM OF SCHOOL COUNSELING—ASCA

NATIONAL MODEL

In the United States, professional school counselors promote the development of

the school counseling program based on the following areas of the ASCA National
Model: foundation, delivery, management, and accountability, which is can be a
good system to follow changes, and adaptations can be made depending on the
management philosophy and counselor accessibility.

Foundation
Professional school counselors identify a philosophy based on school counseling
theory and research/evidence-based practice. They put these philosophies into action
and guide the development, implementation and evaluation of a culturally relevant
206 Counseling: Theory, Skills and Practice

and comprehensive school counseling program. They support the school’s mission
and collaborate with other individuals and organizations to promote students’ all
round development.

Delivery
Professional school counselors provide culturally competent services to students,
parents/guardians, school staff, and the community in the following areas:
1. School guidance curriculum: Character education, life skills training,
specific areas management groups, aptitude, and competency training
for various careers, and other knowledge and skills appropriate for their
developmental level. This curriculum is delivered throughout the school’s
overall curriculum and is systematically presented in classroom and group
activities.
2. Individual student planning: Coordinating ongoing systemic activities
designed to help students establish personal goals and develop future
plans.
3. Responsive services: Prevention and/or intervention activities to meet
students’ immediate and future needs requiring any of the following:
Individual or group counseling
Consultation with all the stakeholders like parents, teachers, and other
educators
Referrals
Peer helping
Psycho-education
Intervention and advocacy at the systemic level
4. System support: Management activities establishing, maintaining, and en-
hancing the total school counseling program including professional devel-
opment, consultation, collaboration, supervision, program management
and operations.

Management
Professional school counselors incorporate organizational processes and tools that
are concrete, clearly delineated, and reflective of the school’s needs. Processes and
tools include the following:
Agreements addressing how the school counseling program is organized
and what goals will be accomplished.
Setting up advisory councils comprising of students, parents/guardians and
teachers to review school counseling program goals and results and to make
recommendations.
 Counseling in the Educational Setting and Career Counseling 207

Collecting and utilizing student data to effect systemic change within the
school system so every student receives the benefit of the school counseling
program
Develop action plans for prevention and intervention services defining the
desired student competencies and achievement results
Actively encourage active participation in the school counseling program.

Accountability
Professional school counselors develop and implement data/needs-driven, standards-
based and research-supported programs, and engage in continuous program
evaluation activities to assess immediate, intermediate, and long-range effectiveness
of the school counseling programs.

The Students’ Developmental Needs

The school counselor should understand the nature of the developmental stage and
the corresponding life tasks and skill sets of the group of students she/he is working
with.
“Today’s young people are living in an exciting time, with an increasingly diverse
society, new technologies and expanding opportunities. To help ensure that they
are prepared to become the next generation of parents, workers, leaders and citizens,
every student needs support, guidance and opportunities during childhood, a time
of rapid growth and change. Children face unique and diverse challenges, both
personally and developmentally, that have an impact on academic achievement”
(US Department of Health and Human Services).
School counseling is a very challenging job. Students pass through many stages in
all areas of their development. Not only are there changes; there are lulls and spurts
in their growth, the individual differences are high. Coupled with an indifferent
attitude toward counseling, the counselors in India face many difficulties when
it comes to counseling children. Unless the child shows marked deterioration in
physical and mental characteristics, help is not sought. This is mainly because
parents as well as teachers not informed enough to sight and recognize symptoms
of ill health in their children. More surprisingly, the medical professionals seem
reluctant to associate physical symptoms with psychological factors. This may be
due to the fact that most medical curricula do not include behavioral sciences.
Also the stigma attached to seeing a mental health professional is still strong. All
these factors combined, make it very difficult for the counselors to receive help and
support for their endeavors.
School counseling can be divided into three major areas and the skills and
techniques the counselor needs to adopt for those areas are different.
208 Counseling: Theory, Skills and Practice

Primary school students developmental needs (ASCA.org)

During the early school years students begin to develop their academic self-concept
and their feelings of competence and confidence as learners. It is the time when they
begin to develop decision-making, communication and life skills, as well as character
values. during this period students develop and acquire attitudes toward school,
self, peers, social groups, and family. Thus, schools need to design and execute
comprehensive developmental school counseling programs to provide education,
prevention, and intervention services, all of which are integrated into all aspects
of children’s lives. The counselor’s main role would be to identify early children’s
academic and personal/social needs and intervene when there are obstructions and/
or frustrations in achieving them. this is essential to removing barriers to learning
and in promoting academic achievement. The knowledge, attitudes, and skills that
students acquire in the areas of academic, career, and personal/social development
during these elementary years serve as the foundation for future success.

Middle school students’ developmental needs (ASCA.org)

Middle school is an exciting, yet challenging time for students, their parents and
teachers. During this period of passage from childhood to adolescence, middle school
students are characterized by a need to explore a variety of interests, connecting their
learning in the classroom to its practical application in life and work; high levels
of activity coupled with frequent fatigue due to rapid growth; a search for their
own unique identity as they begin turning more frequently to peers rather than
parents for ideas and affirmation; extreme sensitivity to the comments from others;
and heavy reliance on friends to provide comfort, understanding, and approval.
School counseling programs are essential for students to achieve optimal personal
growth, acquire positive social skills and values, set appropriate career goals, and
realize full academic potential to become productive, contributing members of the
world community.

High school students’ developmental needs (ASCA.org)

High school is the time of transition into adulthood and the world of work as
students. This stage is characterized by separation––kids breaking away from parents
and exploring and defining their independence. During these years, students are
evaluating their strengths, skills, and abilities The culmination of the journey towards
self-discovery, formation of self-identity, identification of aptitude and interests,
and what they will do when they graduate all happen during this period. They are
largely influenced by their peer group. Their search for company and belongingness
lead them to rely heavily on peer acceptance and feedback. In their search for who
they are and where they want to go, they experiment a lot and hence, engage in risk
behaviors involving sex, alcohol, and drugs while exploring the boundaries of more
 Counseling in the Educational Setting and Career Counseling 209

acceptable behavior and mature, meaningful relationships. Here too peer pressure
plays a big role in both ways; either egging them to indulge in risky behavior or
helping them avoid them. Thus, during this stage group counseling helps much
more than individual counseling. They need guidance in making concrete and
compounded decisions. They must deal with academic pressures as they face high-
stakes testing, the challenges of college admissions and entrance into a competitive
job market.

COUNSELOR’S ROLE AND RESPONSIBILITIES IN SCHOOLS

Primary Level
1. School Guidance Curriculum
Academic support, including organizational, study and test-taking skills
Goal setting and decision-making
Career awareness, exploration and planning
Education on understanding self and others
Peer relationships, coping strategies and effective social skills
Communication, problem-solving and conflict resolution
Substance abuse education
Multicultural/diversity awareness

2. Student Planning
Academic planning
Goal setting/decision- making
Education on understanding of self, including strengths and weaknesses
Transition plans

3. Responsive Services
Individual and small-group counseling
Individual/family/school crisis intervention
Conflict resolution
Consultation/collaboration
Referrals

4. System Support
Professional development
Consultation, collaboration and teaming
Program management and operation
210 Counseling: Theory, Skills and Practice

5. Collaboration with
Parents
ã Parent education
ã Communication/networking
ã Academic planning
ã College/career awareness programs
ã One-on-one parent conferencing
ã Interpretation of assessment results
Students
ã Peer education
ã Peer support
ã Academic support
ã School climate
ã Leadership development
Teachers
ã Classroom guidance activities
ã Academic support, including learning style assessment and education
to help students succeed academically
ã Classroom speakers
ã At-risk student identification and implementation of interventions to
enhance success
Administrators
ã School climate
ã Behavioral management plans
ã School-wide needs assessments
ã Student data and results
ã Student assistance team building
Community
ã Job shadowing, service learning
ã Crisis interventions
ã Referrals

6. Parenting classes
Support groups
Career education

Secondary Level
1. School Guidance Curriculum
Academic skills support including organizational, study and test-taking
skills
 Counseling in the Educational Setting and Career Counseling 211

Education in understanding self and others

Coping strategies
Peer relationships and effective social skills
Communication, problem-solving, decision-making and conflict resolution
Career awareness, exploration and planning
Substance abuse education
Multicultural/diversity awareness

2. Individual Student Planning

Goal-setting/decision-making
Academic planning
Career planning
Education in understanding of self, including strengths and weaknesses
Transition planning

3. Responsive Services
Individual and small group counseling
Individual/family/school crisis intervention
Peer facilitation
Consultation/collaboration
Referrals

4. System Support
Professional development
Consultation, collaboration and teaming
Program management and operation

5. Collaboration with
Parents
ã Parent information night
ã Communication/networking
ã Academic planning programs
ã Parent and family education
ã One-on-one parent conferencing
ã Assessment results interpretation
ã Resource referrals
ã College/career exploration
Students
ã Peer education
ã Peer support
212 Counseling: Theory, Skills and Practice

ã Academic support
ã School climate
ã Leadership development
Teachers
ã Career portfolio development
ã Assistance with students’ academic plans
ã Classroom guidance activities on study skills, career development, etc.
ã Academic support, learning style assessment and education to help
students succeed academically
ã Classroom career speakers
ã At-risk student identification and implementation of interventions to
enhance success
ã Parent communication/education
Administrators
ã School climate
ã Behavioral management plans
ã School-wide needs assessment
ã Student data and results
ã Student assistance team building
ã Leadership
Community
ã Job shadowing, service learning
ã Crisis interventions
ã Referrals
6. Parenting classes
ã Support groups
ã Career education

High School Level

1. Classroom Guidance
Academic skills support
Organizational, study and test-taking skills
Post-high school planning and application process
Career planning
Education in understanding self and others
Coping strategies
Peer relationships and effective social skills
Communication, problem-solving, decision-making, conflict resolution
and study skills
 Counseling in the Educational Setting and Career Counseling 213

Career awareness and the world of work

Substance abuse education
Multicultural/diversity awareness

2. Individual Student Planning

Goal setting
Academic plans
Career plans
Problem solving
Education in understanding of self, including strengths and weaknesses
Transition plans

3. Responsive Services
Individual and small-group counseling
Individual/family/school crisis intervention
Peer facilitation
Consultation/collaboration
Referrals

4. System Support
Professional development
Consultation, collaboration and teaming
Program management and operation

5. Collaboration with
Parents
ã Academic planning/support
ã Post-high school planning
ã Scholarship/financial search process
ã School-to-parent communications
ã School-to-work transition programs
ã One-on-one parent conferencing
ã Referral process
Students
ã Academic support services
ã Program planning
ã Peer education program
ã Peer mediation program
ã Crisis management
ã Transition programs
214 Counseling: Theory, Skills and Practice

Teachers
ã Portfolio development, providing recommendations and assisting
students with the post-secondary application process
ã Classroom guidance lessons on post-secondary planning, study skills,
career development, etc.
ã School-to-work transition programs
ã Academic support, learning style assessment and education to help
students succeed academically
ã Classroom speakers
ã At-risk student identification and implementation of interventions to
enhance success
Administrators
ã School climate
ã Academic support interventions
ã Behavioral management plans
ã School-wide needs assessments
ã Data sharing
ã Student assistance team development
Community
ã Job shadowing, worked-based learning, part-time jobs, etc.
ã Crisis interventions
ã Referrals
ã Career education

COLLEGE COUNSELING

Differences between high school and college

(adapted from http://www.iupui.edu/parents/success1.html)
In High School In College
Academic expectations
Academic expectations are not always set Academic expectations are more often set
by the person, they are often set by parents by the person, sense of responsibility is
and/or teachers . much higher. Thus, stress is higher, feelings
of guilt rather than anger occur.
Teacher student contact
Teacher-student contact is close and Teacher student contact is less frequent
frequent. Teachers are usually very with teachers being less accessible and
accessible. distant to address student concerns.
 Counseling in the Educational Setting and Career Counseling 215

Dependence
The teacher prepares a lesson plan and The instructor does not organize the
uses it to tell students how to prepare for material for the students, the constant
the next class period (e.g., “Be sure to read reminders for submission of work are
Chapter 3 in your textbook,” or “Don’t absent, more autonomy and less guidance
forget to study for tomorrow’s test”). given.
Assignments and work
Students are assigned homework and Instructors assume students have learned
assignments, which teachers collect and how to “keep up” with their assignments
check to ensure that assigned work is being in high school and can be trusted to do
done. Student is told what to do in most course work without being constantly
situations. Follow-up on instructions is reminded. Students must exercise more
often the rule. self-discipline in following through and
completing assignments.
Counseling
Parents, teachers, and counselors give Students must learn to rely on themselves
advice to and often make decisions for and begin to experience the results of their
students. Students need to abide by their own good and bad decisions. It is their
parents’ boundaries and restrictions. responsibility to seek advice when they
need it and to set their own restrictions.
Responsibility
Teachers often contact parents if problems Students have much more freedom, and
occur. Parents are expected to help students must take responsibility for their own ac-
in times of crisis. tions. Parents may not even be aware that
a crisis has occurred.
Distractions
Distractions from school and community Distractions can be numerous because of
activities are partially controlled by school opportunities to become involved in non-
and home. There are distractions from academic activities. Time management
school work, but these are at least partially and the ability to prioritize become
controlled by rules at school and home absolutely essential survival skills for
(e.g., curfews, dress codes, and enforced college students.
study hours).
Motivation
Student gets stimulation to achieve or Students must become self-motivating.
participate from parents, teachers, and Parents, faculty, advisors less important.
counselors.
Freedom
Student activity is generally set by school Student has more freedom, particularly
and community tradition and acceptance. in out-of-class time. She/he must be in
charge in scheduling time and establishing
priorities and must accept responsibility
for own actions.
216 Counseling: Theory, Skills and Practice

Value judgments
Student’s judgments are often based on Value judgments become more
parent’s values. self-oriented.

The college counselor mainly works with students in the age range 17 to 23 years.
The above section makes it very clear that the stage characteristics and developmental
tasks are quite different for school and college students. Counseling therefore has to
be geared toward helping the college students effectively.
Responsibilities of a college counselor:
Review, adjust, and improve the college counseling program each year.
Establish and teach the college counseling curriculum in small group
Meet with students individually.
Oversee progress through the spring process of preparing a summer visit
list.
Provide college counseling services through group and individual
counseling.
Organize and maintain College Counseling Center containing college
catalogs, brochures, handbooks, and other appropriate resource materials.
Coordinate and manage the college and program outreach people who are
working with students under the direction of the college counselor.
Train and supervise personnel assisting in the College Center, including
peer college counselors.

Required skills
1. Ability to work with parents, students, faculty, college educational
representatives, as well as community groups.
2. Understanding of student maturity levels and the process of goal
selection.
3. Ability to motivate students and provide academic incentives for success.
4. Ability to use culturally relevant and responsive strategies when planning
programs and making presentations.

CAREER COUNSELING

“No two persons are born alike but each differs from the other in individual endowments,
one being suited for one thing and another for another, and all things will be provided in
superior quality and quantity and with greatest ease, when each man works at a single
occupation, in accordance with his natural gifts.”
—Plato (427–347 B. C.).
 Counseling in the Educational Setting and Career Counseling 217

Definitions
Career counseling
Career counseling is a largely verbal process in which a counselor and counselee(s)
are in a dynamic and collaborative relationship, focused on identifying and acting
on the counselee’s goals, in which the counselor employs a repertoire of diverse
techniques and processes, to help bring about self-understanding, understanding of
behavioral options available, and informed decision making in the counselee, who
has the responsibility for his or her own actions (Herr & Cramer, 1996).

Career
Career is the interaction of work roles and other life roles over a person’s lifespan
including both paid and unpaid work in an individual’s life. People create career
patterns as they make decisions about education, work, family and other life roles.

Career development
Career development is the total constellation of economic, sociological, psychological,
educational, physical and chance factors that combine to shape one’s career (Sears,
1982).
Career counseling is the one-on-one or group professional assistance in
exploration and decision making tasks related to choosing a major/occupation,
transition into the world of work or further professional training (fact-archive.com).
The field is vast and includes career assessment, career placement, career planning,
career development, learning strategies, student development. Career counseling
advisors assess one’s interests, personality, values and skills help them to explore
career options. Counselors teach students how to explore and investigate appropriate
majors, graduate programs, and occupations (indianchild.com).
Career counselors help people make the right career decisions. She/he assesses the
client’s personality, interests, educational level, skills and work history, and matches
them to a suitable career or work industry. They provide help with job search, job
applications, and interview preparations also offering support in cases of job loss,
career transition and work-related stress.
Career counselors are very much needed in today’s world. The economy is
changing rapidly, especially in India and there is a growing trend toward multiple
career changes similar to that observed in the West. Very soon there should be no
dearth of career counselor jobs.
Career counselors can work in job training centers, in career information centers,
and in vocational rehabilitation centers. They can work in local and national
government agencies, in the army, in welfare organizations, in business corporations,
and in schools, colleges, and universities (wisegeek.com). They may also be self-
218 Counseling: Theory, Skills and Practice

employed in group practices or have their own private practice. The career counselor
with a private practice must not only be professionally qualified, but also adept in
marketing, in management, in establishing a wide contacts network and in keeping
skills and knowledge current.
Through participation in career counseling classes and workshops teenagers
benefit tremendously. Not only do they learn which careers they are most suited for,
but they also learn which jobs pay the most and sometime even which companies
to avoid. Through career counseling they will learn about trends in different
industries as well as projected future trends. Students who are happy with their
suggested career choices, and the required courses for that career, tend to do better
in high school and college.
There’s more to career counseling than placement tests, however. Career
counselors help in resume writing, suggest efficient methods of searching for
employment, acquire and strengthen negotiation skills, and basically assist in getting
better salary and promotion packages, and generally steer them in the right direction.
When people are happy in their careers society as a whole benefits. Unhappiness
in the workplace causes stress. Happy workers are also productive workers. The
advancement and growth of any society rests on people’s productivity. There is a
growing trend that is observed among many business leaders who are starting to
now send promising employees to receive career counseling to determine where they
would be the happiest, and subsequently do the most good, within their companies.
This way they can provide them with work conditions, physical or material, that
will enhance their comfort level and ensure that they get the optimum level of
productivity by those chosen. This benefits the economy as well. Those who are
happy with their jobs are less likely to become unemployed. This means there’s a
lower turnover rate among businesses that encourage career counseling for their
employees.
There are various assumptions underlying the practice of career counseling
(UNESCO 2002).
These include the following perspectives:
1. People have the ability and opportunity to make career choices for their
lives. The amount of freedom in choices is partially dependent upon the
social, economic, and cultural context of individuals.
2. Opportunities and choices should be available for all people, regardless of
sex, socio-economic class, religion, disability, sexual orientation, age, or
cultural background.
3. Individuals are naturally presented with career choices throughout their
lives.
4. People are generally involved in a wide range of work roles across their
lifespan. These roles include both paid and unpaid work.
 Counseling in the Educational Setting and Career Counseling 219

5. Career counselors assist people to explore, pursue, and attain their career
goals.
6. Career counseling basically consists of four elements: (a) helping individuals
to gain greater self-awareness in areas such as interests, values, abilities,
and personality style, (b) connecting students to resources so that they can
become more knowledgeable about jobs and occupations, (c) engaging
students in the decision-making process in order that they can choose a
career path that is well suited to their own interests, values, abilities, and
personality style, and (d) assisting individuals to be active managers of their
career paths (including managing career transitions and balancing various
life roles) as well as becoming lifelong learners in the sense of professional
development over the lifespan.
7. The reasons why individuals enter particular occupations vary according
to the amount of importance placed on personal preferences, such as
interests, or external influences, such as labor market trends or parental
expectations.
8. Career decision-making is not something that happens only once in a
person’s life but, rather, it is an ongoing process that might take place at
any age.
9. All forms of work are valuable, and contribute to the success and wellbeing
of a society.

CAREER THEORIES

There are several types of theories of vocational choice and development. They
include trait factor theories, social cognitive theories, and developmental theories.
1. Holland’s Career Typology, 1959: John Holland’s theory explained that
individuals are attracted to that occupation that meets their personal needs
and provides them satisfaction .This he calls modal personal orientation or
a developmental process established through heredity and the individual’s
life history of reacting to environmental demands. Holland’s theory rests
on four assumptions:
1. Individuals can be categorized as one of the six vocational personality/
interest types: realistic, investigative, artistic, social, enterprising or
conventional.
2. There are six modal environments: realistic, investigative, artistic,
social, enterprising and conventional.
3. People search for environments that will let them exercise their skills
and abilities, express their attitudes and values, and take on agreeable
problems and roles.
220 Counseling: Theory, Skills and Practice

4. Behavior is determined by an interaction between personality and

environment.
A hexagonal model was developed to illustrate the relationship between
personality and occupational environment. Congruence is seen when a person’s
vocational interests match his or her work environment types. Congruence has been
found to predict occupation and college major (Betz, N., 2008).
2. The theory of work adjustment (TWA): It was published by Dawis,
England and Lofquist in 1964 as Monograph XV of the Minesota studies
of Vocational Rehabilitation, University of Minnesota. It deals with the
problems of description, prediction and facilitation of work adjustment.
The authors say that many problems posed by work, such as choice of
career, continuing in and progressing in a career, performing satisfactorily
in jobs, and deriving satisfaction from work all can be understood from
the understanding of work adjustment. The TWA is based on the
concept of correspondence between the individual and his environment
and its. this correspondence can be seen in many ways which later lead
to different results. A harmonious relationship between the individual
and the environment predicts job satisfaction, and the suitability of the
individual to the environment and of the environment for the individual
predicts job satisfactoriness. The individual brings into the environment
his requirements, skills and knowledge; and the environment likewise has
its own requirements and expectations of the individual also providing
rewards (wages, prestige, personal relationships) to the individual. Job
satisfaction and satisfactoriness together should determine how long one
remains at a job. In order to survive or exist in the environment, the
individual must achieve some degree of correspondence. When there is a
discrepancy between a worker’s needs or skills and the job’s needs or skills,
then change needs to occur either in the worker or the job environment.
3. Lent, Brown and Hackett’s Social Cognitive Career Theory, 1987:
The SCCT has grown out of Albert Bandura’s social cognitive theory.
It attempts address issues of culture, gender, genetic endowment, social
context and unexpected life events that may interact with and supersede the
effects of career-related choices. It reflects Bandura’s work on self-efficacy
and expands it to interest development, choice making, and performance.
In SCCT, focus is on the connection of person variables which include
self-efficacy beliefs, outcome expectations, and personal goals that influence
the individual’s career choice. The model also includes demographics,
ability, values, and environment. SCCT proposes that career choice is
influenced by the beliefs the individual develops and refines through four
major sources:
 Counseling in the Educational Setting and Career Counseling 221

(a) personal performance accomplishments

(b) vicarious learning
(c) social persuasion
(d) physiological states and reactions
The individual develops an expertise/ability for a particular endeavor. When this
meets with success it reinforces one’s self-efficacy or belief in future continued success
in the use of this ability/expertise. As a result, one is likely to develop goals that
involve continuing involvement in that activity/endeavor. This is an evolutionary
process which begins in early childhood, continues throughout adulthood, and helps
the individual narrow the scope to successful endeavors which gives them a sense of
their competence at a vast array of performance areas and then to focus on and form
a career goal/choice at which they are successful and offers valued compensation.
The contextual factors come into play by influencing the individual’s perception
of the probability of success. If the person perceives few barriers the likelihood of
success reinforces the career choice, but if the barriers are viewed as significant there
is a weaker interest and choice actions.
Through a process of intervening learning experiences that shape further one’s
abilities and impacts self-efficacy and outcome beliefs, one’s vocational interests,
choices and performances are shaped and reshaped. Efficacy and outcome
expectations are theorized to interrelate and influence interest development, which
in turn influences choice of goals and then actions. Environmental supports and
barriers also affect goals and actions. Actions lead to performance and choice stability
over time.
4. Super’s Theory of Vocational Choice, 1954: Career development theories
propose vocational models that include changes throughout the lifespan.
Super’s model proposes a lifelong six life and career development stages.
These stages are
1. The crystallization stage, ages 14–18
2. Specification stage, ages 18–21
3. Implementation stage, ages 21–24
4. The stabilization stage, ages 24–35
5. Consolidation, age 35
6. Readiness for retirement, age 55
These stages followed the pattern of growth, exploration, establishment,
maintenance, and disengagement. Throughout life, people have many roles that
may differ in terms of importance and meaning. Super also theorized that career
development is an implementation of self-concept. He recognized that the self-
concept changes and develops throughout people’s lives as a result of experience.
Over time people successively refine their self-concept(s). And its application to the
world of work creates adaptation in their career choice.
222 Counseling: Theory, Skills and Practice

5. Ginzberg, Ginsburg, Axelrad and Herma Theory, 1951: They recognized

that vocational choice is influenced by four facts:
1. the reality factor
2. the influence of the educational process
3. the emotional factor
4. individual values
…and proposed that it is a development path that leads to career choice.
He also said that individuals pass through three stages:
1. Fantasy stage where the child is free enough to pursue any occupational choice.
Through this process the child’s preferred activities are identified and related to
future career choices.
2. Tentative stage begins in the preteen and continues to high school. During
this stage the individual further defines his or her interests in, capacity for and values
of an occupational choice. The cumulative effect of the process is the transition
process in which the adolescent begins the career choice process, recognizes the
consequences and responsibility of that choice.
3. Realistic stage spans from mid adolescence through young adulthood. This
has three sub-stages: exploration, crystallization and specification. During the
exploration stage the adolescent begins to restrict choice based on personal likes,
skills and abilities. In the crystallization stage an occupational choice is made. This is
then followed by the specification stage where the individual pursues the educational
experiences required achieving his career goal.
6. Linda Gottfredson’s theory of career development—Circumscription and
Compromise, 1981: Vocational choice is seen as a search for a life career
that fits one’s concept of self, both socially and psychologically. Linda
Gottfredson perceived career choice as having a developmental trajectory.
According to this theory, four developmental processes guide the person-
job matching process during the first two decades of life:
1. age-related growth in cognitive ability (cognitive growth)
2. increasingly self-directed development of self (self-creation)
3. progressive elimination of least favored vocational alternatives
(circumscription)
4. accommodation to constraints on implementing most favored
alternatives (compromise).
That is career choice evolves within an individual as they grow up in their family
and society. However there are the effects of socialization which play a major part in
determining career choices. She theorized about a cognitive career decision-making
process that develops through the lifespan.
She begins with four assumptions:
1. Cognitive Growth: The career development process begins in childhood.
Cognitive growth is the development of thinking …intuitively in preschool
 Counseling in the Educational Setting and Career Counseling 223

years; concretely in the elementary years to abstractly in adolescence. As this

process moves on they become able to absorb, comprehend, and analyze
complex information, make out subtle distinctions among people and
occupations, compare them along more dimensions, make inferences about
internal states, and discern patterns in their own behavior. And then by
adolescence, they are able to perceive the complex social structure of work
that adults do, and make a cognitive map of occupations which arrays jobs
according to sex type and prestige level and, within that array, according
to field of work. Young people develop increasingly individualized self-
concepts are better able to discern who they are as unique psychological
beings. The challenge for counselors is to enhance learning by reducing
the complexity of the information they provide and accommodating
counselees’ differences in ability to learn and comprehend (Gottfredson).
2. Self-Expression: Career aspirations are self-expressive reflecting the origins
and boundaries of the individual’s self-concept. Individuals are not born
with a sense of self. It develops through the experiences of the individuals and
are shaped by the interactive influences of the genotype and environment.
The self-concept is the individual’s perceptions of intelligence, social
status, gender, values and personality. It is based to a large extent on social
identity. Career choice is an attempt to implement that self-concept.
3. Circumscription: Early vocational choice proceeds as a process of
elimination. As children become aware of occupational differences in
sextype, then prestige, and finally field of work, they rule out successively
more sectors of work as unacceptable for someone like themselves.
Stage 1: Orientation to Size and Power (Ages 3–5)
Stage 2: Orientation to Sex Roles (Masculinity/Femininity) (Ages 6–8)
Stage 3: Orientation to Social Valuation (Prestige) (Ages 9–13)
Stage 4: Orientation to Unique, Internal Self (Personal Interest) (Ages 14
and Older)
Career satisfaction is dependent on the degree to which the career is
congruent with self-perceptions. Lack of knowledge about the extent of
historical and societal influences causes them to doubt their career choice
in times of duress. At this point the individual feels, as Gottfredson puts it,
“circumscribed”.
4. Compromise: Accessibility to the perfect person-job match is limited the
cost and effort of locating current opportunities for education, training, and
employment, by labor market conditions, the availability of appropriate
training, and many other factors over which the person has no control. Not
all suitable choices are accessible, so individuals must often compromise.
The theory predicts that first the individual compromises on personal
interest, then their prestige and only last on their gender stereotype.
224 Counseling: Theory, Skills and Practice

The counseling challenge is to minimize unnecessary compromise by optimizing

self-investment, specifically, by helping young people assess the accessibility of their
preferred education, training, and employment, and by promoting self-agency in
improving their own opportunities, qualifications, and support network.

Career Counseling
Career counseling may include provision of occupational information, modeling
skills, written exercises, and exploration of career goals and plans (Whiston, S.C.
and Rahardja, D., 2008). It also involves the use of personality or career interest
assessments, such as the Myers-Briggs type indicator or the Strong Interest Inventory,
which makes use of Holland’s theory.
Career counseling can also focus on helping those who need to obtain work.
When people seek out a career counselor or are referred to one, they may work with
that counselor to evaluate skills, learn how to improve skills, learn how to successfully
search for jobs, and develop methods for effectively applying and interviewing for
work.

What does a Career Counselor do?

The career counselor can also help individuals who have trouble maintaining jobs
or who have certain skills that are no longer in demand. This person experiences a
need to transition to a new career. Also people who are finding it difficult to find
employment due to limiting factors as age or disability definitely benefit from seeing
a career counselor. They are helped not only to search for accessible opportunities,
but also to accept or compromise on their expectations or interests.
The vocational counselor identifies interests of the client, through standard tools
of assessment and, of course, conversation. The client who is seeking a new career
is asked by, the counselor to complete some tests that would determine the client’s
strengths. A very common method of doing this is the SWOT analysis which
brings to light the counselee’s strengths, weaknesses, opportunities and threats.
The individual can do a personal SWOT And professional SWOT analysis. The
counselor then helps the counselee analyze employment options, match his or her
personality, aptitude and interests with a career or job and develop the skills necessary
to get a job. If the client has enough skills in a certain area the counselor encourages
the counselee to immediately start applying for work. If not, the counselor could
recommend training programs to gather more skills and find employment in an area
the client could enjoy.
The counselor contacts hiring managers at various companies to determine
if the individual receiving career counseling is a good fit for their organization.
Although the role of a vocational counselor is similar to that of employment agencies,
differences exist. Rather than working to make a profit off job placement, he or she
 Counseling in the Educational Setting and Career Counseling 225

works with the goal of helping job seekers who are unsuccessful in finding work to
obtain employment.
A career counselor begins the job by meeting with client and assessing his or
her abilities, reviews the resume and discusses the professional and educational
experience contained within. Through a series of questions the counselor then
determines what kind of work the client prefers. The counselor also asks about any
special skills the client possesses while discussing technical proficiency. Once the
career counselor understands the client’s background and goals, he or she can work
with companies in need of staff to find a potential employment match.
A career counselor can also be extremely helpful in situations where individuals
need to change careers. These are difficult times, times of recession, and people
are often facing situations, such as downsizing or the gradual obsolescence of a
particular line of work. The counselor then assesses the client’s background, skills,
and experience and help identify other career options that may or may not have
occurred to the displaced employee. This process leads to discovering a whole new
way to make use of the abilities of the employee in a new setting, or identifying what
type of training would be needed to make the employee attractive to prospective
employers.
Many high school and college campuses have career counselors to help students
evaluate their interests and abilities. These counselors provide the student guidance
with decisions on the “right” educational plan:
Which college/company?
How much will it cost?
Understanding the college admission /job seeking process
Instruction in techniques for the admission/job seeking process
Support for complying with procedures and timetables
Learn lifelong skills in
Resume writing
Interviewing

CAMPUS RECRUITMENT TRAINING PROGRAM

Most colleges have a placement training cell so as to help students find placements.
The term “campus recruitment” refers to the system where various organizations
visit college campuses to recruit bright youngsters to work for them. It provides a
platform for the companies to meet the aspirants and pick up intelligent, committed
youth who have the requisite enthusiasm and zeal to prove themselves. With the
growth in IT industries the need for talented and self-motivated youth has grown.
Globalization has caused companies to raise the bar or efficiency and attitude of
the workers. In order to find the best possible placement, students, good or mediocre,
226 Counseling: Theory, Skills and Practice

need to put up their best. The competition has become significantly stiffer and the
companies do not want to compromise on quality. They are willing to pay for the
best. Again, brilliance in academics alone is not going to get the students through
the rigorous recruitment process. Their communication and presentation skills have
to be polished and perfected.
The campus recruitment training program is designed to aid the students in
their preparation for recruitment. Students in their final leg of studies or qualified
candidates looking for placement in reputed organizations make are provided this
training to get trained to deliver their best in the selection processes of organizations.
The participants are trained thoroughly. The various stages of the selection process
stay generally the same for the companies, with maybe some slight variations. The
following are the stages that students normally go through as part of recruitment
process:
1. Aptitude tests
2. Group discussion process
3. Interview process

Aptitude tests
The aptitude tests are used by most organizations as a process of elimination,
especially when the number of applicants is considerable. In addition to that,
these tests give the selectors a good idea of the candidate’s reasoning ability, critical
thinking ability, and communication skills. The campus recruitment training
program hones the students’ existing skills and teaches tips that will help them ace
such Aptitude Tests.

Group discussions
Group discussion exercises are designed to test the candidate’s ability to act as a
leader and a team player. The other traits displayed in such exercises are clarity of
thought process, the ability to think differently, and the ability to lend direction.
The preparation for the GD includes providing basic guidelines on facing a GD
panel and mock GDs to ensure that students gain confidence and overcome their
misgivings. In order to hone their skills and polish their performance these mock
GDs are followed by individual and group feedback sessions.

Personal interviews
The last leg of the selection process is usually a personal interview, which gives the
selectors an opportunity to know the candidate better and to assess the suitability of
the candidate’s skills to the requirements of the organization. Mock interviews are
conducted by expert trainers. Feedback sessions form part of each mock interview
so that the candidate can implement the suggestions and incorporate the feedback
for later mock interviews.
 Counseling in the Educational Setting and Career Counseling 227

v Summary v
Today’s school counselors are vital members of the education team. They
help all students in the areas of academic achievement, personal/social
development, and career development, ensuring today’s students become
the productive, well-adjusted adults of tomorrow.
A school counselor is a counselor and an educator. Certified/licensed
to address all students’ academic, personal/social and career development
needs by designing, implementing, evaluating, and enhancing a
comprehensive school counseling program that promotes and enhances
student success. She/he provides academic, career, college access,
and personal/social competencies to the students. Through leadership,
advocacy, and collaboration, professional school counselors promote equity
and access to rigorous educational experiences for all students.
In the United States, professional school counselors promote the
development of the school counseling program based on the following
areas of the ASCA National Model: foundation, delivery, management, and
accountability. The school counselor should understand the nature of the
developmental stage and the corresponding life tasks and skill sets of the
group of students she/he is working with.
School counseling can be divided into three major areas and the skills
and techniques the counselor needs to adopt for those areas are different.
The counselor is required to possess the following skills: ability to work
with parents, students, faculty, college educational representatives, as well
as community groups, understanding of student maturity levels and the
process of goal selection, ability to motivate students and provide academic
incentives for success, ability to use culturally relevant and responsive
strategies when planning programs and making presentations.
Career counseling is a largely verbal process in which a counselor and
counselee(s) are in a dynamic and collaborative relationship, focused on
identifying and acting on the counselee’s goals, in which the counselor
employs a repertoire of diverse techniques and processes, to help bring
about self-understanding, understanding of behavioral options available,
and informed decision making in the counselee, who has the responsibility
for his or her own actions.
Career counselors help people make the right career decisions. She/
he assesses the client’s personality, interests, educational level, skills and
work history, and matches them to a suitable career or work industry. They
provide help with job search, job applications, and interview preparations
also offering support in cases of job loss, career transition and work-related
stress.
There are several types of theories of vocational choice and
development. They include trait factor theories, social cognitive theories,
and developmental theories.
228 Counseling: Theory, Skills and Practice

Most colleges have a placement training cell so as to help students find

placements. The term “campus recruitment” refers to the system where
various organizations visit college campuses to recruit bright youngsters
to work for them. It provides a platform for the companies to meet the
aspirants and pick up intelligent, committed youth who have the requisite
enthusiasm and zeal to prove themselves. With the growth in IT industries
the need for talented and self-motivated youth has grown. The following
are the stages that students normally go through as part of recruitment
process:
1. Aptitude tests
2. Group discussion process
3. Interview process

References
Betz, N. 2008. ‘Advances in Vocational Theories’, in S. Brown and R. Lent (Eds.), Handbook of
Counseling Psychology, (4th ed). NY: Wiley.
Gottfredson, Linda S. 1981. ‘Circumscription and Compromise: A developmental theory of
occupational aspirations’. Journal of Counseling Psychology. Vol. 28(6), pp. 545–579.
Gottfredson, Linda S. 1996. ‘Gottfredson’s Theory of Circumscription and compromise’ in Career
Choice and Development (3rd ed.), edited by D. Brown and L. Brooks, San Francisco:
Jossey-Bass: pp. 179–232.
Gottfredson, Linda S. 1999. ‘The Nature and Nurture of Vocational Interests’, in Vocational
Interests: Their Meaning, Measurement, and Use in Counseling, edited by M. L. Savickas
and A. R. Spokane. Palo Alto; CA: Davies-Black Publishing: pp. 57–85.
Herr, E. L and S.H. Cramer. 1996. Career Guidance and Counseling through the Life Span. New
York, Longman.
http://www.ascanationalmodel.org/
http://www.fact-archive.com/encyclopedia/Career
http://www.indianchild.com/career_counseling.htm
http://www.schoolcounselor.org/content.asp?contentid=240
http://www.wisegeek.com/how-do-i-become-a-career-counselor.htm
Sears, S. 1982. ‘A Definition of Career Guidance Terms: A National Vocational Guidance
Association Perspective’, Vocational Guidance Quarterly, Vol. 31, pp. 137–143.
US Department of Health and Human Services – “Toward a Blueprint for Youth: Making
Positive Youth Development a National Priority” UNESCO, 2002. Handbook on Career
Counseling.
Whiston, S.C. and D. Rahardja. 2008. ‘Vocational Counseling Process and Outcome’ in S. Brown
and R. Lent (Eds.), Handbook of Counseling Psychology, (4th ed). NY: Wiley.
 9
Workplace Counseling

Chapter Overview
Why workplace counseling?
Models of workplace counseling
Theoretical models of stress
Workplace counseling in India

T
he role of the organization is to support the process of employee
empowerment through promoting mental health education, counseling
and other information services to the workforce.
N. Tehrani, Counseling Psychology Quarterly

Workplace counseling is the latest buzzword in corporate HR across the world––

”Employee Counseling at Workplace.” The level of stress in organizations seems to
be at an all-time high. The modern work place is very demanding with the employees
suffering from “presenteeism”––the need to be seen at work while being overstressed
doing the job. Insecurity about their jobs makes them afraid to take time off. As
employees struggle to cope, employers as well as health experts are working overtime
to develop new ways of managing workplace stress and its inevitable implications.
There are several reasons why employers need to be closely involved in the physical
and mental well-being of their employees. A psychologically healthy workplace fosters
employee happiness and well-being while enhancing organizational performance
and productivity. In today’s fast-paced corporate world, stress cannot be avoided–
–meeting deadlines, achieving targets, lack of time to fulfill both personal and
family as well as professional commitments. The employees are stressed, depressed,
suffering from too much anxiety arising out of various workplace-related issues.
It is getting to be a huge challenge for the organizations to maintain a stress-free
yet motivated and capable workforce. Therefore, many companies have integrated
the counseling services in their organizations and making it a part of their culture.
230 Counseling: Theory, Skills and Practice

Organizations are offering the service of employee counseling to its employees. In

such ever-increasing complexity and stress, employee counseling has emerged as the
latest HR tool to attract and retain best employees and to increase the quality of the
workforce in an organization.
There are times in people’s lives when problems arising from the place of work
or personal life increase their stress levels and start to affect their performance.
Counseling in the workplace provides help and support to the employees to face
and sail through these difficult times in life. The counselors analyze work-related
performance and behavior of the employees to help them cope with it, resolve
conflicts and tribulations and reinforce the desired results.

WHY WORKPLACE COUNSELING?

Illness and productivity do not go together. Every employer has an idea about the
work involved and the resultant pressure and stress. They are now beginning to
realize that it is wise to anticipate stress, and the risks involved and keep counseling
support services handy.
With the economy finding its feet, many organizations are undergoing many
changes. All that they had planned for but were unable to fulfill due to the recession
are starting to take off. As change is never easy, it disrupts, disorients, and throws
people out of balance and causes grief. Support is needed then for the individuals to
cope and adjust, and transition into the new. Counseling helps and improves mental
health and personal effectiveness.
The growth and long-term sustainability of any organization is firmly rooted in its
human resources. Counseling highlights the value of people as organizational assets.
Employee happiness and satisfaction lead to a sense of ownership and belonging
toward their organization. When employees feel that they are well taken care of, the
drive to work and perform will be very high.
Apart from their personal problems, there are various reasons that can create stress
for the employees at the workplace like unrealistic targets or workload, constant
pressure to meet the deadlines, career problems, responsibility and accountability,
conflicts or bad interpersonal relations with superiors and subordinates, problems in
adjusting to the organizational culture. Counseling helps the employee to share and
look at his problems from a new perspective, help himself and to face and deal with
the problems in a better way. Counseling at workplace is a way of the organization
to care about its employees. Counseling programs at the workplace work toward
stimulating personal growth and offering help in addressing many situations that
cause emotional stress.
 Workplace Counseling 231

Counseling services need not necessarily be interventive. They need to be

preventive too. Instead of waiting for a crisis to happen and then intervene,
employees are encouraged to attend and participate in education and counseling
workshops and programs that prevent mental illness. A “wholeness” approach
to employee well-being is now being adopted everywhere catering to physical,
cognitive, emotional, social, and spiritual needs.
A very important duty of the workplace counselor, as with any other counselor,
is appropriate referrals after assessment. Every problem cannot be solved at the
workplace during the work time. And the counselor may not have time for long
term therapy. Some employees may not feel comfortable dealing with their personal
problems in their work environment. These are some of the good reasons for the
workplace counselor to refer to an outside counselor. In case of clinical problems,
the employee needs to be referred to a psychiatrist or a clinical psychologist.

Benefits of a Psychologically Healthy Workplace

Benefits to employees
Increased job satisfaction
Higher morale
Better physical and mental health
Enhanced motivation
Improved ability to manage stress
Helping the individual to understand and help himself
Understand the situations and look at them with a new perspective and
positive outlook
Helping in better decision making
Alternate solutions to problems
Coping with the situation and the stress
Benefits to the organization
Improved quality, performance, and productivity
Reduced absenteeism and turnover
Fewer accidents and injuries
Better able to attract and retain top-quality employees
Improved customer service and satisfaction
Lower healthcare costs
Typical problems that affect work and productivity can be both professional
(arising out of and existing in workplace) as well as personal. They include the
following:
Poor relationship between two key members of a production team.
People who fail to deliver what they promise.
232 Counseling: Theory, Skills and Practice

People who take up more time than necessary with gossip or other time-
wasting activities during meetings.
Not having the authority to do what is required.
Dealing with incompetence in others.
Poor or no direction from the person assigning the task.
Too many tasks and responsibilities—and not enough time to do them.
Inadequate acknowledgement of your efforts.
Criticism from others.
An employee who forgets to do an assignment or who flagrantly refuses to
do an assigned task (insubordination or refusal to accept a reasonable and
proper assignment from an authorized supervisor).
Receiving and making excessive or lengthy personal phone calls (excessive
use of the telephone for personal reasons).
Speaking to a co-worker or supervisor or anyone using undesired and/or
vulgar language (use of profane/abusive language).
Disappearing or leaving the work area without informing a supervisor
for an indefinite or unreasonable period (leaving work station without
authorization).
Sexual harassment
Domestic violence
Alcoholism
Divorce, grief, and other personal problems
Career change and job stress
Social and emotional difficulties related to disability and illness

Problems of Women at the Workplace

Even though we are progressing and more women are taking up careers, it still
seems to be a man’s world. Social attitude to the role of women lags much behind
the law. A gender bias creates an obstacle at the recruitment stage itself. There is a
lot of gender bias dictating what careers women are good at, what roles they must
play, where they are better suited, etc. Thus, women find employment easily in
the routine submissive or caring and nurturing sectors as nurses, doctors, teachers,
secretaries or in assembling jobs. However preference is given to a male even if well-
qualified women engineers or managers or geologists are available.
Family responsibilities, pregnancy, and preferred work timings are stacked up
against women’s smooth upward movement in their chosen career path. In fact,
they have to prove themselves not equal to but better than their male counterparts in
order to receive the same treatment. And even then it is not personally satisfying as
there is a lot of stress to maintain that position. As many women become frustrated
and quit trying to move up after a certain level, the persistently ambitious ones face
 Workplace Counseling 233

loneliness at the top. Their co-workers mainly are men and they have problems
fitting in: right from seemingly very minor issues as coffee break camaraderie,
restroom conversations, and afterwork hangouts, to important decisions being made
over a drink at the pub in an informal meeting, or casual phone calls. Most of the
top managers are men and they also prefer to talk with their subordinates who are
men. The sexual harassment claims have not helped either. Men are very careful to
not be too casual or over friendly with their female co-workers. This leads to a sense
of discomfort, suspicion, and therefore distance between the sexes, which affects
women more negatively.
After crossing all these hurdles if women do manage to reach the top, they are
expected to perform much better in terms of expertise and efficiency than the men,
to command respect and allegiance, and maintain their position. In many places,
the inbuilt conviction that women are capable of less work than men or less efficient
than men governs this injustice of unequal salaries and wages for the same job.
In addition to their problems at work, it is important to note that womens’ work
is not merely confined to paid employment. Almost always she has to shoulder
the burden of the household as well. This coupled with her reduced control over
the money and financial decision making in the family, makes her frustrated and
depressed. So the basic motive for seeking independence through employment
independence is nullified in many women’s case. This affects her productivity at
work. This leads to employers choosing men over women and thus completes a
vicious cycle.
Maternity leave is seldom given. It is much easier to terminate the woman’s
employment and hire someone else. Sexual harassment is one more issue––physical
harassment during travel by public transport, unwanted attention offered by
colleagues, and sexual demands by a higher officer. To add insult to injury, if a
woman is praised for her work or promoted on merit, her colleagues do not hesitate
to attribute it to sexual favors.
Another facet of women’s stress is the fact that they are seldom considered for
out-of-town training programs, conferences or workshops. Sometimes due to family
commitments, women, on their own accord, decline. If she declines twice, she is not
considered the third time. This is not the fault of the employer. She declines as there
is no support at home.
All this puts a very high level of stress and strain on the women. The psychological
pressure of all this can easily lead to women quitting their jobs. Thus, they tend to
be less eager to progress with their careers in male-dominated fields, and revert to
choosing less demanding jobs for which they may be overqualified.
Now where do we begin to resolve these issues? Most of the problems that beset
working women are in reality rooted in the social perspective of the position of
women. Traditionally, men are seen as the bread winners and women as the house-
keepers, child bearers and rearers. This typecast role model continues to place
234 Counseling: Theory, Skills and Practice

obstacles before working women. A fundamental change is required in the attitudes

of employers, policy makers, family members and other relatives and the public at
large.
Counselors at the workplace can help by conducting awareness programs, life
skills training workshops, personal group effectiveness modules, support groups,
etc. Women can receive extra help in ways such as the following:
Performance counseling: It should cover all the aspects related to the
women’s performance like the targets, responsibilities, problems faced,
aspirations, interpersonal relationships at the workplace, etc.
Personal and family well-being: Families and friends are an important and
inseparable part of womens’ life. Many a time, women carry the baggage
of personal problems to their workplaces, which in turn affects their
performance adversely. Therefore, the counselor needs to strike a comfort
level with the women and, counseling sessions involving their families can
help to resolve their problems and getting them back to work—all fresh
and enthusiastic.
Other problems: Ranging from work-life balance to health problems.
Counseling helps to identify the problem and help her to deal with the
situation in a better way.

MODELS OF WORKPLACE COUNSELING

Organizations have not quite known where to put this stranger in their midst. A growing
number recognize its value. Yet how to position the counseling function, where and how
to link it into other organization processes, whilst maintaining its independence, is still
unclear to many. Not knowing how to position counseling, many organizations have it
“outside”. From there it is unable to reach or address many of the issues …
—J. Summerfield and L.van Oudtshoorn, in Counseling in the Workplace

We saw in the last chapter that career counseling is oriented to diagnosis and
prescriptions to see the job-person fit at the point of entry to work. Some experts
feel that it has moved from that to being concerned with development, in particular
development of occupational identity. However, for the purpose of this book I will
hold that workplace counselling differs from career counselling. Many contemporary
organizations are fast recognizing the need to harness people as valuable assets.
Personal development is seen at par with, or even synonymous with corporate
development. Workplace counseling is thus one of the many different types of
activity that can be used to help individuals with their career development.
 Workplace Counseling 235

The workplace counselor understands that stress and its intervention requires a
hard look at both the individual as well as organizational facets. It is important to de-
individualize stress (placing the onus on the individual) as it can be a reflection of an
organizational dysfunction and/or organizationally-induced. Thus, the intervention
strategy should focus both on individual as well as organizational assessment.
Stress counselling is largely multi-modal. The duration of stress as well as the
way the individual copes with it largely depends on his or her perception of it.
To this extent stress counseling must be tailored to the individual. It must draw
on different techniques and address issues of how the event (which caused stress)
was perceived, appraised and coped with. Current models of stress counselling
emphasize the importance of a theoretical basis and an integrative approach. They
integrate “humanistic/person-centred” considerations with a “cognitive-behavioural”
problem-solving approach.
Counseling conducted in the “helping” framework is described with reference to
two models: the skilled helper model and the workplace counseling model. Both are
models that puts the onus on the counselee and assume that she/he is responsible
for problem definition and solution or management. All models are built on an
assumption of the importance of the therapeutic relationship as a base line for
effecting client change. All models also progress the counselling process with an
action focus.
Carroll’s (1996) model emphasizes, in addition to the individual factors, the
administrative (establishing, running, and evaluating counseling provision) and
organizational dimensions (that is, organizational influences on the counseling
service, organizationally induced client problems and conflicts of loyalty and
interest) of counseling.
The skills of helping are divided into those concerning the development of a
therapeutic relationship and working alliance and the techniques of listening and
questioning. The “organizational” roles, responsibilities, and potential contributions
of the counselor are increasingly recognized (for example, as an agent of organizational
change, as having a responsibility to tackle stress at an upstream strategic as well
as a downstream individual level). However, this raises various unique ethical and
professional dilemmas for the counselor, for which as yet there are few best practice
“solutions” or guidelines for dealing with them.
Author Michael Carroll has presented nine models of workplace counseling in
his book Workplace Counseling – A Systematic Approach to Employee Care. They are
as follows:
1. Counseling-orientation models: They are characterized by the use of a
counseling approach as the key factor in employee counseling. Several authors
have taken particular counseling orientations and reviewed how they might
apply these in the workplace counseling, for example, cognitive-behavioral
236 Counseling: Theory, Skills and Practice

therapy (Webb, 1990), neuro-linguistic programming (Sanders, 1990);

Psychodynamic (Gray, 1984), rational–emotive therapy (Morris, 1993).
2. Brief therapy models: Brief therapy or focused counseling may not be suited
for all clients or all problems. The choice of brief therapy in the workplace
may be guided more by economics of the situation rather than by client
need. Occasionally an impression is given in workplace counseling by
the authorities who are anxious that employees will abuse the counseling
provision, shirk duties and responsibilities
3. Problem-focused model: This model sees the counselor’s role as helping with
the immediate problems that the employee brings in.
4. Work-oriented model: This model is centered solely on issues blocking an
individual in his or her work. They pinpoint the immediate problem as
a workplace issue and work with it. Not much attention is paid to the
underlying issue, the root cause of the problem, and how to go about
solving that. The aim is to resolve the symptom and get the employee back
on track as regards work.
5. Manager-based model: It involves viewing managers as quasicounsellors.
When managing people they use basic communication skills, which then
double up as counseling skills. As they are well-informed about the role,
responsibilities, ambience, constraints, and complaints of the employees,
they are more accessible and become the best resources for employee
counseling.
6. Externally based model: The counseling resources are outsourced. This
form of counseling need not necessarily be face to face, but can be through
telephone or online counseling.
7. Internally based model requires in-house provision for a counselor (can be
part time or full time).
8. Welfare-based model: It is based on being sociable, which means combining
a number of roles with the employee: befriending, orienting, information
giving, and counseling.
9. Organizational-change model: This model is not very clear according to
Carroll. He says it is perhaps the process of integrating counseling into
organizational growth, development and, in particular, transition so that
the employee is directly and the organization is indirectly benefited.

THEORETICAL MODELS OF STRESS

1. Carroll’s (1996) integrative model of workplace counseling: Currently,

this is the only model solely focused on counseling in an organizational
context.
 Workplace Counseling 237

The five stages in this model are as follows:

Preparation and assessment of the individual—diagnostic, psychometric,
interpersonal + organizational assessment, contracting/referral, counseling
The “ecology” of the organization; administration
Termination
2. Palmer and Dryden (1991): Transactional Model
Stage One: pressure emanates from the environment
Stage Two: perceptions of pressure and self-appraisal of ability to
cope
Stage Three: stress reaction (psychophysiological)
Stage Four: consequences of coping strategies
Stage Five: feedback
3. Abrams and Ellis (1996): Rational-emotive perspective
Stress does not exist per se, but via the perceptions/reactions of the
individual
Dogmatic irrational beliefs–anguish–stress reaction.
“Awfulizing” (It would be really awful if…), “unconditional demands”
(I must be…).
Aim of therapy: change detrimental personal philosophies
Active-directive disputing (question “musts,” “awful ifs…”)
Reframing (Pollyanna principle)
Emotive-evocative dramatic techniques (e.g., role play)
4. John Lees (Eclecticism and Integration within Workplace Counseling)
talked about the relevance of integration and eclecticism for workplace
counselors. He said that typically a workplace counselor needs to assess
a specific problem, sometimes defined using diagnostic classification such
as the DSM IV. They then have a limited number of sessions, often using
cognitive-behavioral (or at least problem solving and client empowerment)
techniques to bring about change. They may attempt to demonstrate
progress either through clearly stated outcomes or measurable results using
quasiexperimental psychometric techniques. Further exploration would
then generally involve referral to someone else (if this was an option as far
as the client and organization were concerned).
5. The behavioral coaching model in the workplace (coaches-learning-center.
com)
Behavioral coaching integrates research from many disciplines into a validated,
user-friendly model of practice. It incorporates knowledge from psychology
(behavioral, clinical, social, developmental, industrial and organizational), systems
theories, existential philosophy, education, and the management and leadership
literature.
238 Counseling: Theory, Skills and Practice

The behavioral coaching model emphasizes the following aspects of behavior and
learning:
Much of human behavior is acquired through learning.
There are positive as well as negative consequences of the behavior, both
for the individual and those around him or her.
Individuals are systems within systems. It is a two-way process where the
individual affects as well as is affected by these systems and the constant
changes they both are undergoing.
Individuals’ current status and developmental progress need to be defined
in terms of behavior, rather than personality traits or styles.
Specifying the target behavior impacting on the task at hand and measuring
it.
Behavioral change can be effected by exploring and changing core values,
motivation, beliefs, and emotions.
Assessing covert behaviors (thinking patterns and emotions) in relation to
overt actions.
Accessing and assessing emotional events.
Assessing environmental events and the interactions between behavior and
environment.
Providing statistical proof of beneficial change/learning acquisition
Having regular follow-ups for feedback and assessment of mentoring and
coaching strategies.
Norman Claringbull (www.counsellingatwork.org.uk) insists that workplace
counseling should become a knowledge-based, regulated, advanced professional
specialism.
He says, (The workplace counselors) should have a “systematic understanding
… critical awareness of current problems ... forefront of academic discipline …
professional practice.” Advanced professional-level training and knowledge of the
following clusters would greatly increase the marketability of future workplace
counseling specialists:
Cluster 1: Organizational awareness, dynamics, systems and issues; understanding
the world of work; awareness of different and differing workplace cultures and
environments; putting counseling into context.
Cluster 2: Ethical issues/dilemmas around the three-way contract; understanding
the dual client-employer relationship; confidentiality and data protection; employer
best practices (HR, employment law, discipline, etc.).
Cluster 3: Client assessment; mental health assessment; risk assessment; risk
management.
 Workplace Counseling 239

Cluster 4: Critical incident work; time-limited therapy; mediation work; stress

analysis.
In addition to all the above there is plenty of evidence that there are significant
educational, intellectual and professional benefits in inculcating transdisciplinary
critical reflexivity as an essential factor in specialist-level knowledge acquisition,
intellectual debate and discipline centered discourse. Therefore, it is possible that
counseling specialists would better achieve a higher professional status if they acquired
both advanced factual knowledge and new, transdisciplinary ways of knowing. This
is will often be required to devise innovative solutions to unique problems.

Counselor Expertise
All employees are expected to perform their jobs in an efficient and effective manner.
That is an idealistic view. There are times when supervisors need to deal with
workplace problems. These problems arise from individuals and may be discipline-
based, performance-based, or both. In either situation, it is important to keep the
channels of communication free and open. The supervisor should communicate
directly and immediately with the employee when problems or deficiencies first
arise. Any delays in making an employee aware of unacceptable conduct or behavior
and deficiencies in work performance may appear to sanction such behavior
(hr.sc.edu).
Most companies do not want to employ counselors. They would rather train their
managers to perform the role of the counselor as they are in constant touch with
their subordinates and also have an idea about their job profile and portfolios, and
thus will be better equipped to help them integrate their personal and professional
lives.
In an ideal setup, there is a trained and qualified counselor in the organization
attending to the counseling needs of the employees. The person of the counselor,
the maturity, knowledge, and experience are all significant for counseling to be
effective. Vouching confidentiality above all should be among the first things done.
They need to give assurance of complete confidentiality. The organizations would
do well to provide a respectable, quite place for the counselor where the employee
feels free to express himself/herself in private.

Basic Requisites of Employee Counseling

Employee counseling needs to be tackled carefully, both on the part of
the organization and the counselor. The counseling can turn into a
sensitive series of events for the employee and the organization; therefore,
the counselor should be either a professional or an experienced, mature
employee.
240 Counseling: Theory, Skills and Practice

The counselor should be flexible in his or her approach and a patient

listener. She/he should have the warmth required to win the trust of the
employee so that she/he can share his or her thoughts and problems with
the counselee without any inhibitions.
It cannot be stressed enough that the most important aspects of the
employee counseling is active and effective listening.
Time should not be a constraint in the process.
The counselor should be able to identify the problem and offer concrete
advice.
The counselor should be able to help the employee to boost his or her
morale and spirit, create a positive outlook, and help him take decisions to
deal with the problem.
The competent stress counsellor: Milner and Palmer (1998); Palmer and Dryden
(1996)
Cognitive-behavioural techniques
Rational-emotive behavioural techniques
Counselling and listening skills
Group facilitation skills
Problem-solving skills
Can educate
Can use psychometric tests
Has sound knowledge base (relevant research)
Has knowledge of various lifestyle options
Understanding of organisational and occupational issues

WORKPLACE COUNSELING IN INDIA

Workplace counseling is still to pick up and become prominent in India (Kaila,

2006). It is still considered a taboo and person who avails counseling is looked
down. Though many organizations like the BPOs and IT companies are now
employing counselors to cater to employee well-being, the counselors have a hard
time impressing upon the employees to seek help. The employees would rather pay
exorbitantly and go to private practitioners than go see the workplace counselor for
free! This is quite frustrating for the workplace counselors as well as the organizations,
which in good faith want to do good for their employees.
Even so, these organizations are few and far between. Author Kaila has quoted
Bhooma Dand, Assistant Manager, CETC, who says that workplace counselors
have yet to become a permanent feature in companies. Organizations are unwilling
to spend money on the well being of the employees. She says in India counseling in
workplace has emerged in three trends.
 Workplace Counseling 241

1. The first trend was seen when organizations started to recognize the
importance of HR training to resolve problems and enhance productivity.
These programs covered topics like stress management, time management,
assertiveness, communication skills, etc., these increased employee problem-
solving skills and thus, self-esteem.
2. As the employees began to undergo these training program they were
increasingly sensitized to their own counseling needs. The managers and
superiors started to lend a helping ear to the employee problems. However,
they were not very effective as they did not have the appropriate training
or skills to handle deeper level problems. Also it is uncomfortable to talk
about work problems with superiors.
3. Thus, the people started to feel the need for an objective, unbiased, trained
professional to help them with their problems (be they professional or
personal).
As mentioned earlier organizations are still not keen on hiring an in-house
counselor. Added to that is the problem of a reporting structure: if there is to be a
counselor who should she/he report to, how much to report, how to bring about the
confidence of the employee to share, etc.
Author Kaila has quoted a primary research carried out by Professor Ghauri Joshi
at a manufacturing company in Mumbai in 2002. The results were as follows:
Majority of the employees of the company (61 percent of the sample) were
unaware of the concept of employee counseling. Those who had a partial
correct idea (25 percent) knew that it was related to helping an employee in
distress, advising, creating self-awareness and personality development. The
remaining 14 percent had an incorrect understanding about the concept.
After the researcher had explained what employee counseling was all about,
69 percent of the sample agreed that there was a (perceived) need for
employee counseling in the company.
78 percent agreed that it was part of HR function.
Thus, the awareness of the concept of workplace counseling is quite low in India
both among employers as well as employees. However, with the corporate sector
in India opening up to the world economy employee-oriented HR practices like
counseling, coaching, and mentoring are becoming routine in organizations, albeit
in a small way.

v Summary v
Workplace counseling is the latest buzzword in corporate HR across the
world. Employees suffer from ‘presenteeism’ where they want to be
seen at work while being overstressed doing the job. The modern work
242 Counseling: Theory, Skills and Practice

place is very demanding. Insecurity about their jobs makes employees

afraid to take time off. As employees struggle to cope, employers as
well as health experts are working overtime to develop new ways of
managing workplace stress and its inevitable implications.
In today’s fast-paced corporate world, stress cannot be avoided. A
psychologically healthy workplace fosters employee happiness and well-
being while enhancing organizational performance and productivity.
Employers now see that they need to be closely involved in the physical
and mental well-being of their employees. Every employer is now
beginning to realize that it is wise to anticipate stress, and the risks
involved and keep counseling support services handy.
Counseling highlights the value of people as organizational assets.
Employee happiness and satisfaction lead to a sense of ownership and
belonging toward their organization. When employees feel that they
are well taken care of, the drive to work and perform will be very high.
Counseling helps the employee to share and look at his problems from
a new perspective, help himself and to face and deal with the problems
in a better way.
Counseling at workplace is a way of the organization to care about
its employees. Counseling programs at the workplace work toward
stimulating personal growth and offering help in addressing many
situations that cause emotional stress. Counseling services need not
necessarily be interventive. They need to be preventive too. Counselors
at the workplace can help by conducting awareness programs, life skills
training workshops, personal group effectiveness modules, support
groups, etc. Workplace counseling is thus one of the many different
types of activity that can be used to help individuals with their career
development.
The workplace counselor understands that stress and its intervention
requires a hard look at both the individual as well as organizational
facets. It is important to de-individualize stress (placing onus on the
individual) as it can be a reflection of an organizational dysfunction and/
or organizationally-induced. Thus, the intervention strategy should focus
both on individual as well as organizational assessment.
Current models of stress counselling emphasize the importance of a
theoretical basis and an integrative approach. They integrate “humanistic/
person-centred” considerations with a “cognitive-behavioural” problem-
solving approach.
 Workplace Counseling 243

References
http://www.azadindia.org/social-issues/problems_of_working_women.html.
http://www.uk.sagepub.com/.../files/.../ch6_overview.doc.
http://www.coaches-learning-center.com/executive_coachi.ng_behavioral_m_4.htm
http://hr.sc.edu/relations/erwkprb.html.
 10
Hospital Counseling

Chapter Overview
Grief counseling
Counseling the terminally ill
Pain management counseling
Rehabilitation counseling in the hospital

P
sychology is relevant to anybody who works in a clinic or medical setting.
That is why it is important for students pursuing any medical or paramedical
courses to take psychology courses as part of their studies.
The services that can be provided by psychologists at hospitals are myriad. A few
examples are (psywww.com):
Diagnostic testing, using standard psychological tests to assess mental
disorders, level of adaptive functioning, brain damage, or other clinically-
relevant characteristics.
Patient interviews to determine the possible relevance of psychological
factors or possible need for counseling before or after medical
intervention.
Staff support, talking to the physicians and making morning rounds with
them.
Counseling patients before surgery, chemotherapy, and radiation treatments
on what emotional reactions to expect and how to deal with them.
Therapy for specific disorders, such as pain, facial or muscle tics, and
bedwetting.
Rehabilitation counseling and training for amputees and for victims of
stroke, burn, spinal cord injuries, and heart disease.
Counseling overutilizers, patients who use medical services too often.
Psychologists are being increasingly employed in hospitals. With the fast growing
field of health psychology being recognized and accepted by clinicians, health
 Hospital Counseling 245

psychologists perform a variety of services in the health industry. The biomedical

model of medicine suggests that every disease process can be explained in terms
of an underlying deviation from normal function such as a pathogen, genetic, or
developmental abnormality, or injury. This has given way for the biopsychosocial
model, which is a general model or approach that posits that biological (e.g., genetic
predisposition), psychological (which entails thoughts and emotions), behavioral
factors (e.g., lifestyle, stress, health beliefs) and social factors (e.g., cultural influences,
family relationships, social support) all play a significant role in human functioning
in the context of disease or illness. Thus, the role of behavioral sciences is widening
in the medical context.
The APA defines Health Psychology (division 38) in the following way: “Health
Psychology seeks to advance contributions of psychology to the understanding
of health and illness through basic and clinical research, education, and service
activities and encourages the integration of biomedical information about health
and illness with current psychological knowledge.” Health Psychology focuses on
the more medical aspects of psychology and applies psychological principles to
healing physical illness and medical problems.
Health psychologists and counselors in hospitals attempt to aid the process of
communication between physicians and patients during medical consultations.
Medical terms are not easily understood by the regular patient. As a result there are
many problems in this process. One main area of research on this topic involves
“doctor-centered” or “patient-centered” consultations. The psychologists in the
hospital attempt to get people to follow medical advice and adhere to their treatment
regimen. This is a very difficult task. Either people do not remember to take their
pills, or are inhibited by the side effects of their medicines. In a country like ours
where medicines are expensive and healthcare not easily available or accessible, this
has many ramifications. Failing to take prescribed medication proves very costly
and wastes millions of usable medicines that could otherwise help other people.
Estimated adherence rates are difficult to measure. However, adherence could be
improved by tailoring treatment programs to individuals’ daily lives.
Health psychology examines how psychological factors contribute to pathology,
and demonstrates how psychology can contribute to recovery and illness prevention
for such somatic disorders as heart disease, cancer, and diabetes. It focuses on
understanding how biology, behavior, and social context influence health and illness.
The other terms that are used synonymously with it are “behavioral medicine” and
“medical psychology.” The health psychologists work in many a setting. They work
together with other medical and paramedical professionals (e.g., physicians, dentists,
nurses, dieticians, social workers, pharmacists, physical and occupational therapists)
in clinical settings providing clinical assessments and treatment services. They work
in the community on behavior change in public health promotion. They also teach at
universities and conduct research. Health psychologists conduct research to identify
246 Counseling: Theory, Skills and Practice

behaviors and experiences that promote health, give rise to illness, and influence the
effectiveness of health care. They also recommend ways to improve health care and
health-care policy (Sharman, S. J., Garry, M., Jacobsen, J. A., Loftus, E. F., and Ditto,
P. H., 2008). Health psychologists have worked on developing ways to promote
health and prevent illness. They have also studied the association between illness
and individual characteristics. For example, health psychology has found a relation
between the personality characteristics thrill seeking, impulsiveness, hostility/anger,
emotional instability, and depression, on one hand, and high-risk driving, on the
other (Beirness, D. J., 1993). Its early beginnings can be traced to the field of clinical
psychology. However, four different divisions within health psychology—clinical
health psychology, public health psychology, community health psychology, and
critical health psychology; and one allied field—occupational health psychology
have developed over time.
Clinical health psychology (ClHP) is a major contributor to the field of
behavioral medicine within psychiatry. It includes education, the techniques of
behavior change, and psychotherapy. In some countries, with additional training
the clinical health psychologist can become a medical psychologist and, thereby,
obtain prescription privileges.
Public health psychology (PHP) is population-oriented and is allied to other
public health disciplines including epidemiology, nutrition, genetics and biostatistics.
This field works to investigate potential causal links between psychosocial factors
and health at the population level and present the research results to educators,
policy makers, and health care providers. in order to promote better public health.
Some PHP interventions are targeted toward at-risk population groups (e.g.,
under-educated, single pregnant women who smoke; teenage mothers) and not the
population as a whole (e.g., all pregnant women).
Community health psychology (CoHP) investigates community factors that
contribute to the health and well-being of individuals who live in communities.
CoHP also develops community-level interventions that are designed to combat
disease and promote physical and mental health.
Critical health psychology (CrHP) focuses on the distribution of power and
the impact of power differentials on health care systems, health experience and
behavior, and health policy. It concerns itself with social justice and the universal
right to health for all people regardless of any distinctions like races, genders, ages,
and socioeconomic positions. It works towards eradication of health inequalities, a
major concern. The CrH psychologist strives to be an agent of change, not simply
an analyst or cataloger.
Counselors also have a big role to play in hospitals. More and more hospitals
are starting to realize that clinical psychologists and psychiatrists are not sufficient
 Hospital Counseling 247

to take care of counseling needs in hospitals. The focus on family members of the
patients has led hospitals to take in counselors. This area has not caught on in India
at all. It is felt that the time has come for psychologists to start to sensitize the
hospital management to the wide scope for counselors in hospitals.
This chapter focuses on some major responsibilities of the hospital counselor.
1. Grief counseling
2. Counseling the terminally ill
3. Pain management
4. Rehabilitation counseling

GRIEF COUNSELING

Grieving allows us to heal, to remember with love rather than pain.

It is a sorting process.
One by one you let go of things that are gone
and you mourn for them.
One by one you take hold of the things that have become a part of
who you are and build again.
—Rachael Naomi Remen

What is Grief?
Grief is a person’s response or reaction to loss, which encompasses physical,
psychological, social, and spiritual components. The way individuals and families
cope with dying, death, grief, loss, and bereavement is as unique as a fingerprint
(Ben Wolfe). No two people grieve the same, and no two people grieve for the same
time period. The process of grief does not happen in a linear fashion. The process
is cyclical and manifests in many different ways. It is a process as unique as an
individual person (Michele Metche). The grieving process also includes the process
of coping with other life events and adaptations to one’s present and future. In the
broadest context, losses can be thought of as the loss of one’s possessions, one’s self,
one’s developmental losses, or one’s significant others.

Types of Grief (Parkes, 1996)

1. Loss of loved one through death, separation, divorce, incarceration.
2. Loss of an emotionally charged object or circumstance, e.g., loss of a prized
possession or a valued job or position.
248 Counseling: Theory, Skills and Practice

3. Loss of a fantasized love object, e.g., death of a intrauterine fetus, birth of

a malformed infant.
4. Loss resulting from narcissistic injury, e.g., amputation, mastectomy.

Loss, Transition, and Change

Loss throws one into a place of uncertainty, even if the loss is anticipated or planned.
The experience of loss signals a time of re-evaluation. The loss creates a void and
disrupts routine, patterns, and focus. Sometimes this loss is a situational loss. A
long-standing job, career, someone moving away, is sick or a divorce or separation.
Whatever be the loss it has a profound effect on one’s way of viewing the self, a role/
title. The person then has to restructure and reorganize his or her life, way of being
and relating without what she/he has lost. There is a gap, a vacuum that needs to
be filled.
Change is healing the self. It is taking the time to focus on the loss and bring the
meaning of the loss into the present. As there is no time limit on healing and also
one does not know how heal the shattered emotions, the person identifies the need
for support and seeks it. Support is crucial, to allow the time to grieve, to reminisce,
to reflect, to allow a healthy expression of all the emotions and feelings, And in order
to accept and come to terms with the loss and then move forward from the loss and
what it means needs to be expressed.

Giving Space to Grieve

Is not grief a normal reaction to loss? Do all need counseling or therapy? Are people
not able to cope with loss as they have in the past or are individuals not being
provided the same type of support they received in previous generations? Individual
and family geographic living arrangements are different in the twenty-first century
than in past years. The joint family system in India has given way to nuclear families.
The support and care of the extended family that people used to rely so much upon
is now a thing of the past. People have moved away from each other, and there is no
time stay after the funeral to adjust and rehabilitate one’s mind. The bereavement
landscape has been changed drastically by traumatic and violent deaths and thus
whatever had helped individuals and families in the past in many situations has
eroded, sometimes no longer useful.
People do not know how to help a person deal with his/her loss. People are
rather uncomfortable when it comes to dealing with a person experiencing a loss.
Meaningless statements like “don’t worry,” it is going to be okay,” “try to get on with
your life,” and “you’ll be alright” are made. Otherwise, they avoid eye contact at the
least or altogether avoid the person. For many who are grieving the communication
from others is loud and clear: “get over it, and soon, so friends and family can feel
 Hospital Counseling 249

more comfortable”. The message is hurry up and grieve and then join life again the
same way you did before the loss. This message and ultimately this belief system
cause stress-distress of the body and mind.
This is where a bereavement counselor or a spiritual counselor or a transpersonal
therapist comes in. She/he can help the grieving person understand that if we would
keep a space open for loss and what it evokes in us there can be a deeper meaning in
our life and new insight and understanding.
Grief counseling is used not only by individuals and families, but in many situations
by schools, agencies, and organizations, and in some cases by entire communities
affected by death (Ben Wolfe). The need for grief counselors is starting to be realized
more and more by hospitals now as they are aiming to move towards becoming a
“wholesome” health services provider taking care of not only the physical but also
emotional health needs of clients.

Grief Counseling and Grief Therapy

Grief counseling is a form of therapy, which focuses on the individual’s intense
feelings of loss. This may be used for an individual or for groups. Counseling may
be undertaken in case of death of a loved one or even during other grief-provoking
situations, such as the diagnosis of a fatal illness, the break up of a marriage, the loss
of a job, or a myriad of other reasons. Grief counseling in group settings is quite
effective because peer counseling and relationships with others who can empathize
with one’s loss reduce feelings of isolation caused by grief.
These are some key stages and feelings that come up for an individual, a family, or
a nation when encountering the process of dying, death, loss and major change. The
process of counseling the bereaved is quite complex and requires a lot of expertise
and practice. No two people grieve the same, and no two people grieve for the same
time period. The process of grief does not happen in a linear fashion. The process
is cyclical and manifests in many different ways. It is a process unique for each
individual person. The counselor is there to hold a space for healing and create a safe
place for feelings to be expressed and explored. Obviously this needs to be done in a
nonjudgmental way and in a way that honors the individual’s inner process. There
needs to be flexibility in approach and in assistance. The individual, family or group
grieving will not always need the same assistance.
On the other hand, the goal of the counselor is to be “present” for the bereaved.
This is sometimes called compassioning. Being there for the counselee may be to help
the person by simply listening in an active manner and demonstrating empathy.
There is the recognition among grief counselors that grief is a process that cannot be
rushed. Thus one attempts to be “right there” in whatever stage of grief the person is
currently experiencing. Reminding the person that the feelings they have or choices
they make while grieved are quite natural and normal becomes a major part of grief
250 Counseling: Theory, Skills and Practice

counseling. Initially when a person loses a loved one, he or she may receive lots of
kind attention from friends and family. And then friends and family may move on.
The grieving person on the other hand, may not be ready to “move on.” This is
when grief counseling becomes most effective. It gives the person a way to continue
to process their loss and receive compassion that may not be available from society
or even close friends or family. The counselor does not want to speed up the process
of grieving. She/he also understands that grief is felt and expressed differently by
people, which is also important. For example, some couples seek out grief counseling
after the loss of a child. Most likely, part of the difficulty for the couple is that each
partner will grieve differently, and may not grieve in a fashion that seems as intense
as his or her partner. Counseling becomes a learning process—learning that grieving
can be done in many ways, often saving couples/families from accusing each other
of grieving too much or too little. Each learns to respect the unique process of grief
undergone by each person. This can, in turn, promote empathy and a greater degree
of intimacy between partners/family members.
Grief therapy, on the other hand, utilizes specialized techniques that help people
with abnormal or complicated grief reactions and helps them resolve the conflicts of
separation. This is also supplemented by pharmacotherapy. Worden (1991) believes
grief therapy is most appropriate in situations that fall into three categories: (1) The
complicated grief reaction is manifested as prolonged grief; (2) the grief reaction
manifests itself through some masked somatic or behavioral symptom; or (3) the
reaction is manifested by an exaggerated grief response.

Goals of Grief Counseling and Therapy

Grief counseling is a little different from grief therapy in that the principal goals are
not quite the same. In Grief Counseling and Grief Therapy (1991), the clinician and
researcher William J. Worden, PhD, makes a distinction between grief counseling
and grief therapy. He believes counseling involves helping people facilitate
uncomplicated, or normal, grief to a healthy completion of the tasks of grieving
within a reasonable time frame. Grief therapy is where one wants or needs to change
behavior. Professionals believe that there are diverse frameworks and approaches to
goals and outcomes of the grief counseling and therapy process. Robert Neimeyer
(1998) believes, “The grief counselor acts as a fellow traveler [with the bereaved] rather
than consultant, sharing the uncertainties of the journey, and walking alongside,
rather than leading the grieving individual along the unpredictable road toward a
new adaptation” (Neimeyer, 1998). Janice Winchester Nadeau clearly reminds grief
counselors and grief therapists that it is not only individuals who are grieving, but
entire family systems. A person is not only grieving independently within the family
system, but the interdependence within the family also affects one’s actions and
 Hospital Counseling 251

reactions. According to Worden there are three types of changes that help one to
evaluate the results of grief therapy. These are changes in (1) subjective experience,
(2) behavior, and (3) symptom relief.

Stages of Death and Dying: Elizabeth Kubler-Ross

Much of grief counseling theory today is based on the fundamental work of Elizabeth
Kubler-Ross, who identified several stages of grief. Kubler-Ross’ work has become a
springboard for other theories that expand on her work. For many, prior to Kubler-
Ross’ work, there existed little understanding that grief is a non-linear process that
can take a great deal of time.
1. Shock and denial: Patient’s initial reaction is shock, followed by denial that
anything is wrong. Some patients never pass beyond this stage and may go doctor
shopping until they find one who supports their position. During this stage, as not
much reaction is expressed, it may look as if the person is dealing rather well with
the loss. They may even talk and laugh as if there was nothing wrong and tell others
that they are fine, nothing to worry. It may be difficult to ascertain whether this is
real or whether they are denying their feelings. The counselors will do well to give
them some time when it will become apparent that their services are needed.
2. Anger: Patients become frustrated irritable, and angry that they are ill; they
ask, “Why me?” Patients in this stage are difficult to manage because their anger
is displaced on doctors, hospital staff, church/God, and family. Sometimes anger
is directed at themselves in the belief that illness has occurred as a punishment for
wrongdoing. They may feel angry with themselves for having argued or fought with
the loved one who is now dead. They need to be given “permission” to verbally
express those feelings by letting them know it is alright, and actually healthy, to feel
anger over the loss.
3. Bargaining: This stage is characterized by the “if-then” thinking. If only I
had done this…this would not have happened! Counselee may attempt to negotiate
with physicians, friends, or even God, that in return for a cure, he/she will fulfill
one or many promises, e.g., give to charity or attend church regularly. Helping
them sort out what was and was not within their control can be quite soothing and
comforting. Also the counselee may need know that whatever they did it was out of
love for the dead one, and that they would have tried their best to do what is right.
The counselee may have had to make tough choices like adhering to the “Do not
resuscitate” instructions of the loved one. The counselee is likely to feel very lonely
and may miss the departed very much. There may also be feelings of guilt over
somethings that had been said or done that had hurt the loved one, or even over
the feeling of relief if the person had died after a long illness. Explaining that these
feelings are normal always helps. A little self-disclosure on the part of the counselor
252 Counseling: Theory, Skills and Practice

explaining personal stories of grief can be helpful. However the focus should be on
the process of adjustment to the death yourself.
4. Depression: Patient shows clinical signs of depression: withdrawal, hopelessness,
psychomotor retardation, sleep disturbances, and possibly suicidal thoughts. The
depression may be a reaction to the effects of the illness on his/her life, for example,
loss of job, economic hardship, isolation from friends and family, or it may be in
anticipation of the actual loss of life that will occur shortly.
5. Acceptance: Person realizes that death is inevitable and accepts its universality.
These stages do not always follow one after another, and thus cannot be used as
a checklist toward acceptance. The transition from one stage to another is neither
smooth nor assured. Many get stuck in the denial stage it self not being able to move
further. The individual may go back and forth a lot of times. It is also normal to
skip certain stages, or re-visit a single stage while progressing through the others. It is
important as a counselor to listen to the individual and be aware of their emotional
needs and cues as much as possible.
Counselors please note that I have mostly talked about the stages as if the loss
were death of a loved one. But the situation or the handling of it can very easily be
extrapolated and generalized to any loss.

Stages of Loss and Bereavement

1. Denial and disbelief or numbness
2. Alarm—anxiety and fear
3. Pining—searching for or being reminded of the lost person.
4. Anger and guilt
5. Bargaining
6. Despair and depression
7. Identification phenomena—adopting traits, habits of deceased/adopting
behavior patterns to insure that the loss/perceived loss does not occur
again in the person’s environment. One may also begin to repress certain
aspects of their personality and curtail their instinct to reach and respond
in relationship to their environment and world.
8. Pathological variants:
(a) Depression—feelings of hopelessness, withdrawal from family and
friends, cannot go on living.
(b) Delayed/prolonged/inability to grieve.
(c) Listlessness and lack of motivation “why try again?” “It’s no use.”
(d) The individual may feel “stuck,” blocked, or feel a virtual victim of
circumstance and environment.
In order to move through the cycle and restructure it is important for the
individual to grieve. It is at this point that many people may.
 Hospital Counseling 253

9. Acceptance: Non-acceptance or resignation? This is the beginning of the

road to recovery where the individual is faced with a decision-making
situation. A resolution is mandated at this point.
10. Recovery and reorganization: The realization that life goes on, does not wait
for anyone. New adjustments are required and the goals may be different.
At this juncture, the restructuring begins.

Four Tasks of Mourning (Worden, 1991)

1. To accept the reality of the loss
2. To work through the pain of grief
3. To adjust to an environment in which the deceased is missing
4. To emotionally relocate the deceased and move on with life.
Anything the counselor can do that helps family members stay connected to each
other and to extended families and extra familial resources will have a profound
impact on the long-term post death adjustment of the family.

Process of Bereavement Counseling: Transitional Counseling

1. The counselor help the person actualize the loss. Talk about the loss. Visit
the gravesit.
2. The counselor needs to aid in identifying and expressing feelings of anger,
guilt, fear, anxiety, and sorrow, those that are the stumbling blocks in the
person’s moving forward in life.
3. The counselor helps the counselee to imagine and then live a life without
the deceased/person/situation/job/status/income.
4. Slowly the individual must start feeling detached from the loss. It is
important to help the counselee realize that this detachment does not
reduce the significance of the lost person or relationship or thing. Emotional
withdrawal only helps reduce the pain.
5. Grief and its expression are very important for the counselee to fully process
the pain and come out of it.
6. The counselor needs to assess the counselee’s behavior/relating pattern and
identify whether it is “normal” or “pathological”, assess for referral if there
is absence, deferred or prolonged grieving and arrange a referral.
7. The counselor must allow for individual behavior and support the emotional
expression or maybe refer to a support group.
8. The counselee’s defenses and coping mechanisms (alcoholism, drug
addiction, withdrawal) must be explored to identify the ones that are
helpful and those that are not.
254 Counseling: Theory, Skills and Practice

Normal Grief
1. Feelings—sadness, anger, guilt and self-reproach, anxiety, loneliness,
fatigue, helplessness, shock, yearning (“pining”), emancipation, relief,
numbness.
2. Physical sensations—hollowness in the stomach, tightness in the chest,
tightness in the throat, oversensitivity to noise, depersonalization, shortness
of breath, weakness in the muscles, lack of energy, dry mouth.
3. Cognitions—disbelief, confusion, preoccupation, sense of presence of the
deceased, hallucinations.
4. Behaviors—sleep disturbances, appetite disturbances, absent-minded
behavior, social withdrawal, dreams of the deceased, avoiding reminders
of the deceased, searching and calling out, sighing, restless over-activity,
crying, visiting places or carrying objects that remind the survivor of the
deceased, treasuring objects that belonged to the deceased.

Abnormal Grief Reactions—Diagnostic Clues

(Worden, 1991)
1. The person cannot speak of the deceased without experiencing intense and
fresh grief.
2. Some relatively minor event triggers an intense grief reaction.
3. Themes of loss come up in the person’s talk.
4. The person who has sustained loss is unwilling to move material possessions
belonging to the deceased.
5. The person is developing physical symptoms like those the deceased
experienced before death.
6. The person makes radical changes in lifestyle following a death or excludes
from their life friends, family members, and/or activities associated with
the deceased.
7. The person seems chronically depressed (together with persistent guilt and
low self-esteem) or experiences false euphoria following a death.
8. Person shows a compulsion to imitate the deceased.
9. Self-destructive impulses.
10. Unaccountable sadness occurring at a certain time each year.
11. A phobia about illness or death.
12. Facts about how they acted at the time of the death (e.g., avoiding visiting
the grave or participating in funeral, etc.).
 Hospital Counseling 255

Useful Techniques
(Adapted from Robert Neimeyer (1998), Michele Meiché)
1. Evocative language
2. Use of symbols
3. Writing: it helps to write about the loss, not necessarily literally, but what
it invokes in you. Writing letters to deceased, journaling (keeping a journal
of the thoughts and feelings)
Creating – drawing/art/sculpture/(esp. with children), poetry
4. Role playing
5. Cognitive restructuring—identify damaging self-talk, e.g., “No one will
ever love me again.”
6. Memory book
7. Directed imagery—imagine deceased as present and address him/her
8. Video filming
9. Collage the person’s life
10. Collage what you are feeling and experiencing because of the loss
11. Reading books on loss—reading about others’ experiences with loss, such
as C.S. Lewis’ A Grief Observed
12. A pictorial memorial
13. Writing a biography of the deceased
14. Writing an epitaph of the deceased
15. Examining how we are like the deceased (also known as a life imprint)
16. Integrating objects that link the deceased into our lives
17. Writing about the loss as if you are a third person describing it
18. Constructing a memory book honoring the deceased
19. Using metaphors to describe the loss and your reactions to it
20. Expanding the metaphors into a metaphoric story
21. Going on a personal pilgrimage
22. Creating and conducting a personal ritual about the loss
23. Art and music therapy
24. Meditation
25. Creation of personalized rituals
26. Spiritual counseling
27. Communication with the deceased (through writing, conversations, etc.)
28. Bringing in photos or possessions that belonged to the person who has
died
29. Role playing: the “empty chair” or Gestalt therapy technique is also
an approach widely used by grief counselors and grief therapists. This
technique involves having an individual talk to the deceased in an empty
chair as if the deceased person were actually sitting there; afterward, the
256 Counseling: Theory, Skills and Practice

same individual sits in the deceased person’s chair and speaks from that
person’s perspective. The dialogue is in first person, and a counselor or
therapist is always present.

Factors Affecting Degree of Disruption to the Family System

(Worden, 1991)
1. Social and ethnic context
2. History of previous losses
3. Timing of death in the life cycle
4. Nature of death
5. Family position of the dead or dying family member
6. Openness of the family system (differentiation/level of family stress): the
lower the level of differentiation (and the higher the level of stress), the
lesser the ability to express directly to each other divergent or anxiety-
provoking thoughts and feelings without either becoming angry or upset.

Funerals as rites of passage—Family systems issues

It is important to note that it is really the family that is making the transition to a
new stage of life rather than the identified member. The months before and after
rites of passage are “nodal” periods that function as “hinges of time.” As events
occur, not at random, but at critical times in the family life cycle this is the time
when family relationship systems unlock so that doors between family members can
be opened or closed with less effort than at other times.
Death creates a vacuum, and emotional systems will rush to fill it. Six opportunities
during this rite of passage:
1. This can be the time when the individual can take or shift responsibility.
2. This may be a time when the individual can reestablish contact with
distant relatives (or close relatives who live at a distance). This socializing
opportunity somehow helps in venting the grief, and sharing it with others
who feel similarly.
3. It many be an opportunity to learn family history. Connecting with people
who are in the family but one has never met, or getting to know the family
tree is quite rejuvenating.
4. The funeral can be a learning experience a chance to learn how to deal with
the most anxious forces that formed one’s emotional being.
5. It can be a chance to shift energy directions in the family triangles, all of
which seem to resurrect themselves at such moments.
6. Chance to reduce the debilitating effects of grief.
 Hospital Counseling 257

Grief Counseling in India (Swami Tejomayananda,

Chinmaya Mission)
Grief counseling takes the form of spiritual counseling in India. Ancient Indian
philosophy is all about understanding that the true nature of the self is not this
transient physical body, nor the mind. Thus, there is no need to fear loss or death,
or grieve over it.

King Yudhishthira of ancient India when asked, “What is the greatest wonder in the
whole world?” replied: “That we see people dying all around us and never think that we
too will die.”
“You are grieving over those that should not be grieved for; yet, you speak words like a
man of wisdom. The wise grieve neither for the living nor for the dead”
—Bhagvad Gita: II:11

In India it is natural to invite death into spiritual practice. Death is an inescapable

and inevitable reality (Swami Adiswarananda). To ignore it is utter foolishness. To
avoid it is impossible. To hope for physical immortality is absurd. It is important to
do the following to “beat” death:
(a) Make death a part of life by understanding that life without death is
incomplete. As soon as we are born, we begin to die. Life is sacred and so
we cannot afford to squander it in daydreams, fantasies, and false hopes.
Life without death, pleasure without pain, light without darkness, and
good without evil, are never possible. We must either accept both or rise
above both, by overcoming embodiment through the knowledge of the
self. Death is certain for all who are born. As the Bhagavad Gita says: “For
to that which is born, death is certain, and to that which is dead, birth is
certain. Therefore, you should not grieve over the unavoidable.”
(b) Develop immunity against death by practicing meditation and dispassion.
In meditation, we try to reach our true identity, the deathless Self, by
crossing over the three states of consciousness—waking, dream, and
deep sleep—and becoming videha, or bereft of body consciousness. In
this practice, we partially and temporarily die in our physical and mental
existence. Along with meditation, practice dispassion, which is knowing
that nothing material will accompany us when we leave this earth, and that
nothing in this world can be of any help to us to overcome death.
(c) Build your own raft. Vedanta compares this world to an ocean, the near
shore of which we know, while the far shore remains a mystery to us. The
ocean has bottomless depth, high winds, fearful currents, and countless
whirlpools. Life is a journey, an attempt to cross this ocean of the world
and reach the other shore, which is immortality. No one can take us across
258 Counseling: Theory, Skills and Practice

this ocean. Vedanta urges us to build our own raft by practicing meditation
on our true self. No practice of this self-awareness is ever lost. As we go
on with our practice, all our experiences of self-awareness join together
and form a raft of consciousness, which the Upanishads call the “raft of
Brahman.” Sitting on this raft of Brahman, a mortal crosses the ocean
of mortality: “The wise man should hold his body steady, with the three
(upper) parts erect, turn his senses, with the help of the mind, toward the
heart, and by means of the raft of Brahman cross the fearful torrents of the
world.”
(d) Free yourself from all attachments. Our attachments and desires keep us
tied to our physical existence. We often hope for the impossible and want
to achieve the unachievable. To free ourselves from these attachments and
desires, we need to cleanse ourselves. Just as we cleanse our body with soap
and water, so do we cleanse our mind with self-awareness. The Mahabharata
advises us to bathe in the river of Atman: “The river of Atman is filled
with the water of self-control; truth is its current, righteous conduct its
banks, and compassion its waves. O son of Pandu, bathe in its sacred water;
ordinary water does not purify the inmost soul.” (13)
(e) Know your true friends. Know that our only true friends are our good deeds:
deeds by which we help others in most selfless ways. At death, everything of
this world is left behind; only the memories of all the deeds we performed
in this life accompany us. The memories of good deeds assure our higher
destiny and give us freedom from fear of death, while the memories of bad
deeds take our soul downward. Therefore, a person must try to accumulate
as many memories of good deeds as possible while living.
(f) Perform your duties. Life is interdependent. For our existence and survival,
we are indebted to God, to our fellow human beings, and to the animal
and vegetable worlds. Many have to suffer to keep us happy, and many
have to die for our continued existence. We are indebted to all of them.
To recognize this indebtedness and make active efforts to repay them is the
sacred duty of life. By doing our duties, we become free from all sense of
guilt. Be a blessing to all, not a burden. Remember, when you were born
you cried, but everybody else rejoiced. Live your life in such a way that
when you die everybody will cry, but you alone will rejoice.
(g) Know for certain that death has no power to annihilate your soul. Our
soul, our true identity, is the source of all consciousness. It is separate and
different from our body and mind, which are material by nature and are
subject to change and dissolution. The consciousness of the soul in each of
us is part of the all-pervading Universal Consciousness and is the deathless
witness to the changes of the body and mind. The Universal Consciousness
is like an infinite ocean and we are like drops of water. We rise to the sky
 Hospital Counseling 259

from the ocean, and again we fall into the ocean as raindrops, will in the
end, sooner or later, come together as part of the ocean. In the words of
Swami Vivekananda:

“One day a drop of water fell into the vast ocean. When it found itself there, it began to
weep and complain just as you are doing. The great ocean laughed at the drop of water.
“Why do you weep?” it asked. “I do not understand. When you join me, you join all your
brothers and sisters, the other drops of water of which I am made. You become the ocean
itself. If you wish to leave me, you have only to rise up on a sunbeam into the clouds.
From there you can descend again, a little drop of water, a blessing and a benediction to
the thirsty earth.”

This counseling is also used for counseling the terminally ill. The only difference
is that when counseling the person awaiting death it that person receiving the
counseling, and in grief counseling the next of kin.

COUNSELING THE TERMINALLY ILL

One of the most difficult areas for counselors to work is in hospice settings with
individuals who are dying. The needs of the dying are complex and little has been
written to guide counselors in providing service.
Counselors provide service in a variety of settings and to diverse individuals with
many different challenges (Darlene Daneker, 2006). The diagnoses of a terminal
disease is rarely met immediately with a sense of peace and acceptance. As we have
seen in the section on grief counseling, it is quite normal for the individual in
question will travel though five separate stages of grief-denial and isolation, anger,
bargaining, depression, and finally acceptance. It is important for the counselor to
recognize the stage of grief the individual is currently experiencing. That helps to
tailor the counseling approach to the exact need of the counselee.
The first stage of denial cannot be dealt with by repeatedly confronting the
counselee with the reality of the situation. This will only anger him or her further,
cause more pain as well as create a wall of resentment. Counselors can take this as
an opportunity to educate the counselee on the specifics of their condition and the
various treatments available. The energy of optimism that accompanies the denial
can be taken advantage of to replenish the strength within the counselee.
At the same time it is imperative to help the counselee combat the desire to isolate
themselves from friends and family. Often, as the disease progresses, the individual
may start becoming increasingly tired. They may be sedated or in extreme pain and
may require the soothing company of their near and dear. However, they must also
260 Counseling: Theory, Skills and Practice

be allowed their space sometimes to express their pain in their own company. It can
be embarrassing to have someone see them in so much discomfort. But they can be
encouraged to involve their family and friends in everyday tasks, as well as enjoyable
outings that will create comfortable memories for everyone involved.
Grief counselors have found that the most difficult stage to deal with is the
anger stage. Anger is the outcome of fear, disappointment and coming to grips
with the inevitability of the situation. It is the time when all options and ways out
have been explored and acceptance is the only choice left. The inner self or what
lay people call ego does not want to let go of hope. Defiance creeps in making it
very difficult for everyone who is helping the individual. The person can be very
rude and mean causing the caregivers to distance themselves from him or her. And
this may result in feelings of guilt in the survivors. The counselor can step in and
provide the necessary understanding of the situation and help bring in peace and
calmness in the relationships. The friends and family have to understand that the
individual’s reactions have nothing to do with them or their behavior. It is part of
a normal process of grieving. And this stage will give way to more serene times,
once acceptance has set in. also they must be helped to understand that distancing
themselves from the person can harm the individual’s trust and make them more
scared. Thus, the adverse reactions due to fear can be dealt with by letting the
individual know that you are there should they need you. That it is okay for them
to be angry, scared or feel defenseless.
The bargaining stage is typically characterized by “if/then” thinking…only if I
had taken care, then I would not be here…this is bargaining with the past. Then they
can also bargain with their future…making pacts with God…heal me and I will…
This stage very quickly leads to despair and depression. The knowledge that the
condition and its course are here to stay and nothing can ever be done about it
is pretty frustrating. If individuals hold themselves responsible for their situation
then they experience extreme guilt, not only because they have let themselves
down but also because they have let others who care for them down. If they do not
hold themselves responsible then they suffer from extreme self-pity and view their
situation as unfair punishment or simply undeserved.
Here religious or spiritual counseling has proven very effective. This has been
dealt with in the previous section on grief counseling. Also it is important to take
care of the individual physically as they would take care of themselves, for instance
grooming, cleaning, etc., change flowers in the vase everyday, make them watch
TV and update themselves with current affairs. Everything other than their illness
can be kept normal. It is very important to let the individual know that you are
not afraid to face their illness or death and there is no reason for them to fear them
either. Constantly reassure them that it is ok to be sad.
If this stage is handled effectively, then it will lead to acceptance—acceptance
of their illness, the various issues they have dealt with in life, and an acceptance
 Hospital Counseling 261

of their coming death. This time then is filled with writing or updating wills,
settling financial and relationship matters, saying goodbye, finishing the unfinished
businesses, forgiving and asking for forgiveness, expressing love and admiration, and
spending intimate time with loved ones. Counselors can help them by being there,
helping out with planning and executing of the counselee’s agendas.

Needs of the Terminally Ill

A counselor working in with the terminally ill works on a multidisciplinary team.
The tasks of counselors include helping the dying individual prepare for the reality of
death through education and supportive therapeutic interventions about the dying
process that address the physical, emotional, social, spiritual, and practical needs
(Davies, Reimer, Brown, and Martens, 1995; Doka, 1997; Parkes et al., Rando,
1984; Rando, 2000).
Physical needs: One of the most important concerns of caring for the terminally ill
is pain management (National Hospice Foundation, 2001). Today a multi-pronged
approach is adopted in addition to pain medication like the use of traditional
psychological interventions—biofeedback, hypnosis, relaxation, and imagery
techniques which provide skills that increase the client’s awareness and control of
pain (Arnette, 1996; Cook and Oltjenbruns, 1998; Rando, 1984; Rando, 2000). The
counselors need to educate the individuals about the physical changes and common
processes prior to one’s death providing information on how the body changes,
what changes to expect in the future, and when to contact a physician so that they
can be well prepared. This helps in alleviating anxiety and diminishing erroneous
preconceptions about dying (Parkes et al., 1996; Rando, 1984; Rando, 2000).
The media’s portrayal of death can be quite different from actual reality. Dying
individuals who have preconceived notions from the media may be disillusioned
when their notions do not match reality (Cook and Oltjenbruns 1998). Counselors
need to address the clients experience of loss in strength, increased fatigue, requiring
greater sleep and rest, decrease in or loss of appetite due to nausea, constipation,
and pain, loss of functional ability as the illness progresses. The individual finds it
difficult to lead life as before, is not able to do the things he/she was once able to do.
All this affect the individuals’ emotional state, producing feelings of sadness, anger,
helplessness, and hopelessness. In addition to that the feeling of guilt at being a
burden to the caregivers can be quite depressing. Reconciling the loss of body parts
or changes from treatment (e.g., hair loss) with the individual’s identity is important
for emotional health (Cook and Oltjenbruns, 1998).
Emotional needs: This is the time when dying individuals have to cope with
intense emotions such as anger, fear, guilt, and grief (Doka, 1997; Rando, 1984).
Counselors can help by explaining that these emotions are both a normal part of the
process of dying. Addressing the anticipatory grief of the individual which includes
262 Counseling: Theory, Skills and Practice

helping clients redefine life as it currently is, facilitating expression of feelings of

being a burden, providing emotional support clients as they struggle with change,
encouraging the search for meaning, and allowing the client to live day-by-day
(Davies et al., 1995) is critical for counselors (Parkes et al., 1996; Rando, 2000).
The counselor needs to encourage open communication within the family during
this stressful time.
Social needs: The social environment is as important and needed or even more
so than he or she did before the illness (Davies et al., 1995; Parkes et al., 1996).
Interventions by a counselor can facilitate the ability of friends and family to enable
the dying individual to maintain a social life in the face of physical limitations
(Davies et. al., Kubler Ross, 1969; Rando, 1984). The individual needs to attend to
unfinished business, like taking care to mend relationships with friends and family,
connecting with long-term friends, expressing love and asking forgiveness. This is
an important part of this social realm—are all important to the dying individuals’
peace of mind (Davies et al., Rando, Shneidman). Developmentally appropriate
care should be given by counselors working with dying children. They need to be
aware of the unique social needs of children to provide that (Stevens and Dunsmore,
1996). Intervention can take the form of play therapy, art therapy, peer support,
and support groups are common forms of intervention that allow children with
serious illness to live as normally as possible (Cook and Oltjenbruns, 1998).
Spiritual needs: Spirituality may be heightened as one confronts death” (Doka
and Morgan, 1993, p. 11). We have seen in an earlier chapter how Erikson has
described the last stage of human life. This is the stage where people tend to slow
down and productivity decreases. Then they begin to explore life, the achievements
and failures, try to integrate them into a whole and see whether as a whole their life
has been a success or fruitful. Each one has his or her parameters for defining success
and according to that they rate their lives. If on their scale they have failed, this
leads to despair when they look back on a life of disappointments and unachieved
goals. So too the terminally ill individuals goes through the rigors of examining his
or her life and makes certain conclusions. The counselor’s objectivity can facilitate
the integration of life events and experience to create meaning by providing time
for reflection and encouraging exploration of events that have been witnessed or
things the individual has done. This way individuals can find meaning in their
lives and in the illness the failure to find which can create a deep spiritual pain or
emptiness. Also this kind of exercise helps in giving the individual hope that there
are still some things that may be rectified (taking care of unfinished business) and
resolved. Doka (1993) discusses helping clients create a personal definition (in a
way that is consistent with their self-identity) of an appropriate death—manner of
death, care of the body after death, and the disposition of possessions after death.
Indian philosophy (as explained in the earlier section) helps the clients transcend
death. Doka states that an important spiritual need is transcendental in that we
 Hospital Counseling 263

seek assurance that our life has had meaning and we have contributed something
of value.
Practical problems: Such as distribution of possessions, settling financial affairs,
arranging wills and trust funds, and prefuneral planning are all important topics for
discussion, but are ones that family members often are hesitant to approach (Rando,
1984) is an area where counselors often are involved.
Supervision of others: Although this area is not often mentioned in the grief
literature, Vacc (1989) found that the single greatest proportion of time for counselors
working with oncology patients was spent in supervising volunteers and counselors
in training. Counselors also may be involved in training other professionals in the
emotional, psychosocial, and spiritual needs of the dying individual and their family
(Parkes et al., 1996).

Preparing for Serious Illness

As people develop symptoms of advanced illness, they increasingly lose control over
their bodies and lives. One task of counseling is to help clients recognize what they
can control. It is best to raise the difficult and painful issues long before there is any
apparent need for them when he or she is more likely to have the necessary energy
to plan for these difficult realities. It helps to discuss concrete plans like a living will,
medical proxy, and treatment options.

Crucial Points to Specifically Discuss with Clients

(Michael Shernoff, 1996)
Which hospital does he or she want to be taken to in the event of an
emergency? Who in their support system is aware of this?
If the client lives alone or with small children, who will help them get to
the hospital and/or to care for children or pets during a crisis?
A current and complete list of all prescribed medications and dosages that
should be brought to the hospital during an emergency admission.
How aggressively they wish to be kept alive if there is not any reasonable
hope for recovery or for a good quality of life. If a client does not wish
to be resuscitated then a “do not resuscitate” (DNR) order needs to be
written and placed in his or her chart. Clients need to be reminded that
they can always revise these instructions if any of their feelings change over
the course of their illness.
A living will.
Designate a health care proxy (a family member or close friend) to ensure
that the client’s wishes will be followed even if those wishes are contrary to
what the proxy feels is best.
264 Counseling: Theory, Skills and Practice

Pain Management
As Rabkin et al., (1994) state, “Most people fear that they will be in excruciating pain
as they near death from a terminal illness. Clients need to be assured that they will not
suffer. Most major hospitals have physicians who are pain management specialists
who can consult with the patient about helping him or her remain comfortable
at this phase of the illness. Some people prefer to be unconscious, others wish to
be alert, but sedated and pain free.” Thus, in order for the physician, or others
who are helping them manage the pain like nurses, hypnotherapists, counselors,
physiotherapists, yoga masters, etc., to take good care of the patients, the latter need
to explicitly describe how much pain they are experiencing. Not everyone knows
how to communicate their pain effectively and they have to be taught. They can
be taught in the earlier stages so that when they are is acute pain the process will be
more efficient.
Some patients may require those medicines that may be addicting which physicians
may be reluctant to prescribe. Conversely some patients may not absolutely require
them but their fear of pain or the ‘good feeling’ that the drugs may cause they
may insist upon. Counselors, nurses as well as hospital social workers need to take
the right call and advocate for or against as the case may be. At these junctures it
is recommended that they take a collective call with the physician and other care
managers who are working with the patient. Counselors and social workers need to
be alert to the above mentioned dynamics and be prepared to advocate for chemically
dependent patients who are not being adequately medicated. The counselors may
need to remind people that taking prescribed medication to alleviate pain is not
the same as abusing drugs. And if the patient is insisting on a drug that in expert’s
opinion they may not need counselors can intervene with psychological techniques
to manage pain such as visualization, relaxation, etc.

Choices in Dying
People who are dying are faced with a major issue—the diminished or total inability
to control what happens to them. Counselors can help them greatly by engaging
them in a discussion about where they want to die. This exercise of choice makes
them feel empowered and less depressed. They can make this choice, whether to die
at home, in the hospital or in a hospice along their loved ones can and should do
this in consultation with the physician. This can be done in a few separate sessions.
First the counselor can help the patient explore all of his or her feelings about this
emotionally laden issue. Next the discussion can be continued with the people who
are part of the client’s support team, such as next of kin, friends, etc., in order to
explore all the emotional as well as logistical and practical issues involved.
It is an essential and completely appropriate role of the counselor to encourage
the client to explore his or her feelings about whether or not to cease treatments
 Hospital Counseling 265

or to continue fighting for extra time. This time can be a time to bond, finishing
unfinished businesses, achieving closure both for the terminally ill person as well as
those who love him or her. Rabkin et al., (1994) correctly note that it is far easier to
believe in the right to choose the timing of one’s death when the person is actively
dying and when their remaining time is likely to be hours or days. Once the client
has decided to discontinue medical procedures or drugs is started with the double
purpose of alleviating pain and possibly, accelerating the timing of impending
death.

PAIN MANAGEMENT COUNSELING

One who has control over the mind is tranquil in heat and cold, in pleasure and pain,
and in honor and dishonor; and is ever steadfast with the Supreme Self.
—The Bhagavad Gita

For the last 300 years, the human body has been seen as a complex machine which is
separate from the process of perception. This idea has dominated the understanding
of pain dominated. But it has now been acknowledged and understood that pain
is an experience which cannot be separated from the patient’s mental state, the
environment and cultural background. These factors can be so critical that they can
actually cause the brain to trigger or abolish the experience of pain, independent
of what is occurring elsewhere in the body. Therefore, when assessing a complaint
of pain, it is critical to also investigate the appropriate mental and environmental
factors (Steven Richeimer, 2000).
Living with pain often causes a ripple effect that touches many parts of life.
One may feel a range of emotions, such as fear, anger, hopelessness, confusion, and
isolation. Those around him or her may have similar feelings. Individual counseling
and in some cases, counseling with the family can help. Many people find great
benefit from individual or group counseling specifically focused on pain and related
worries. Counselors and therapists teach useful skills and provide needed emotional
support and guidance.
Pain management is a branch of medicine employing an interdisciplinary
approach for easing the suffering and improving the quality of life of those living
with pain (Hardy, Paul A. J., 1997). The typical pain management team includes
medical practitioners, clinical psychologists, physiotherapists, occupational
therapists, and nurse practitioner (Main, Chris J.; Spanswick, Chris C., 2000).
Treatment approaches to long term pain include pharmacologic measures, such as
analgesics, tricyclic antidepressants and anticonvulsants, interventional procedures,
physical therapy, physical exercise, application of ice and/or heat, and psychological
measures, such as biofeedback and cognitive behavioral therapy (en.wikipedia.org).
266 Counseling: Theory, Skills and Practice

What is Pain?
Pain is a complex experience. It includes both physical as well as psychological
factors. It can be defined as “an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or described in terms of such
damage” (healthpsychology.net). Pain can be classified as either “acute” or “chronic.”
Acute pain is the most common reason why patients seek medical attention. Acute
pain usually comes on quickly and severely and lasts for a short duration of time.
It is the normal, predicted physiological response to a noxious chemical, thermal
or mechanical stimulus; can be the signal of tissue being damaged and typically is
associated with invasive procedures, trauma and disease. It is generally time-limited
and usually disappears when the injury heals, e.g., headache, skinned knee, muscle
aches, labor pain. Acute pain is an adaptive, beneficial response necessary for the
preservation of tissue integrity (The Neuroscientist, Vol. 5, No. 5, 1999) because it
alerts us to the presence and location of tissue injury and corrects behavior that may
be causing or contributing to it. Acute pain has a crucial function for good health
because it is a warning of actual or potential physical harm. In situations of acute
pain the pain usually stops before physical healing is complete (painrelief.co.nz).
Chronic pain has several different meanings in medicine. Traditionally, the
distinction between acute and chronic pain has relied upon an arbitrary interval
of time from onset; the two most commonly used markers being 3 months and 6
months since the initiation of pain, though some theorists and (wikipedia.org). It
has no protective role and is not necessarily associated with tissue damage as viewed
from imaging techniques, such as MRI or X-ray. Failure to treat acute pain promptly
and appropriately at the time of injury, during initial medical and surgical care can
contribute to the development of chronic pain. Chronic pain is often associated
with functional, psychological and social problems. It is easy to see how then chronic
pain can have a significant impact on the person, his family and friends.

Types of Pain
Pain can be of many types. The differences are important for understanding the
nature of the pain problem and especially for determining how to treat the pain
(Richeimer, 2000).
1. Nociceptive pain: A nociceptor is a sensory receptor (nerve) that sense
and respond to potentially damaging stimuli from parts of the body
which are affected. When activated, they transmit pain signals (via the
peripheral nerves as well as the spinal cord) to the brain. This process,
called nociception, usually causes the perception of pain. They signal tissue
irritation, impending injury, or actual injury. The pain is typically well
localized, constant, and often with an aching or throbbing quality.
 Hospital Counseling 267

Nociceptive pain is usually time limited, meaning when the tissue damage heals,
the pain typically resolves (Except arthritis which is not time limited). Nociceptive
pain can be divided into two separate categories.
Somatic pain: Caused by the activation of pain receptors in either the
cutaneous tissues (body surface) or deep tissues (musculoskeletal tissues).
Common causes include post-surgical pain or pain related to a laceration.
Visceral pain: “Viscera” refers to the internal areas of the body that are
enclosed within a cavity. Visceral pain is not well localized, and is caused
by activation of pain receptors resulting from infiltration, compression,
extension, or stretching of the chest, abdominal, or pelvic viscera. Visceral
pain is usually described as pressure-like, deep squeezing.
2. Neuropathic pain: Neuropathic pain is the result of an injury or malfunction
in the peripheral or central nervous system, often triggered by an injury
which may or may not involve actual damage to a nervous system. Nerves
can be infiltrated or compressed by tumors, strangulated by scar tissue,
or inflamed by infection. The patient in neuropathic pain describes the
sensation as “shooting,” “electric,” “stabbing,” or “burning.” they may feel
it traveling along a nerve path from the spine into the arms and hands or
into the buttocks, legs, or feet. Neuropathic pain is frequently chronic and
can be managed with proper treatment.
3. Mixed category pain: In some conditions the pain appears to be caused
by a complex mixture of nociceptive and neuropathic factors. An initial
nervous system dysfunction or injury may trigger the neural release of
inflammatory mediators and subsequent neurogenic inflammation. For
example, migraine headaches.
4. Phantom pain: Phantom pain sensations are described as perceptions that
an individual experiences relating to a limb or an organ that is not physically
part of the body. Limb loss is a result of either removal by amputation or
congenital limb deficiency (Giummarra et al., 2007). It is a sensation of
pain coming from a part of the body that has been amputated, i.e., below
the level of the amputated limb, or in that part of the body where the
nerves have been destroyed and sensation is impossible.

Pain Measurement
Pain is a personal, subjective experience influenced by cultural learning, the meaning
of the situation, attention, and other psychological variables. Pain scales are based
on self-report (verbal and numeric self-rating scales), observational (behavioral),
visual or physiological data. The subjective nature of the experience often becomes
a source of frustration to the person with chronic pain who frequently hears “you
don’t look like you’re in pain!” And so it is for physicians who are unable to find
268 Counseling: Theory, Skills and Practice

structural pathology to account for a person’s pain complaint. The factor of empathy
or understanding the pain of another becomes a difficult task as what one person
finds painful may not be painful to another. The complex nature of the experience
of pain suggests that measurements from these domains may not always show high
concordance. Because pain is subjective, patients’ self-reports provide the most valid
measure of the experience (Katz J, Melzack R, 1999).
There are a few scales for measuring pain. They are as follows:
1. Numerical Rating Scales: A scale of 0 to 10 where 0 signifies “no pain”
and 10 signifies “worst possible pain”. The Individual is asked to choose a
number from 0 to 10 that best reflects their level of pain.
2. Visual Analogue Scales: These scales use a vertical or horizontal line with
words that convey “no pain” at one end and “worst pain” at the opposite
end and the individual is asked to place a mark along the line that indicates
the level of pain.
3. Wong-Baker FACES Pain Rating Scale:
Face 0 is a happy face (no hurt)
Face 1 is still smiling (hurts a little bit)
Face 2 is not smiling or frowning (hurts a little more)
Face 3 is starting to frown (hurts even more)
Face 4 is definitely frowning (hurts a whole lot)
Face 5 is crying although you don’t have to cry to choose this face (hurts
the worst)
This scale is particularly useful for individuals who may not have verbal skills to
express their pain level, especially children.

The Pain Cycle (Adapted From Healthpsychology.Net)

As we have already discussed earlier, the experience of pain s a combination of actual
physical, physiological discomfort as well as perceptual factors. Thus the focus on
emotional well-being can help alleviate the pain to a large extent. Reactions to
chronic pain include feelings of irritation, frustration, depression, fear and anxiety.
Other factors, such as mood, beliefs about pain, and coping style have also been
found to play an important role in an individual’s adjustment to chronic pain. All
this can make it very difficult for the individual to conquer the pain. Addiction
to pain relieving drugs (e.g., alcohol, narcotics, even prescription medications) is
also quite common. This complicates the situation further. As the pain causes the
individual to slow down on activities, including work, social activities, or hobbies,
it can lead to withdrawal and isolation from the social milieu, increasing depression.
Being less active or perhaps totally inactive can cause their muscles to weaken. The
individual may begin to gain or lose weight, and the overall physical conditioning
may decline. This can contribute to the belief that one is disabled.
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The persistence of the pain may lead to the development of negative beliefs about
the experience of pain (e.g., “this is never going to get better”) or negative thoughts
about themselves (e.g., I’m worthless to my family because I can’t work). These
thoughts, along with decreased participation in enjoyable and reinforcing activities,
can lead a person to feel depressed and anxious (distress). All of these things can fuel
and maintain the pain cycle.
Thus, the vicious pain cycle—
PAIN ——> DISABILITY ——> DISTRESS ——> PAIN

Treatment of chronic pain

The treatment of chronic pain can be pretty challenging. As most often the reason
is not clear, and it may take several different types and combination of treatments
before one finds relief. As the treatment starts, the patient may find that the pain
has increased. This may be due to the fact that their chronic pain had rendered
them inactive causing them to lose their strength and flexibility. However, over
time treatment may reduce the pain and increase one’s ability to function. It also
possible that the individual learns new ways of doing ordinary tasks to fell less pain.
It is important to note that chronic pain may not be cured, but can be treated and
managed so that quality of life can be significantly improved.
A multidisciplinary treatment approach comprising of psychology, anesthesiology,
neurology, physical therapy, yoga and spirituality, is the most effective way to address
the complex problem of chronic pain. The multidisciplinary treatment teams, each
with expertise in the assessment and treatment of chronic pain, combine to help the
patient. Members of the team work together in a coordinated manner to provide the
best treatment for a patient’s pain.

Initial treatment
The goal of any treatment is to reduce distress and, if possible, remove the cause.
In chronic pain physicians are doubtful if the latter can be done. Thus, the goal
becomes reduce the pain and increase the ability to function effectively. The
stress is on getting rest, sleep, improve coping skills and reduce stress that causes
hypersensitivity. Thus, the individual can return to the regular activities. The nature
and level of pain, its origin perhaps (illness, injury, or unknown) is identified and
assessed. And then a combination of therapies is administered.
Along with pharmacotherapy rest, exercise, balanced diet, and alternative medical
approaches (acupuncture, meditation) are recommended.

Psychological Approaches to Pain Management

Endorphins (“endogenous morphine”) are endogenous opioid peptides that function
as neurotransmitters. They are released in the body in response to pain or sustained
270 Counseling: Theory, Skills and Practice

exertion. They are produced by the pituitary gland and the hypothalamus in
vertebrates during exercise, excitement, pain, consumption of spicy food and orgasm,
and they resemble the opiates in their abilities to produce analgesia and a feeling of
well-being (http://en.wikipedia.org/wiki/Endorphin#cite_note-UPMC-1). They
serve as internal analgesia. These need to be increased. Psychological approaches
such as stress management, wellness techniques and exercise aid in doing just that.
Dialogical therapy, inspirational narratives, reading autobiographies of people who
have overcome pain and gone on to do something big, all help to release these
endorphins, help dopamine production, which act as antidepressants, reducing the
perception of pain and encouraging the individual to fight the pain. Meditation
and spiritual counseling lessens stress and creates a calm which in turn reduces the
experience of pain.
Health psychology attempts to find treatments to reduce and eliminate pain, as
well as understand pain anomalies. Psychological therapy that can help people in
chronic pain are counseling, cognitive behavioral therapy (CBT), biofeedback, and
hypnosis.
CBT has proved to be very effective in helping patients to reduce all aspects of the
pain cycle—pain, distress and disability perception. Modifying negative thoughts
related to pain leads to increased activity and productive functioning and the feeling
of well being that results from that. Treatment can be delivered individually or in a
group. Techniques of CBT include:
1. Relaxation Training
2. Cognitive Restructuring
3. Stress and Anger Management
4. Sleep Hygiene
5. Activity Pacing
This is a short term, focused form of psychotherapy. The client and the therapist
identify goals and use problem-solving approach to find ways of reaching them.
With any type of therapy, it is important to take an active role in the process.
Patients who are assertive and fully engaged in their own health care cope better than
those who are more passive. Mindfulness-based cognitive therapy, the use of stress
reduction and relaxation, has been found to reduce chronic pain in some patients
(Kabat-Zinn, J; Lipworth, L; Burney, R (1985), Kabat-Zinn, J (1982)). Applied
behavior analysis views chronic pain as a consequence of both respondent and
operant conditioning, where a patient learns to display pain behavior in the presence
of specific environmental antecedents and consequences (wapedia). The calming
strategies of CBT stress counseling, meditation and the here-and-now emphasis
are likely to increase the release of GABA (gamma-aminobutyric acid)—which
prevents neuron hyperactivity and decreases sensitivity to pain causing stimuli.
 Hospital Counseling 271

Counseling (Ivey et al., 2009)

Impact of counseling on the brain, or affecting neurotransmitters through effective
and quality counseling is being seen by many therapists, informally. Scientific research
is yet to emerge in the area. The microskills of attending, observation, and the basic
listening sequence culminating in the communication of empathy cause changes in
the brain activity of the client. Other microskills like encouraging, paraphrasing,
and summarizing causes the brain to conclude that something good is happening
and creates a feeling of pleasure. The limbic system organizes bodily emotions and
includes the amygdale, hypothalamus, thalamus, hippocampal formation, and
cortex. Reflection of feelings and empathizing reduce the intensity of emotions
and thus those that psychologically increase the perception and experiencing of
pain are lowered resulting in decrease in experience of pain. Gentle and supportive
confrontations often can reach underlying emotional structures as the empathic
atmosphere provides the setting for creative new learning. This helps the client
devise newer techniques and methods to manage pain. Reflection of meaning works
like an antidepressant and this reduces the experience of pain. As Victor Frankl
points out, pain can be endured when there is meaning attached to it.

Biofeedback
Biofeedback is a learning technique that utilizes specialized equipment to assist a
person in gaining control of their natural body functions. It involves the monitoring
of a life process (bio) and the return of that information to the patient and therapist
in a meaningful form (feedback) (www.agscenter.com/glossary.asp). It is the process
of becoming aware of various physiological functions like brainwaves, muscle tone,
skin conductance, heart rate and pain perception, using instruments that provide
information on the activity of those same systems, with a goal of being able to
manipulate them at will. Biofeedback may be used to improve health or performance,
and the physiological changes often occur in conjunction with changes to thoughts,
emotions, and behavior. Eventually, these changes can be maintained without the
use of extra equipment (Durand, Vincent Mark, Barlow, David; 2009).
Three professional biofeedback organizations, the Association for Applied
Psychophysiology and Biofeedback (AAPB), Biofeedback Certification Institution
of America (BCIA), and the International Society for Neurofeedback and Research
(ISNR), arrived at a consensus definition of biofeedback in 2008:
“Biofeedback is a process that enables an individual to learn how to change
physiological activity for the purposes of improving health and performance.
Precise instruments measure physiological activity such as brainwaves, heart
function, breathing, muscle activity, and skin temperature. These instruments
rapidly and accurately ‘feed back’ information to the user. The presentation of
this information—often in conjunction with changes in thinking, emotions, and
272 Counseling: Theory, Skills and Practice

behavior—supports desired physiological changes. Over time, these changes can

endure without continued use of an instrument (http://en.wikipedia.org/wiki/
Biofeedback_Therapy).
In this technique people are trained to improve their health by using signals from
their own bodies. This can be used for a number of conditions like helping stroke
victims regain movement in paralyzed muscles, helping tense and anxious clients
learn to relax, helping patients cope with pain.
Using this treatment technique the connections between emotions and health
are monitored and fine tuned. To do this devices sensitive to very small changes
in bodily conditions are used. These are called sensor modalities. These devices
include:
Electromyograph (EMG) uses surface electrodes to detect muscle
action potentials from underlying skeletal muscles that initiate muscle
contraction.
Feedback thermometer detects skin temperature.
Electrodermograph (EDG) measures skin electrical activity directly (skin
conductance and skin potential) and indirectly (skin resistance)
Electroencephalograph (EEG) measures the electrical activation of the
brain from scalp sites located over the human cortex.
Photoplethysmograph (PPG) measures the relative blood flow through a
digit to monitor the temporal artery.
Electrocardiograph (ECG) uses electrodes placed on the torso, wrists,
or legs, to measure the electrical activity of the heart and measures the
interbeat interval.
Pneumograph or respiratory strain gauge can provide feedback about the
relative expansion/contraction of the chest and abdomen, and can measure
respiration rate.
Capnometer uses an infrared detector to measure end-tidal CO2 exhaled
through the nostril into a latex tube. Shallow, rapid, and effortful breathing
lowers CO2, while deep, slow, effortless breathing increases it.
Hemoencephalography measures the differences in the color of light
reflected back through the scalp based on the relative amount of oxygenated
and deoxygenated blood in the brain.
Clinical biofeedback techniques that grew out of the early laboratory procedures
are now widely used to treat an ever-lengthening list of conditions. These include
the following:
Migraine headaches, tension headaches, and many other types of pain
Disorders of the digestive system
High blood pressure and its opposite, low blood pressure
Cardiac arrhythmias (abnormalities, sometimes dangerous, in the rhythm
of the heartbeat)
 Hospital Counseling 273

Raynaud’s disease (a circulatory disorder that causes uncomfortably cold

hands)
Epilepsy
Paralysis and other movement disorders
ADHD
Panic attacks and stress, anxiety disorders and depression
Asthma and other psychophysiological disorders
There is much ongoing research linking specific modalities to specific disorders.
For, e.g., HRV biofeedback is used when treating asthma, depression, unexplained
abdominal pain; EMG used for worry, chronic pain, anxiety, headache, lower back
pain, etc., EEG or neurofeedback for addiction, attention deficit hyperactivity
disorder (ADHD), learning disability, anxiety disorders (including worry, obsessive-
compulsive disorder and posttraumatic stress disorder), depression, migraine, and
generalized seizures; etc. Specialists who provide biofeedback rely on many other
techniques in addition to biofeedback. Patients are taught some form of relaxation
exercise. Some learn to identify the circumstances that trigger their symptoms.
They may also be taught how to avoid or cope with these stressful events. Most are
encouraged to change their habits, and some are trained in special techniques for
gaining such self-control (psychotherapy.com).
Thanks to biofeedback, the connection between the brain and the body becomes
a two-way street. Biofeedback basically provides visual or auditory information
about normally undetectable physiological processes.

Hypnotherapy
Hypnotherapy is often applied in order to modify a subject’s behavior, emotional
content, and attitudes, as well as a wide range of conditions including dysfunctional
habits, anxiety, stress-related illness, pain management, and personal development
(wikipedia.org). When used in an appropriate manner, hypnosis has proven itself
to be an effective tool in the management of pain and pain perception. Trained
hypnotherapists use hypnosis as an adjunct to their treatment programme, create
an environment by which the clients can access their inner resources in their own,
unique way.

Modalities
Traditional hypnotherapy mainly employed direct suggestion of symptom removal,
with some use of therapeutic relaxation. Hypnoanalysis was used by Freud and
Breuer to regress clients to an earlier age in order to help them remember and abreact
supposedly repressed traumatic memories. Ericksonian hypnotherapy made use of
a more informal conversational approach with many clients and complex language
patterns, and therapeutic strategies. Cognitive/behavioral hypnotherapy (CBH)
274 Counseling: Theory, Skills and Practice

is an integrated psychological therapy employing clinical hypnosis and cognitive

behavioral therapy (CBT).

How hypnosis works

The mechanism of hypnosis is yet to be conclusively explained. Unfortunately the
psychological and physiological mechanisms by which hypnosis operates are neither
well characterized, nor understood. The most common psychological explanation
for how hypnosis works is based upon a dissociation model which is commonly
referred to as the “hidden observer” model of cognition.

Pain management through hypnosis

(Edward and Newton, 2001.)
Pain management should only be taught on the strength of a doctor’s referral and
frequently in consultation with and supervision by him/her. There is good reason
for this: pain is a symptom of something wrong in body and/or mind. If the primary
cause of the pain is physical, the client can be taught to induce analgesia or anesthesia
in the painful area.
Pain management techniques:

Objectification and identification: The pain is objectified and then identi-

fied as an external shape (e.g., circle) or object whose visual imagery can then be
manipulated (e.g., moved away from the self, diminish, melt away, etc.) resulting
in lower pain. The success of the technique depends on how well the patient has
objectified his pain.

Pain displacement or pain transference: moving the pain to an insignifi-

cant place in the body (e.g., an earlobe) where it can be modified and reduced.

Glove anesthesia: One of the hands is made numb and then that numbness is
applied to the painful site as it leaves the hand.

Ideomotor exploration and turning pain off at unconscious level:

The source of the pain can be discovered with questions to be answered by ideo-
motor signals (the movement of a finger perhaps). Then an “on/off” switch can be
imagined which when moved to the “off” position in hypnosis turns off the pain.

The inner advisor: The client imagines an inner advisor who will modify or
release the pain.

The protective shield: Here, the client imagines a protective dorce around the
body shielding the body from pain and/or unpleasant feelings.
 Hospital Counseling 275

Time and body dissociation: Escape to the enjoyment of a pleasant past

event while healthy and pain free and/or escape to a peaceful place.

REHABILITATION COUNSELING IN THE HOSPITAL

Rehabilitation Psychology is the helping profession dedicated to assisting people—

individuals, family members, and caregivers who are struggling with the effects of a
disability and are seeking to restore hope and meaning to their lives (findcounseling.
com). It is the study and application of psychosocial principles on behalf of people
who have physical, cognitive, developmental, or emotional disabilities (Bruyere,
1992). Whatever is the origin or type of disability the individual is generally faced
with personal, social, and situational barriers to effective functioning in society.
Disability refers to a limitation. This limitation can be in any one or more areas—
physical, sensory, cognitive (thinking), emotional functioning which can affect the
individual’s capacity to work, to learn, to manage personal or family responsibilities,
to maintain relationships, or to participate in recreational activities.
Some barriers (such as movement, self-care, etc.) are inherent in the disabling
condition, while others (psycho-emotional-socio-environmental) arise out of
widespread myths which contribute toward a devaluation or neglect of people who
are perceived as different from others. Dembo, Diller, Gordon, Levitan, and Sherr
(1973) conceptualized rehabilitation as that branch of psychology characterized
by concern with the amelioration of problems of deprivation and disability. Other
authors distinguish rehabilitation psychologists from other psychologists by the
importance placed on the stresses arising from socio-environmental factors: the
rehabilitation psychologist focuses on assisting people with disabilities to identify
and remediate barriers in their interpersonal or physical environment that may be
impeding their maximum participation in the community at large (Eisenberg and
Jansen, 1983).
Rehabilitation is “restoration to a satisfactory physical, mental, vocational
or social status after injury or illness, including mental illness and congenital
malfunctioning,” for example, rehabilitation counseling and training for amputees
and for victims of stroke, burn, spinal cord injuries, and heart disease. Psychologists
are involved in two different types of rehabilitation at medical centers (Dewey @
www.psywww.com):
1. Rehabilitation psychology or rehabilitation counseling is aimed at helping
people adjust to the after effects of injury or disease, counsel people
suffering medical disorders or facing medical treatment that requires
lifestyle adjustments.
276 Counseling: Theory, Skills and Practice

2. Psychological (or psychiatric) rehabilitation is aimed at helping of formerly-

hospitalized psychiatric patients to adjust to the “outside world” so they can
live independently outside the hospital Psychologists aid in the adjustment.

Stroke Rehabilitation
A stroke is caused by a clot or a bleed in the brain which causes brain cells to die.
People affected by stroke may experience the following (adapted from royalbucks.
co.uk/neurorehab):
Motor impairment, weakness, causing difficulties in walking, movement,
or coordination or paralysis (often affecting one side of the body, known as
hemiparesis or hemiplegia).
Swallowing difficulties causing trouble with eating or drinking, if not
managed effectively food or liquid passes into the windpipe and lungs
instead of the gullet resulting in chest infections including pneumonia. Lack
of proper food and fluid intake can cause dehydration or constipation.
Speech or language difficulties, usually a result of damage to the brain’s left
hemisphere, including difficulties in understanding, speaking (dysphasia,
aphasia), reading, writing, and calculation.
Problems of perception can include trouble recognizing or being able to use
everyday objects such as a kettle or teapot, difficulties telling the time, and
problems interpreting what the eyes see, even where vision is not affected.
Cognitive difficulties such as thinking clearly and logically, learning,
attending, memory, decision-making, and forward planning.
Behavior changes: These may include being slower to react, excessive
caution, disorganization, difficulty in adjust to change and becoming
confused or irritated.
Difficulties with bowel or bladder control (urinary or fecal incontinence
Fatigue: (the reason for which is not fully understood) sleep disturbance
which is caused by damage to areas of the brain controlling the body’s
sleep-wake cycle or could also be linked to depression which is extremely
common following a stroke.
Psychological impairment/mood changes/mood swings, irritability,
inappropriate laughing or crying or even when not triggered by internal
happiness or sadness, depression, and changes in cognitive functioning.
Other symptoms, such as loss of appetite, insomnia, crying, low self-
esteem, and anxiety that can all be signs of depression.
Post-stroke pain: some people develop a burning, shooting, throbbing pain
that does not respond to painkillers following a stroke.
Epilepsy: 7–20 per cent of people who have strokes develop epilepsy.
 Hospital Counseling 277

Recovery from stroke and rehabilitation

About half of people who survive a stroke will be left with significant disability.
However, the adaptability of the brain helps the cells that have sustained damage to
recover some of their functions. Also other areas of the brain take over the functions
performed by the cells that have died. Commonly it takes about a year to 18 months
for the people to have a surge of recovery. However, the time is extremely variable.
Rehabilitation following stroke is about the process of achieving the best level of
independence as possible by
learning new skills
relearning skills and abilities
adapting to the physical, emotional and social consequences of the stroke.
Therapy aims at providing a patient-centered, goal-orientated approach to stroke
rehabilitation to enable the individuals to reach their optimum level of recovery.

Head Injury Rehabilitation

Head injury is a trauma to the head resulting in injury to the brain which can
include complications, such as trauma, hypotension, intracranial hemorrhage and
raised intracranial pressure. Head injury, similar to stroke, can result in one or more
physical, cognitive, emotional, and behavioral deficits, for example:
Memory problems – both short-term and long-term
Executive functioning – planning, organization, problem solving
Information processing – speed, capacity, and control of information
Communication problems
Changes in mobility
Sleep disorders
Mood and personality changes
These are just a few of the range of difficulties people may experience. These
problems are often multiple and overlap in a complex way.

Other Neurological Conditions

Multiple sclerosis
Multiple sclerosis (abbreviated MS, also known as disseminated sclerosis or
encephalomyelitis disseminata) is a disease of the central nervous system where the
fatty myelin sheaths around the axons within the brain or spinal cord becomes
inflamed and then destroyed by the person’s own immune system. This leads to
demyelination and scarring in some areas of the brain or spinal cord. Disease onset
usually occurs in young adults. MS affects the ability of nerve cells in the brain and
spinal cord to communicate with each other. Almost any neurological symptom can
278 Counseling: Theory, Skills and Practice

appear with the disease, and often progresses to physical and cognitive disability
(Compston A, Coles A; April 2002).

Parkinson disease
Parkinson disease (PD) is a chronic as well as a progressive disorder. It is a
neurodegenerative condition of the central nervous system leading to the death
of dopamine containing cells of the substantia nigra often impairing the sufferer’s
motor skills, speech, and other functions. PD belongs to a group of conditions
called movement disorders and the primary symptoms include muscle rigidity,
tremor, a slowing of physical movement (bradykinesia) and even loss of physical
movement (akinesia) in extreme cases. Secondary symptoms may include high level
cognitive dysfunction and subtle language problems. Though it is predominantly
a movement disorder, people can develop psychiatric problems, such as depression
and dementia.

Motor neuron diseases

Motor neuron diseases (MND) are group of progressive neurodegenerative disorders
that attack the upper and lower motor neurons—the cells that control voluntary
muscle activity, including speaking, walking, breathing, swallowing and general
movement of the body. Degeneration of the motor neurons leads to weakness and
wasting of muscles, causing increasing loss of mobility in the limbs, and difficulties
with speech, swallowing and breathing.

Spinal injury
Spinal cord injuries cause myelopathy or damage to nerve roots or myelinated fiber
tracts that carry signals to and from the brain (Lin VWH, Cardenas DD, Cutter NC,
Frost FS, Hammond MC, 2002; Kirshblum S, Campagnolo D, Delisa J. Lippincott
Williams and Wilkins, 2001). A spinal cord injury is damage or trauma to the
spinal cord that results in loss or impaired function, resulting in reduced mobility
or feeling. It is often caused by: trauma, tumor, ischemia, developmental disorders,
neurodegenerative diseases, demyelinative diseases, transverse myelitis, and vascular
malformations. The resulting damage to the cord is known as a lesion, and the
paralysis is known as quadriplegia, or tetraplegia if the injury is in the cervical region,
or paraplegia if the injury is in the thoracic, lumbar, or sacral region.
The effects of spinal cord injury depend on the type and level of the injury.
Injuries can be divided into two areas:
Complete—There is no function (no sensation or voluntary movement) below
the level of the injury.
Incomplete—There is some function below the level of injury. A person may be
able to feel parts of the body that cannot be moved, she/he may be able to move one
limb more than the other.
 Hospital Counseling 279

Cardiac Rehabilitation
Cardiac rehabilitation is a medically supervised program that helps improve the
health and well-being of people who have heart problems. These rehabilitation
programs include exercise training, education on heart healthy living, and life-style
counseling to reduce stress and help the patient return to an active life. the focus of the
program is not only rehabilitation after a heart attack or heart surgery. It focuses on
preventing future hospital stays, heart problems, and death related to heart problems
by addressing risk factors. These risk factors include high blood pressure, high blood
cholesterol, overweight or obesity, diabetes, smoking, lack of physical activity, and
depression and other emotional health concerns that lead to coronary heart disease
and other heart problems. Counseling helps the patients adopt healthy lifestyle
changes including a heart healthy diet, increased physical activity, and learning how
to manage stress. Overall the goal is improved health and quality of life.
Negative emotional states, such as stress, anxiety, depression, and anger which
must have had an impact on traditional cardiac risk factors and pathologic precursors
such as decreased heart rate variability, impaired hemodynamic recovery, and
increased platelet aggregation need to be addressed in counseling. As they must also
have had an indirect influence on these factors via their link to unhealthy lifestyle
patterns and poor adherence to treatment recommendations, these must be focused
on during cardiac rehabilitation counseling in order to prevent future problems. It is
very easy for the patient to slip back to earlier lifestyles and ways of behaving.
A significant number of cardiac patients experience clinically significant
adjustment problems, clinical depression, anxiety disorders, increased irritability
and marital problems following their event, which places them at higher risk for
poor medical outcomes and increased rates of cardiac morbidity and mortality.
Psychological interventions address these problems and improve cardiac patients’
medical risk factor profile, adherence to lifestyle and medication regimens, return
to premorbid levels of psychosocial functioning and quality of life to a great extent,
thus reducing the risk of cardiac morbidity and mortality in the years following a
cardiac event.
Psychologists also target the “at risk” population. They educational programs
that include instruction in nutrition, exercise and stress management, information
on cardiovascular disease, and supervised exercise sessions. They receive cognitive-
behavioral therapy (CBT) strategies for stress and depression management, and
relaxation training, address their lifestyle adherence concerns. The individual sessions
can also be supplemented with group seminars, e.g., groups for depression, various
anxiety disorders, and insomnia, a more extended course of CBT. Patients with
severe levels of distress need to receive crisis intervention and be referred for more
extensive individual CBT to address their illness adjustment problems. Psychotropic
medication is often recommended for these individuals.
280 Counseling: Theory, Skills and Practice

Amputee Counseling
Most of us are born as whole complete human beings. Mind and body is connected
through nerves, muscle, and bone. Unfortunately, this system is sometimes torn
apart by disease or unfortunate accidents. Regardless of the cause of the amputation,
the person goes through basically the same five psychological stages of grief
(Kubler-Ross). When a limb or a part of a limb which everyone takes for granted is
functionally useless and has to be removed, a person naturally starts feeling helpless
or inadequate. The emotional stress starts when the requirement for amputation is
created (Pallavi Bhattacharya, 2004). It is common to experience the feeling of denial
initially and a hope against hope that the limb may be saved. And then gradually
as the person starts facing the reality, he is overcome by depression. Recovering
from a leg amputation can be a difficult and lengthy process that includes physical
and mental recovery processes. Some people do it in a short time, while others
take several months. It is important, however, that the person acknowledges and
understands the process. The loss of a limb is associated with two most common
types of grief—anticipatory grief and normal uncomplicated grief. (adapted from
http://www.amputee-coalition.org). This is where counselors come in. Amputees
feel a loss of possession giving rise to a loss of control. Suicides may be prevented by
both pre and post-amputation counseling.
Counselors have a role to play both before and after the amputation surgery.
Anticipatory grief occurs before a loss and is associated with a diagnosis of a life-
threatening illness, and a forthcoming amputation. The patients need to talk
extensively before the procedure so that they know what to expect. It will help to
discuss feelings, concerns and information about the procedure and recovery with
friends and family.
After the amputation the patient may experience psychological issues following
a leg amputation, including depression, fear, anxiety and lowered self-esteem and
self-image, fear of rejection from mate, and financial problems. Probably one of the
most difficult problems is losing one’s sense of independence and having to rely on
others for some of the most common everyday needs. During this period, stress is
at its highest level. Many amputees undergo counseling to learn to cope with the
feelings and thoughts an amputation provokes (eHow.com). The postamputation
counseling includes interpersonal therapy, cognitive behavior therapy for both the
patient as well as the family members. Although complicated grief is not common
in amputee patients, counselors should be aware of its symptoms, which include
severe isolation, violent behavior, suicidal ideation, workaholic behavior, severe or
prolonged depression, nightmares, and avoiding reminders of the amputation.
Soon after amputation, many amputees feel the presence of a phantom limb or a
feel that there is a limb where there isn’t. Phantom sensation can range from tingling
sensations to a biting pain which needs professional help. Methods of relief from
 Hospital Counseling 281

phantom pain include medications, electric nerve stimulation, massage, heat, cold,
compression, acupuncture, acupressure, cranial sacral therapy, and touch treatment
therapy (Bhattacharya, 2004).

v Summary v
Counselors working in a hospital with the bereaved, the terminally
ill, individuals in pain or in rehabilitation units of a hospital, work in a
multidisciplinary team to provide psychological comfort to the patient and
their family. They may normalize emotions during a difficult time, provide
spiritual support, educate about normal physical, emotional, and social
changes, and assist in managing practical problems. A large part of the
counselors’ time may be spent in supervising and training volunteers or
counselors in training.
One last aspect of this work is self care for the counselor. Working in
hospice settings can be emotionally taxing and counselors feel grief when
their clients die. It is critical for the counselors to take care of themselves to
prevent distancing themselves from their own emotions or their clients’ and
to prevent burn-out. Some counselors perform rituals to help themselves
process the grief, such as lighting candles, keeping a memory journal,
attending the funeral, or arranging a memorial service with other team
members. It also is helpful to see a variety of clients, for example working
with children on social skills or classroom behavior, to provide balance in the
counselors’ case load. Working with pain, loss and death can be challenging
and very rewarding for counselors. Many counselors report feeling greater
love of life, greater appreciation of friends and family, and a more spiritual
life from this rich experience of working with people during the last dance
of life.

References
Arnette, J. K. 1996. Physiological effects of chronic grief: A biofeedback treatment approach.
Death Studies, 20, 59-72.
Beirness, D. J. 1993. Do we really drive as we live? The role of personality factors in road crashes.
Alcohol, Drugs & Driving, 9, 129-143.
Cook, A. S., and Oltjenbruns, K. A. 1998. Dying and grieving: Life span and family perspectives
(2nd ed., pp. 38-52). New York: Harcourt Brace College Publishers.
Darlene Daneker. 2006. Counselors Working with the Terminally Ill. http://counselingoutfitters.
com/Daneker.htm.
Davies, B., Reimer, J.C., Brown, P., Martens, N. 1995. Fading away: The experience of transition
in families with terminal illness. Amityville, NY: Baywood.
Doka, K. J. 1997. Living with grief when illness is prolonged. Bristol, PA: Taylor and Francis.
282 Counseling: Theory, Skills and Practice

Gaies, J. & Knox, M. 1991. The therapist and the dying client. In FOCUS: A Guide to AIDS
Research and Counseling, 6(6), pp.1-2. http://www.wisegeek.com.
Janice Winchester Nadeau. 1998. Families making sense of death. Sage publications Inc.
Michele Metche @ http://www.selfinlight.com/Bereavement.html http://www.sadly-missed.com/
resources/bereavement_counselling.php
Kubler-Ross, E. 1969. On death and dying. New York: Macmillan.
Marrone, R. 1999. Dying, mourning, and spirituality: A psychological perspective. Death Studies,
23, 495-519.
Michael Shernoff. 1996. Counseling End Stage Clients With AIDS. AIDS/SIDA Mental Hygiene
Project, School of Education, New York University @ http://www.thebody.com/content/
art2451.html.
Neimeyer, Robert. 1998. Lessons of Loss: A Guide to Coping. New York: McGraw-Hill.
Parkes, C. M., Relf, M., & Couldrick, A. 1996. Counselling in terminal care and bereavement.
Baltimore, MA: Paul H. Brookes.
Rabkin, J., Remien, R. & Wilson, C. (Eds). 1994. Good Doctors, Good Patients: Partners in HIV
Treatment. New York: NCN Publishers.
Rando, T. A. 1984. Grief, dying, and death: Clinical interventions for caregivers. Champaign, IL:
Research Press.
Rando, T. A. 2000. Clinical dimensions of anticipatory mourning: Theory and practice in working
with the dying, their loved ones, and their caregivers. Champaign, IL: Research Press.
Sharman, S. J., Garry, M., Jacobsen, J. A., Loftus, E. F., & Ditto, P. H. 2008. “False memories
for end-of-life decisions.” Health Psychology, 27, 291-296.
Swami Adiswarananda. The Fear of Death (The Exhortations of Vedanta). The Vedanta Kesary,
English monthly from R K Math, Chennai.
Weiss, C. 1991. “Working with Chemically dependent HIV-infected patients on an inpatient
medical unit.” In (M. Shernoff, ed) Counseling chemically dependent people with HIV
illness, New York: Haworth Press, pp. 45-53.
Wolfe, Ben at http://www.deathreference.com/Gi-Ho/Grief-Counseling-and-Therapy.html.
Wolfe, Ben, and John R. Jordan. “Ramblings from the Trenches: A Clinical Perspective on
Thanatological Research.” Death Studies 24. 2000. 569–584.
Worden, J. William. Grief Counseling and Grief Therapy, 2nd edition. New York: Springer.
1991.
Hardy, Paul A. J. 1997. “Chronic pain management: the essentials.” U.K.: Greenwich Medical
Media. ISBN 1 900 151 855.
Main, Chris J.; Spanswick, Chris C. 2000. Pain management: an interdisciplinary approach.
Churchill Livingstone. ISBN 0 443 05683 8.
http://en.wikipedia.org/wiki/Pain_management#cite_ref-1.
http://www.healthpsychology.net/Pain_Management.htm en.wikipedia.org/wiki/Chronic_pain
Steven Richeimer. 2000. The Richeimer Pain Update from The Richeimer Pain Medical Group
@ http://www.helpforpain.com/arch2000dec.htm
Giummarra, Melita J.; Gibson, Stephen J.; Georgiou-Karistianis, Nellie; Bradshaw, John L.
April. 2007. “Central Mechanisms in Phantom Limb Perception: The Past, Present, and
Future”, Brain Research Reviews 54 (1): 219–232.
Katz J, Melzack R, 1999. Measurement of pain. Surg Clin North Am. 1999. Apr; 79(2):231-52.
http://www.healthpsychology.net/Pain_Management.htm.
Oswald Steward. 2000. Functional Neuroscience. Springer – Verlag New York, Inc. Page 116.
“The Reality of the “Runner’s High””. UPMC Sports Medicine. University of Pittsburgh Schools
of the Health Sciences. Retrieved 2008-10-15.
“‘Sexercise’ yourself into shape”. Health. BBC News. 2006-02-11. Retrieved 2008-10-15.
 Hospital Counseling 283

“Get more than zeds in bed -”. Mind & body magazine - NHS Direct. UK National Health
Service. Retrieved 2008-10-15.
Kabat-Zinn, J; Lipworth, L; Burney, R. 1985. “The clinical use of mindfulness meditation for the
self-regulation of chronic pain”. Journal of Behavioral Medicine 8 (2): 163-190.
Kabat-Zinn, J. 1982. “An outpatient program in behavioral medicine for chronic pain patients
based on the practice of mindfulness meditation: theoretical considerations and
preliminary results”. General hospital psychiatry 4 (1): 33-47. PMID 7042457. http://
brainimaging.waisman.wisc.edu/~perlman/kabatzinn-mbsr-1982.pdf.
http://wapedia.mobi/en/Pain_Management.
Durand, Vincent Mark and Barlow, David. 2009. Abnormal psychology: An integrative approach.
Belmont, CA: Wadsworth Cengage Learning. pp. 331. ISBN 0-495-09556-7.
“What is biofeedback?”. Association for Applied Psychophysiology and Biofeedback. 2008-05-18.
Retrieved 2010-02-22.
http://psychotherapy.com/bio.html.
http://en.wikipedia.org/wiki/Hypnotherapy.
The Find Counseling.com Interactive Glossary of Mental Health and Disability Terms was
written by C. J. Newton, MA, Learning Specialist, and published in July. 1996. on
www.MirConnect.com, changed to www.TherapistFinder.net in 2000, and to www.
FindCounseling.com in. 2006.
Bruyere, Susanne M. 1992. Careers in rehabilitation psychology - Careers in Rehabilitation,
American Rehabilitation, Summer @ http://findarticles.com/p/articles/mi_m0842/
is_n2_v18/ai_12450532/
Dembo, T., Diller, L., Gordon, W.A., Levitan, G., & Sherr, R.L. 1973. “A view of rehabilitation
psychology.” American Psychologist, 28, 719-722.
Eisenberg, M., & Jansen, M. 1983. “Rehabilitation psychology: State of the art.” In E.L. Pan,
T.E. Backer, & C.L. Vash (Eds.), Annual Review of Rehabilitation (Vol. 3, 1-31). New
York: Springer.
Dewey @ http://www.psywww.com/intropsych/ch14_frontiers/psychology_in_hospitals.
http://www.royalbucks.co.uk/neurorehab.htm
Compston A, Coles A April. 2002. “Multiple sclerosis”. Lancet 359 (9313): 1221–31.
Lin VWH, Cardenas DD, Cutter NC, Frost FS, Hammond MC. 2002.Spinal Cord Medicine:
Principles and Practice. Demos Medical Publishing.
Kirshblum S, Campagnolo D, Delisa J. Lippincott Williams & Wilkins. 2001 Spinal Cord
Medicine. Demos Medical Publishing.
eHow.com Best Way - Recovery From Leg Amputation http://www.ehow.com/way_5701021_
recovery-leg-amputation.html#ixzz0wYG4YPbF.
Bhattacharya, Pallavi. 2004. http://www.boloji.com/health/articles/01027.htm.
 11
Trauma Counseling:
Psychological First Aid

Chapter Overview
What is psychological first aid?
Delivering PFA: Professional Behavior
Some guidelines for PFA administration
Applications of PFA
PFA for students and teachers

WHAT IS PSYCHOLOGICAL FIRST AID?

Counselors are increasingly called to respond to acute emergency and disaster

situations. Immediate counseling interventions in a disaster scenario are by
necessity short, population-based, and supportive of the natural resiliency of
affected individuals and communities (Uhernik, J. A. and Husson, M. A., 2009). In
emergency or disaster situations many injuries can occur. So having the skills in basic
first aid to help the victim is very essential for all helpers. But what about the injuries
that cannot be seen, such as those which are psychological? Using psychological
first aid can be a vital first response. When one works with people during and after
a traumatic situation, it is common to see reactions of combinations of confusion,
fear, hopelessness, helplessness, sleeplessness, physical pain, anxiety, anger, grief,
shock, aggressiveness, mistrustfulness, guilt, shame, shaken religious faith, and loss
of confidence in self or others. The first responder’s early contact with them can
help alleviate their painful emotions and promote healing and, more importantly,
hope. PFA aims to mollify the painful range of emotions and physical responses
experienced by people exposed to disaster and reduce further harm that can result
from initial reactions to disasters. The goal of PFA is to promote an environment of
safety, calm, connectedness, self-efficacy, empowerment, and hope.
 Trauma Counseling: Psychological First Aid 285

Psychological first aid (PFA) is as natural, necessary and accessible as medical first
aid. It means assisting people with emotional distress resulting from an accident,
injury or sudden shocking event. Significantly, like medical first aid skills, one does
not need to be a doctor, nurse or highly trained professional to provide immediate
care to those in need.
“Psychological first aid (PFA) refers to a set of skills identified to limit the distress
and negative behaviors that can increase fear and arousal.” (National Academy of
Sciences, 2003). It is an acute mental health intervention, seems uniquely applicable
to public health settings, the workplace, the military, mass disaster venues, and even
the demands of more well circumscribed critical incidents, e.g., dealing with the
psychological aftermath of accidents, robberies, suicide, homicide, or community
violence (Everly, G. S., Jr., and Flynn, B. W., 2005).
With natural as well as man-created disasters increasing by leaps and bounds,
PFA is fast emerging as the crisis intervention of choice in the wake of such critical
incidents, such as trauma and mass disaster. Research by Center for Disease Control
and Prevention (CDC, 2002) provides insight into the potential need for acute
psychological care in the wake of disasters. The American Psychiatric Association
(APA, 1954) noted that whether a disaster is a function of nature or enemy attack,
people will suffer from a level of stress not usually encountered. It is important that a
disaster worker or first responders must be familiar with common patterns of reaction
and understand the basic principles for responding effectively with disturbed people.
In the wake of critical incidents such as violence, fatal accidents, and disasters, there
is a significant need to provide some form of psychological support.

As Raphael (1986) notes “. . . In the first hours after a disaster, at least 25% of the
population may be stunned and dazed, apathetic and wandering—suffering from the
disaster syndrome—especially if impact has been sudden and totally devastating . . . At
this point, psychological first aid and triage . . . are necessary . . . .” (p. 257).

The Institute of Medicine (IOM, 2003) has found the following: “In the past
decade, there has been a growing movement in the world to develop a concept
similar to physical first aid for coping with stressful and traumatic events in life. This
strategy has been known by a number of names but is most commonly referred to as
psychological first aid (PFA). Essentially, PFA provides individuals with skills they
can use in responding to psychological consequences of [disasters] in their own lives,
as well as in the lives of their family, friends, and neighbors.” (p. 4–5).
Everly and Flynn (2005) have proposed one such model of psychological first
aid (PFA) that may be applied to individuals. The National Child Traumatic Stress
Network and National Center for PTSD (2005) have collaborated to create a highly
useful field manual for mental health personnel in the administration of PFA to
286 Counseling: Theory, Skills and Practice

individuals. Parker, Everly, Barnett, and Links (in press) have even developed specific
‘‘evidence-informed’’ competencies for training public health personnel in PFA.
IOM (2003) defined PFA as “psychological first aid is a group of skills identified
to limit distress and negative health behaviors. PFA generally includes education
about normal psychological responses to stressful and traumatic events; skills in
active listening; understanding the importance of maintaining physical health
and normal sleep, nutrition, and rest; and understanding when to seek help from
professional caregivers.’’ (p. 7)

The History of Psychological Response to Disaster

Psychological first aid is a few decades old. The focus on providing psychological
help after a disaster came after the Vietnam war. Mental health professionals started
to show up en masse in the wake of a major disaster. The US soldiers returned from
Vietnam clearly shaken by their battle experiences. They experienced a range of
psychological reactions (as mentioned earlier) apart from their physical ailings. It was
then the American psychiatry came up with a formal definition of Post Traumatic
Stress Disorder (PTSD)––which gave credence to the idea that experiencing a
traumatic event emotionally devastates some part of the people exposed to the
trauma.
Once that definition was firmly established, trauma started being studied,
researched and understood widely. The mental health scientific and therapeutic
community became activated and started to provide services for people who are
experiencing traumatic events. However, they were not very clear about what to
do in the event of such tragedy and the resulting reactions such as how to handle
an individual who was in pain, or even how to prevent PSTD. Thus there was a
tremendous amount of experimentation, not all of it successful.
Subsequent to the September 9/11 terrorist attacks on the World Trade Center,
the CDC Behavioral Risk Factor Surveillance System initiative sampled 3,512 adult
residents of Connecticut, New Jersey, and New York via a random digit dialed
telephonic survey. The ‘results of the survey suggest a widespread psychological and
emotional impact in all segments of the three states’ populations’ (CDC, 2002, p.
784). Around 75 percent of the respondents reported having problems attributed to
the attacks: 48 percent of respondents reported that they experienced anger after the
attacks, 37.5 percent reported worry, 23.9 percent reported nervousness, and 14.2
percent reported sleep disturbance. Thus, people realized that psychological support
is an indispensable part of disaster preparedness, management and response.

Debriefing Tragedy
One big idea that became popular in the late 1970s, 1980s and early 1990s
was “debriefing.” Debriefing is a generic word meaning a review after an event.
Sometimes it means, “We’re going to ask you what happened and talk about it.”
 Trauma Counseling: Psychological First Aid 287

The disaster responders typically utilized components of a Critical Incident Stress

Management (CISM) model. This model, originally developed for military use, was
later expanded on by Jeffrey Mitchell for use by EMS responders and others such as
the police and fire-responders for emergency response use. But typically, what we are
talking about in the context of disasters is post-disaster work in Critical Incidence
Stress Debriefing (CISD) (Vernberg, 2007). The idea that it was important for the
victims to talk about their trauma in detail started to take shape. It seemed like a
pretty commonsensical idea that if one is in a tragic overwhelming, life experience,
sharing that story with people and going through it point by point... would have a
cathartic effect and lessen the emotional damage so that this event would not came
back to haunt them in the future. Thus therapists were taught that within days, or
even hours, of a traumatic event, s/he should arrive on the scene to carefully walk
them through each minute of the horror and ask them to describe how they felt
about it. Ideally, the counselor would meet with the survivors over several sessions,
often in a group setting, providing psychoeducation as well as talking about details
of what happened.
And so, after Oklahoma City, after 9/11, even after Katrina, the Asian Tsunami,
etc, mental health professionals rushed in to help. They sat with victims coaching
them through these very painful sessions.
By the mid 1990s, research protocols began to investigate the efficacy of CISD
procedures. The research did not support the efficacy of CISD in reducing symptoms
of post-traumatic stress disorder and other trauma related symptoms following
disaster
(Van Emmerik, Kamphuis, Hulsbosch, and Emmelkamp, 2002). They
concluded that either it doesn’t have any effect in terms of the eventual development
of posttraumatic stress disorder (PTSD), or that it actually has the paradoxical and
unexpected effect of making symptoms worse rather than better for some participants,
i.e., pointed that the cathartic ventilation of feelings and emotion may potentially
do more harm and cause re-traumatization of survivors and first responders, than
good in the short term as well as long term to have them revisit their trauma in
such detail made room for research on how best to handle the victims (Raphael,
Meldrum, and McFarlane, 1995; Rose, Bisson, Churchill, and Wessely, 2008; Van
Emmerik et al., 2002).

The New Idea—PFA

Debriefing gave way to what is now known as Psychological first aid. This details
how mental health professionals need to approach survivors/victims. It is a practical
approach to help the victim physically (food, clothing and shelter) and socially
(helping connect with lost ones). Thus, clearing a path for people and reduce the
stress on victims, which ultimately helps them avoid more serious psychological
repercussions down the road.
288 Counseling: Theory, Skills and Practice

Among a number of response modalities, Psychological First Aid (PFA) is

emerging as the preferred response and is now recommended in Federal guidelines as
specified in the 2008 National Response Framework (US Department of Homeland
Security, 2008).

Who Delivers Psychological First Aid?

Psychological First Aid is designed for delivery by mental health specialists who
provide acute assistance to affected children and families as part of an organized
disaster response effort. These specialists may be imbedded in a variety of response
units, including first responder teams, incident command systems, primary
and emergency health care providers, school crisis response teams, faith-based
organizations, Community Emergency Response Teams (CERT), Medical Reserve
Corps, the Citizens Corps, and disaster relief organizations. PFA is designed for
delivery in diverse settings. Sites may include shelters, schools, hospitals, homes,
staging areas, feeding locations, family assistance centers, and other community
settings. Following weapons of mass destruction (WMD) events, PFA may be
delivered in mass casualty collection points, hospitals, and in field decontamination
and mass prophylaxis locations.
The latest trend shows that a growing number of counselors are being called upon
by various disaster management groups such as the Red Cross, army, etc., for their
services. The principles and recommended actions of PFA provide the counselors
with the necessary specific tools and guidance for response efforts. Counselors are
not only providing counseling services but are also helping in organizing community
disaster responses, as well as targeting their services at individualized counseling.
They work together with medical, nursing, public health, and mental health
professionals.

Strengths of Psychological First Aid

Whenever there is a disaster, information needs to be gathered to help mental
health specialists make rapid assessments of the survivors’ immediate concerns
and needs and to tailor interventions in a flexible manner. PFA is an evidence-
informed modular approach for assisting children, adolescents, parents/caretakers,
and families in the immediate aftermath of disaster and terrorism (Brymer et al.,).
It is designed to reduce the initial distress caused by traumatic events, and to foster
short- and long-term adaptive functioning. According to The Medical Reserve Corp
Psychological First Aid Field Operations Training Manual (National Center for
Child Traumatic Stress Network, 2006) principles and techniques of Psychological
First Aid meet four basic standards. They are:
1. Consistent with research evidence on risk and resilience following trauma
2. Applicable and practical in field settings
 Trauma Counseling: Psychological First Aid 289

3. Appropriate for developmental levels across the lifespan

4. Culturally informed and delivered in a flexible manner (which is a challenge
for any mental health professional)
PFA is straightforward, practical and easily understandable and thus, of great
assistance to providers who are often experiencing high levels of stress themselves.
Working in post-disaster environments is quite stressful. It is also consistent with
common sense, prioritizing the actions of the provider very neatly. A very important
strength of PFA is that it does not assume that all survivors will develop severe mental
health problems or long-term difficulties in recovery. Instead, it focuses on the broad
range of early reactions (for example, physical, psychological, behavioral, spiritual)
that the victims experience and may or may not exhibit. PFA also understands that
some of these reactions will cause enough distress to interfere with adaptive coping,
and recovery may be helped by support from compassionate and caring disaster
responders.
PFA offers specific recommendations of actions that seem consistent with our
current scientific understanding of trauma recovery (Vernberg, 2007). Psychological
First Aid includes basic information-gathering and assessment techniques relying on
field-tested, evidence-informed strategies that can be provided in a variety of disaster
settings. It is practical making use of handouts that provide important information
about post-disaster reactions and adversities for individuals of various ages and
cultures for use over the course of recovery.
There is consensus among international disaster experts and researchers that PFA
can help alleviate these painful emotions and reduce further harm that can result
from initial reactions to disasters.
Psychologists concur in the fact that first responders should not go to post -
disaster areas as freelancers, alone. There is the danger of duplicating services, adding
to the confusion, or not knowing where to get further help. It always helps to be part
of an organized response team to maximize efficiency and effort.

Basic objectives of psychological first aid (Brymer et al., 2006)

Establish a human connection in a non-intrusive, compassionate manner.
Enhance immediate and ongoing safety, and provide physical and emotional
comfort.
Calm and orient emotionally overwhelmed or distraught survivors.
Help survivors to articulate immediate needs and concerns, and gather
additional information as appropriate.
Offer practical assistance and information to help survivors address their
immediate needs and concerns.
Connect survivors as soon as possible to social support networks, including
family members, friends, neighbors, and community helping resources.
290 Counseling: Theory, Skills and Practice

Support positive coping, acknowledge coping efforts and strengths, and

empower survivors; encourage adults, children, and families to take an
active role in their recovery.
Provide information that may help survivors to cope effectively with the
psychological impact of disasters.
Facilitate continuity in disaster response efforts by clarifying how long the
Psychological First Aid provider will be available, and (when appropriate)
linking the survivor to another member of a disaster response team or to
indigenous recovery systems, mental health services, public-sector services,
and organizations.
From a tactical perspective, according to Everly and Flynn (2005), PFA may be
intended to achieve any of the following:
The provision of information/education.
Provision of comfort and support (intervention based on providing
soothing human contact is legitimate and can be universally applied).
An acceleration of recovery.
The promotion of mental health.
The facilitation of access to continued or escalated care.
Raphael (1986) suggests that PFA consists of numerous processes that may be
summarized as follows:
1. Meeting basic physical needs, such as
physical protection
establishing a sense of security
provision of physical necessities
2. Meeting psychological needs, such as
consolation
provision of emotional support
provision of behavioral support
allowing emotional ventilation
fostering constructive behavior
3. Fostering social support, such as
reuniting victims with friends or family
utilization of acute social and community support networks
4. Fostering ongoing care, such as
triage and referral for those in acute need
referral to subacute and ongoing support networks
Understanding the stress reactions to any trauma is important for any care
provider. These can be classified into four reactions: emotional, cognitive, physical
and social.
 Trauma Counseling: Psychological First Aid 291

Emotional reactions Cognitive effects

Shock Impaired concentration
Anger Impaired decision-making ability
Despair Memory impairment
Emotional numbing Disbelief
Terror Confusion
Guilt Distortion
Grief or sadness Decreased self-esteem
Irritability Decreased self-efficacy
Helplessness Self-blame
Loss of derived pleasure from regular Intrusive thoughts and memories
activities
Dissociation Worry
Defense mechanisms
Cognitive distortions
Physical Social
Fatigue Alienation
Insomnia Social withdrawal
Sleep disturbance Increased conflict within relationships
Hyperarousal Vocational impairment
Somatic complaints School impairment
Impaired immune response Desire for retaliation
Headaches Scapegoating
Gastrointestinal problems
Decreased appetite
Startle response

Factors that influence reactions in a crisis situation:

Pre-trauma factors like multiple trauma, mental illness, lower socio-economic
status, intensity and duration of the exposure, gender and age. Mistrust, stigma,
fear (e.g., fear of deportation), and lack of knowledge about disaster relief services
are important barriers to seeking, providing, and receiving services for these
populations.
292 Counseling: Theory, Skills and Practice

Post-trauma factors are on-going support, opportunity to share their story, sense
of closure, media exposure, substance abuse, re-exposure or re-victimization.

Goals of PFA
Enhance immediate and on-going safety by providing emotional support.
Offer practical assistance and coping skills to help deal with the emotional
impact of a traumatic event.
Recognize common stress responses in children/adults, and provide basic
triage skills to know when to refer to professional Behavioral Health
services.
Recognize the signs and symptoms of personal stress and learn self care
strategies to increase resilience in yourself and others.
At the individual level to try to get people to do what they need to do to
take care of themselves and avoid doing things that are not in their best
interest.
At the health care system level to try to provide for disaster survivors, and
current clients/patients, safeguard staff and first responders, and respond
effectively in a crisis.
At the community level to trying to promote healthy behaviors, reduce
illness and injury, promote pro-social behavior, reduce fear, and safeguard
the healthcare system.

DELIVERING PFA: PROFESSIONAL BEHAVIOR

The professional needs to understand the basics of PFA

Expect normal recovery
Assume survivors are competent
Recognize survivor strengths
Promote resilience
When delivering PFA the care provider needs to:
Operate only within the framework of an authorized disaster response
system, and remain within the scope of expertise and designated role.
Be visible and available and model sound responses; be calm, courteous,
organized, and helpful, maintain confidentiality as appropriate.
Be knowledgeable and sensitive to issues of culture and diversity (culture
alert): Culture sensitivity is number one on the list of ‘knowledge to be
acquired’ by the professional. As they generally move to the disaster hit
areas which may not necessarily be their familiar hometown, learning a
little about the culture and society of the geographical area beforehand
goes a long way to be able to handle alien issues sensitively. The type of
 Trauma Counseling: Psychological First Aid 293

physical or personal contact considered appropriate may vary from person

to person and across cultures and social groups, for example, how close
to stand to someone, how much eye contact to make or whether or not
to touch someone, especially someone of the opposite sex. Unless you
are familiar with the culture of the survivor, you should not go too close
to someone, make prolonged eye contact, or touch. You should look for
clues to a survivor’s need for “personal space,” and seek guidance about
cultural norms from community cultural leaders who best understand local
customs.
In working with family members, find out who is the spokesperson for the
family and
Initially address this person.
Pay attention to one’s own emotional and physical reactions, and actively
manage these reactions. Compassion fatigue is very common among health
care providers. One must take care of himself or herself when starting to
show signs of stress and burnout. Proceeding when not being able to can
seriously compromise the efficacy of the care process and may result in
harm or damage.
Make referrals as they are important when one is not equipped in terms
of qualifications, experience, training or capability, or transference and
counter-transference issues and additional expertise is needed. In case the
person hints or talks openly of suicide or homicide, when there is any
indication of a medical emergency, when there is a possibility of abuse
or any criminal activity, substance abuse, social isolation, imaginary ideas
or feelings of persecution, difficulty in maintaining real contact with the
victim, recognized signs of mental illness, referral to a specialist is advised.
When doing that one needs to inform the individual about the intentions
to refer, confer with the victim and present different options; assure them
that you will continue to be in touch if they need you, reassure them of
your support until the referral is complete, and arrange for follow up.

Preparing to Deliver Psychological First Aid

In order to be of assistance to disaster-affected communities, the provider must be
knowledgeable about the nature of the event, the post-event circumstances, and the
type and availability of relief and support services.

Entering the Setting

PFA begins when a disaster mental health specialist enters an emergency man-
agement setting in the aftermath of a disaster. As mentioned earlier it is important
294 Counseling: Theory, Skills and Practice

for the care provider to work within the framework of an authorized organization
in which roles and decision-making are clearly defined. Communication must be
established with authorized personnel or organizations that are managing the setting
and coordinate all activities with them. One also needs to have accurate information
about what is going to happen, what services are available, and where services can be
found. Effective entry requires that this information be gathered as soon as possible,
as providing such information is critical to reducing distress and promoting adaptive
coping.

Providing Services
In some settings, the authorities may demarcate certain areas for PFA. In other
settings, PFA providers may need to circulate around the facility to identify those to
be approached for assistance. The PFA provider should concentrate on how people
reaction to or interact with in any setting. Those showing signs of acute distress such
as disorientation, confusion, panic, extreme withdrawal, apathy, hypersensitivity,
high irritability, extreme anger, and worry are the ones who need assistance. Identify
those you can help and refer the others to a specialist. Plan and arrange for regular
meetings, referrals and follow-ups within the time and constraints of the setting.

Maintain a Calm Presence

It is very important for the PFA provider to maintain a calm presence. This has a
calming effect on the victims. This demonstration of calmness and clear thinking
helps the individuals feel that they can rely on you. This also helps them remain
focused even if they do not feel calm, safe, effective, or even hopeful. PFA providers
often model the sense of hope that affected persons cannot always feel while they are
still attempting to deal with what happened and current pressing concerns.

Be Sensitive to Culture and Diversity

This aspect cannot be stressed enough. Sensitivity to culture and ethnic, religious,
racial, and language diversity is central to providing PFA. As dealt with clearly in
an earlier chapter, it helps to be aware of their own values and prejudices, and how
these may coincide or differ with those of the community being served. The victims
may need to be helped to maintain or reestablish customs, traditions, rituals, family
structure, gender roles, and social bonds. It helps to gather information about the
community being served, including how emotions and other psychological reactions
are expressed, attitudes toward governmental agencies, and receptivity to counseling
beforehand. This can be done with the assistance of community cultural leaders
who represent and best understand local cultural groups.
 Trauma Counseling: Psychological First Aid 295

Be Aware of At-Risk Populations

Individuals who are at special risk after a disaster include the following:
Children (especially those whose parents have died or are missing)
Those that have had multiple relocations and displacements
Medically frail adults
The elderly
Those with serious mental illness
Those with physical disabilities or illness
Adolescents who may be risk-takers
Adolescents and adults with substance abuse problems
Pregnant women
Mothers with babies and small children
Professionals or volunteers who participated in disaster response and
recovery efforts
Those that have experienced significant loss
Those exposed first hand to grotesque scenes or extreme life threats

SOME GUIDELINES FOR PFA ADMINISTRATION

First and foremost it is important for the PFA provider to keep in mind
that the goal of Psychological First Aid is to reduce distress, assist with
current needs, and promote adaptive functioning, not to elicit details of
traumatic experiences and losses. which can be handled at a later stage.
Politely observe first, don’t intrude. Let the victim guide the conversation.
The victim will talk about what is bothering him or her the most at that
time. This gives the care provider an idea of where to start focusing. Then
it helps to ask simple respectful questions, either about what the victim is
talking, or how to provide assistance.
It is important to get a feel of the situation, person or family before
embarking on full-fledged intervention to determine that contact is not
likely to be an intrusion or disruptive. Initiate contact only after that.
Different people react differently. Either they rush to seek help or avoid
getting help. The professional needs to be prepared for either situation. Any
aggressive move to either make contact with the person who is avoiding or
providing help to those who seek help can prove to be ending in frustration
for the professional. Thus, one can make brief but respectful contact with
each person who approaches and wait to see if those who avoided come
forward.
296 Counseling: Theory, Skills and Practice

As in all counseling situations this too calls for one to speak calmly, speak
slow (if necessary), simple and concrete terms, listen patiently and focus
on learning what they want to tell you and how you can be of help––be
responsive and sensitive.
People need to know what they are doing right, and how they are helping
themselves. This instills a sense of hope and confidence in their otherwise
shattered mind. The professional can help this only by acknowledging the
positive features of what the person has done in order to be safe and reach
the current setting by positively reacting.
Confusion and panic renders the person oblivious of even what is in front
of their eyes. They find it difficult to think and assimilate even simple
information. Thus it becomes the job of the care provider to simplify the
necessary information, adapt to directly address the person’s immediate
goals and clarify answers repeatedly as needed.
The professional needs to be careful to give information that is accurate
and age-appropriate, and correct inaccurate beliefs and myths that float
around aplenty in crisis situations. There is no harm in acknowledging that
you don’t know and offer to find out.
When communicating through a translator, look at and talk to the person
you are addressing, not at the translator. This helps create personal rapport
and make use of nonverbal communication like holding hand, or giving a
hug, more effective.

The Core Actions of Psychological First Aid

PFA is the effort to provide basic needs while providing stabilization of the lives
of the individuals who have been affected. It is made of eight core components.
Reference to the development of PFA can be found in the Field Operations Guide
for Psychological
First Aid published by the National Center for Child Traumatic Stress Network
and National Center for PTSD (2006).
Psychological First Aid includes a set of eight interventions that can be used to
support survivors after a disaster or traumatizing event. These eight core actions and
focus goals include:

1. Contact and engagement

Goal: To respond to contacts initiated by affected persons, or initiate contacts in a
non-intrusive, compassionate, and helpful manner. Respect the confidentiality of
the individual. Make prudent decisions to divulge information.
 Trauma Counseling: Psychological First Aid 297

2. Safety and comfort

Goal: To enhance immediate and ongoing safety, and provide physical and
emotional comfort. This is about how to make people feel safe, de-arouse people
and make them feel calm.
1. Ensure immediate physical safety
2. Provide information about disaster response activities and services
3. Attend to physical comfort
4. Promote social engagement
5. Attend to children who are separated from their parents/caregivers
6. Protect from additional traumatic experiences and trauma reminders
7. Help survivors who have a missing family member
8. Help survivors when a family member or close friend has died
9. Attend to grief and spiritual issues
10. Provide information about casket and funeral issues
11. Attend to issues related to traumatic grief
12. Support survivors who receive a death notification
13. Support survivors involved in body identification
14. Help caregivers confirm body identification to a child or adolescent

3. Stabilization (if needed)

Goal: To calm and orient emotionally-overwhelmed/distraught survivors.
1. Stabilize emotionally overwhelmed survivors
2. Orient emotionally overwhelmed survivors
3. The role of medications in stabilization

4. Information gathering: Current needs and concerns

Goal: To identify immediate needs and concerns, gather additional information,
and tailor PFA interventions.
1. Nature and severity of experiences during the disaster
2. Death of a loved one
3. Concerns about immediate post-disaster circumstances and ongoing
threat
4. Separations from or concern about the safety of loved ones
5. Physical illness, mental health conditions, and need for medication
6. Losses (home, school, neighborhood, business, personal property, and pets)
7. Extreme feelings of guilt or shame
8. Thoughts about causing harm to self or others
298 Counseling: Theory, Skills and Practice

9. Availability of social support

10. Prior alcohol or drug use
11. Prior exposure to trauma and death of loved ones
12. Specific youth, adult, and family concerns over developmental impact

5. Practical assistance
Goal: To offer practical help to the survivor in addressing immediate needs and
concerns.
1. Offering practical assistance to children and adolescents
2. Identify the most immediate needs
3. Clarify the need
4. Discuss an action plan
5. Act to address the need

6. Connection with social supports

Goal: To help establish brief or ongoing contacts with primary support persons
or other sources of support, including family members, friends, and community
helping resources.
1. Enhance access to primary support persons (family and significant others)
2. Encourage use of immediately available support persons
3. Discuss support-seeking and giving special considerations for children and
adolescents
5. Modeling support

7. Information on coping
Goal: To provide information (about stress reactions and coping) to reduce distress
and promote adaptive functioning.
1. Provide basic information about stress reactions
2. Review common psychological reactions to traumatic experiences and
losses
Intrusive reactions
Avoidance and withdrawal reactions
Physical arousal reactions
Trauma reminders
Loss reminders
Change reminders
Hardships
Grief reactions––traumatic and otherwise
Depression
Physical reactions
 Trauma Counseling: Psychological First Aid 299

3. Talking with children about physical and emotional reactions

4. Provide basic information on ways of coping
5. Teach simple relaxation techniques
6. Coping for families
7. Assist with developmental issues
8. Assist with anger management
9. Address highly negative emotions
10. Help with sleep problems
11. Address alcohol and substance use

8. Linkage with collaborative services

Goal: To link survivors with needed services, and inform them about available
services that may be needed in future.
1. Provide direct link to additional needed services
2. Referrals for children and adolescents
3. Referrals for older adults
4. Promote continuity in helping relationships
These core goals of PFA constitute the basic objectives of providing early
assistance (e.g., within days or weeks following an event). These objectives will need
to be addressed in a flexible way, using strategies that meet the specific needs of
children, families and adults. The amount of time spent on each goal will vary from
person to person, and with different circumstances according to need.
Not much research has been done on the above model. However, slowly
researchers are starting to focus on PFA. Ruzek (2007) says, “There is a great
need for both program evaluation and RCTs that will evaluate the effectiveness of
Psychological First Aid principles in a number of contexts” (p. 5). He maintains
that the basic premise of PFA is to support individual and community resiliency,
to reduce acute distress following disaster, and encourage short- and long-term
adaptive functioning. Napoli (2007), outlines the characteristics of resiliency to
include “inquisitiveness, optimal optimism, active coping and problem-solving,
effectiveness despite being fearful, emotional self-regulation, bonding for a common
mission, positive self-concept, internal control, desire to improve oneself, altruism,
social support, the ability to turn traumatic helplessness into learned helpfulness,
humor and meaning” (p. 2).
PFA aims to promote resilience in the victims. For disaster responders, the
principles of PFA honor the adage of Primum non nocere or ‘First Do No Harm’ as
an appropriate initial guide for the application of PFA (Uhernik, J.A. and. Husson,
M. A., 2009).
300 Counseling: Theory, Skills and Practice

APPLICATIONS OF PFA

PFA has evolved such that it has been made applicable for working with specific
subgroups of individuals, such as children and adolescents, first responders, groups
of survivors, military, and those who may require further assistance or who may
have special needs during a disaster.

Working with children and adolescents—National Child Traumatic

Stress Network
Preschool Through Second Grade (Adapted from: Pynoos RS,
Nader K: 1988)
Response to Trauma
(1) Helplessness and passivity
(2) Generalized fear
(3) Cognitive confusion (e.g., do not understand that the danger is over)
(4) Difficulty identifying what is bothering them
(5) Lack of verbalization––selective mutism, repetitive nonverbal traumatic
play, unvoiced questions
(6) Attributing magical qualities to traumatic reminders
(7) Sleep disturbances (night terrors and nightmares, fear of going to sleep,
fear of being alone, especially at night)
(8) Anxious attachment (clinging, not wanting to be away from parent,
worrying about when parent is coming back, etc.)
(9) Cognitive confusion (e.g., do not understand that the danger is over)
(10) Anxieties related to incomplete understanding about death: fantasies of
“fixing up” the dead: expectations that a dead person will return, e.g., an
assailant
First Aid
(1) Provide support, rest, comfort, food, opportunity to play or draw
(2) Reestablish the adult protective shield
(3) Give repeated concrete clarifications for anticipated confusions
(4) Provide emotional labels for common reactions
(5) Help to verbalize general feelings and complaints (so they will not feel
alone with their feelings)
(6) Separate what happened from physical reminders (e.g., a house, monkey-
bars, parking lot)
(7) Encourage them to let their parents and teachers know
(8) Provide consistent caretaking (e.g., assurance of being picked up from
school, knowledge of caretaker’s whereabouts)
 Trauma Counseling: Psychological First Aid 301

(9) Tolerate regressive symptoms in a time-limited manner

(10) Give explanations about the physical reality of death

Third Through Fifth Grade

Response to Trauma
(1) Preoccupation with their own actions during the event: issues of
responsibility and guilt
(2) Specific fears, triggered by traumatic reminders
(3) Retelling and replaying of the event (traumatic play)
(4) Fear of being overwhelmed by their feelings (of crying, of being angry)
(5) Impaired concentration and learning
(6) Sleep disturbances (bad dreams, fear of sleeping alone)
(7) Concerns about their own and other’s safety
(8) Altered and inconsistent behavior (e.g., unusually aggressive or reckless
behavior, inhibitions)
(9) Somatic complaints
(10) Hesitation to disturb parent with own anxieties
(11) Concern for other victims and their families
(12) Feeling disturbed, confused, and frightened by their grief responses, fear of
ghosts
First Aid
(1) Help to express their secretive imaginings about the event
(2) Help to identify and articulate traumatic reminders and anxieties; encourage
them not to generalize
(3) Permit them to talk and act it out; address distortions, and acknowledge
normality of feelings and reactions
(4) Encourage expression of fear, anger, sadness, in your supportive presence
(5) Encourage to let teachers know when thoughts and feeling interfere with
learning
(6) Support them in reporting dreams, provide information about why we
have bad dreams
(7) Help to share worries; reassurance with realistic information
(8) Help to cope with the challenge to their own impulse control (e.g.,
acknowledge “It must be hard to feel so angry”)
(9) Somatic complaints
(10) Offer to meet with children and parent(s) to help children let parents know
how they are feeling
(11) Encourage constructive activities on behalf of the injured or deceased.
(12) Help to retain positive memories as they work through the more intrusive
traumatic memories
302 Counseling: Theory, Skills and Practice

Adolescents (Sixth Grade and Up)

Response to Trauma
(1) Detachment, shame, and guilt (similar to adult response)
(2) Self-consciousness about their fears, sense of vulnerability, and other
emotional responses; fear of being labeled abnormal
(3) Post-traumatic acting out behavior, e.g., drug use, delinquent behavior,
sexual acting out
(4) Life threatening reenactment; self-destructive or accident-prone behavior
(5) Abrupt shifts in interpersonal relationships
(6) Desires and plans to take revenge
(7) Radical changes in life attitudes, which influence identity formations
(8) Premature entrance into adulthood (e.g., leaving school or getting married),
or reluctance to leave home
First Aid
(1) Encourage discussion of the event, feelings about it, and realistic expectations
of what could have been done
(2) Help them understand the adult nature of these feelings; encourage peer
understanding and support
(3) Help to understand the acting out behavior as an effort to numb their
responses to, or to voice their anger over, the event
(4) Address the impulse toward reckless behavior in the acute aftermath; link
it to the challenge to impulse control associated with violence
(5) Discuss the expectable strain on relationships with family and peers
(6) Elicit their actual plans of revenge; address the realistic consequences of
these actions; encourage constructive alternatives that lessen the traumatic
sense of helplessness
(7) Link attitude changes to the event’s impact
(8) Encourage postponing radical decisions in order to allow time to work
through their responses to the event and to grieve

Counselor Database
Counseling follows through the following stages. Initially the counseling can focus
on establishing the focus through free drawing and storytelling. A slight reference to
the trauma may be made.
Next, the counselee may be helped to relive the experience through emotional
expression (release), reconstruction of the event, perceptual experience, special
detailing, talking about the worst moment, any violence or physical mutilation.
The counselee is then helped to cope with the experience. Discuss the expectable
strain on relationships with family and peers. Elicit their actual plans of revenge;
address the realistic consequences of these actions; encourage constructive
 Trauma Counseling: Psychological First Aid 303

alternatives that lessen the traumatic sense of helplessness. Link attitude changes to
the event’s impact. Encourage postponing radical decisions in order to allow time to
work through their responses to the event and to grieve.
Finally closure results from doing the following:
(1) Recapitulation
(2) Underscore realistic fears
(3) Universalize the child’s responses
(4) Describe expectable course
(5) Acknowledge child’s courage in undertaking the interview
(6) Invite child critique of consultation
(7) Proper leave-taking

Counselor Skills (NCTSN Manual)

When making contact with children or adolescents, it is good practice
to make a connection with a parent or accompanying adult to explain
counselor’s role and seek permission. When speaking with a child in distress
when no adult is present, it is important to find a parent or caregiver to let
them know about the conversation.
Sit or crouch at a child’s eye level.
Help children verbalize their feelings, concerns, and questions; provide
simple labels for common emotional reactions (e.g., mad, sad, scared,
worried). Match the children’s language to help you connect with them,
and to help them to feel understood and to understand themselves. Do
not increase their distress by using extreme words like “terrified” or
“horrified.”
Match your language to the child’s developmental level. Children 12 years
and under typically have much less understanding of abstract concepts and
metaphors compared to adults. Use direct and simple language as much as
possible.
Adolescents often appreciate having their feelings, concerns and questions
addressed as adult-like, rather than child-like responses.

PFA FOR STUDENTS AND TEACHERS

Some traumatic incidents that affect just one individual child (being bullied, ragged,
abused, etc.,) drastically affects students’ thoughts, feelings, and behaviors. This may
lead to staying away from school, truancy, psychosomatic symptoms, trouble while
sleeping, problems at school and with friends, trouble concentrating and listening,
and not finishing work or assignments, irritability, anger, sadness, worry, etc. Just
304 Counseling: Theory, Skills and Practice

as the teachers help students with appropriate academic and counseling services
under normal circumstances, he or she is in an excellent position to help students to
return to school, stay in school, continue to learn, and return to their usual school-
based activities after such an event. The steps of PFA after a disaster, school crisis,
or emergency are as follows:
• Listen: Listen and pay attention to both verbal and non-verbal cues about
thoughts and feelings. Listen to risk factors, such as suicidal thoughts,
taking drugs, telling untruths, loss of a family member, schoolmate, or
friend, observing serious injury or the death of another person, family
members or friends missing after the event. Getting hurt or becoming sick
due to the event, home loss, family relocations, changes in neighborhood,
and/or loss of belongings, being unable to evacuate quickly, past traumatic
experiences or losses, etc.
• Encourage them to talk, draw, and play, but do not force it.
• Protect: Answer questions simply and honestly, clearing up confusion
student/s may have about what happened. Let know that they are not alone
(if it is a school disaster) in their reactions to the event. Talk to students
about what is being done by school and community to keep everyone safe
from harm. Watch for anything in the environment that could retraumatize,
e.g., bullying behavior. One of the best things to do would be to maintain
daily routines, activities, and structure with clear expectations, consistent
rules, and immediate feedback; and limit unnecessary changes, access to TV
and internet that show disturbing scenes of the event. Most importantly
the students can be made to feel helpful to the classroom, the school, and
the community. Remind students that disasters are rare, and discuss other
times they have felt safe.
• Connect: Check in with the students on a regular basis. Find resources
that can offer support to the students and classroom. Keep communication
open with others involved in the students’ lives interactive school activities
can be restored. Model. Be aware of own thoughts, feelings, and reactions
about the event, which can be seen and affect students. Model coping
behavior. Monitor conversations that students may hear. Acknowledge the
difficulty of the situation, but demonstrate how people can come together
to cope after the event.
• Teach: Positive coping strategies. Help them set realistic, achievable, short-
term goals. Remind students that with time and assistance, things get
better. If they don’t, they should let a parent or teacher know. Help them
in problem-solving to get through each day successfully.
These steps can help them bounce back more quickly.
 Trauma Counseling: Psychological First Aid 305

v Summary v
“Psychological first aid (PFA) refers to a set of skills identified to limit
the distress and negative behaviors that can increase fear and arousal.”
(National Academy of Sciences, 2003). It is an acute mental health
intervention, seems uniquely applicable to public health settings, the
workplace, the military, mass disaster venues, and even the demands
of more well circumscribed critical incidents, e.g., dealing with the
psychological aftermath of accidents, robberies, suicide, homicide, or
community violence (Everly, G. S., Jr., & Flynn, B. W., 2005). Psychological
First Aid is a few decades old. The focus on providing psychological help
after a disaster came after the Vietnam War. Mental health professionals
started to show up en mass in the wake of a major disaster.
Psychological First Aid is designed for delivery by mental health
specialists who provide acute assistance to affected children and families
as part of an organized disaster response effort. Whenever there is
a disaster information needs to be gathered to help mental health
specialists make rapid assessments of survivors’ immediate concerns
and needs and to tailor interventions in a flexible manner. It focuses on
the broad range of early reactions (for example, physical, psychological,
behavioral, spiritual) that the victims experience and may or may not
exhibit. PFA offers specific recommendations of actions that seem
consistent with our current scientific understanding of trauma recovery
(Vernberg, 2007).
Psychological First Aid includes basic information-gathering and
assessment techniques relying on field-tested, evidence-informed
strategies that can be provided in a variety of disaster settings. In order
to be of assistance to disaster-affected communities, the provider
must be knowledgeable about the nature of the event, the post-event
circumstances, and the type and availability of relief and support
services.

References
Raphael, B. 1986. When disaster strikes. New York: Basic Books.
Center for Disease Control and Prevention. 2002. ‘Psychological and emotional effects of the
attacks on the World Trade Center—Connecticut, New Jersey, and New York. 2001.
MMWR (Morbidity and Mortality Weekly Report), 51, 784–786.
American Psychiatric Association. 1954. Psychological first aid in community disasters. Washington,
DC: Author.
 306 Counseling: Theory, Skills and Practice

Institute of Medicine. 2003. Preparing for the Psychological Consequences of Terrorism. Washington
D.C.: National Academies Press.
Everly, G. S. Jr. and B. W. Flynn. 2005. ‘Principles and practice of acute psychological first
aid after disasters’. In G. S. Everly Jr. and C. L. Parker (Eds.), Mental health aspects of
disasters: Public health preparedness and response, revised (pp. 79–89). Baltimore, MD:
Johns Hopkins Center for Public Health Preparedness.
National Child Traumatic Stress Network and National Center for PTSD. 2005. Psychological
first aid: Field operations guide. Terrorism Disaster Branch of the National Child
Traumatic Stress Network and the National Center for PTSD.
Parker, C. I., G. S. Everly Jr., D. Barnett and J. Links (in press). ‘Establishing evidence-informed
core intervention competencies in psychological first aid for public health personnel’.
International Journal of Emergency Mental Health. Page number missing.
Everly, G S.,Jr., Phillips Suzanne. B, Kane, Dianne and Feldman, Daryl. 2007. Introduction to
and Overview of Group Psychological First Aid. Available at http://btci.edina.clockss.org/
cgi/content/full/6/2/130#BIB13.
Brymer M, A. Jacobs, C. Layne, R. Pynoos, J. Ruzek, A. Steinberg, E. Vernberg, and P. Watson
. 2006. Psychological First Aid: Field Operations Guide: National Child Traumatic Stress
Network and National Center for PTSD: 2nd Edition. July.
Vernberg. 2007. in Research on Psychological First Aid.
An interview with Eric Vernberg, Ph.D. Available at http://66.92.43.14/tdc/ATDFall07.pdf.
Uhernik, J.A. and M. A. Husson. 2009. Psychological First Aid: An Evidence Informed Approach
for Acute Disaster Behavioral Health Response. In G.R. Walz, J.C. Bleuer, and R.K. Yep
(Eds.), Compelling counseling interventions: VISTAS 2009 (pp. 271–280). Alexandria,
VA: American Counseling Association.
Raphael, B., L. Meldrum, and A.C. McFarlane. 1995. ‘Does debriefing after psychological trauma
work’? British Medical Journal, 310, 1479–1480.
Van Emmerik, A. A. P., Kamphuis, J. H., Hulsbosch, A. M., and Emmelkamp, P. M. G. 2002.
‘Single session debriefing after psychological trauma: ameta-analysis’. The Lancet 360:
pp. 766 –771.
Napoli, J. C. 2007. Resiliency, resilience, resilient: A paradigm shift? Retrieved September 18, 2008,
from www.resiliency.us
Ruzek, J. I. 2007. ‘Psychological first aid’. Journal of Mental Health Counseling 29(1), pp. 17–33.
Pynoos R.S. and K Nader. 1988. ‘Psychological first aid and treatment approach to children
exposed to community violence: Research implications;. Journal of Traumatic Stress 1:
pp. 445–473.
 12
Counseling in
Special Situations

Chapter Overview
Relationship counseling
Rehabilitation counseling
Issues relevant to the mental and physical well-being of women
Social injustice issue counseling
Addiction counseling
Counseling juvenile delinquents
Suicide counseling
Fatigue and taking care of oneself
Spirituality and wellness

T
he world is moving forward. Material comforts of life are increasing due
to scientific explosion. Myriad studies show that people are enjoying the
goodness that a better life-style, standard of living can provide or so it seems.
There is equal evidence to show that as material benefits are increasing, mental health
is deteriorating. Statistics show that the rate of psychological disturbances leading to
suicide, homicide, marital breakdown, alcoholism, drug abuse, etc., is increasing at
an alarming rate across the world.
Figures show that 20 to 30 million individuals in India are in need of some form
of mental health care, and this figure is increasing every year. These figures do not
reflect the ones who have no knowledge of or access to help. It is common knowledge
that more than 60 percent of them can recover completely with specialized help,
which is the key.
Counseling is not a one-size-fits-all-field. There are different kinds of problems
for which there are different counselors, those who have had experience in helping
308 Counseling: Theory, Skills and Practice

people handle those specific problems. Thus, there are relationship counselors,
de-addiction counselors, pediatric counselors, and so on. This is what the present
chapter is all about. This chapter may help the student of counseling decide on his
or her specialty according to his or her interest and aptitude. The last part of this
chapter is devoted to a very important, perhaps the most important aspect of a
professional’s life—self care.

RELATIONSHIP COUNSELING

Relationship counseling is the process of counseling the parties of a relationship in

order to try and reconcile differences. The relationship involved may be between
people in a family, between employees in a workplace, or between a professional
and a client. Relationship counseling as a discrete, professional activity is a recent
phenomenon. Until the late 20th century, the task of relationship counseling
was informally fulfilled by close friends, family members, or local religious
leaders. Psychologists and psychotherapists dealt almost entirely with individual
psychological issues. In many less technologically advanced cultures around the
world today, the institution of family, the village or group elders fulfill the task of
relationship counseling.
Increasing modernization and westernization have seen a perceptible shift toward
isolated nuclear families. The old support structures offered by the joint family system
are no longer available. This has made the need for relationship counseling greater
than ever. In the western society, it is not unusual for people to seek the services of the
counselor for even minor issues. This trend towards trained relationship counselors
is catching on in India too. Many communities and government departments are
beginning to have their own team of trained voluntary or professional relationship
counselors. UGC has mandated that every university and college should have a
counselor to take care of the students’ issues. These counselors can train volunteers
from among the student peer group, to operate similar services. Even the corporate
world is opening up to the idea and starting to maintain full-time professional
counseling staff in order to facilitate smoother interactions between employees, and
prevent personal difficulties affecting work performance.
Relationship counselors are extremely helpful at any stage/type of a relationship.
There are counselors specializing in premarital counseling, couples counseling
as well as those working with married couples experiencing difficulties of many
years’ duration. Generally, the initial session is with both the counselees, although
sometimes one person will start therapy and his or her partner/spouse will join later.
Relationship counseling aims to help recognize and to better manage or reconcile
troublesome differences and repeating patterns of distress. The goal of relationship
 Counseling in Special Situations 309

counseling is to help couples improve communication skills, learn to handle conflicts

constructively, and help to resolve old childhood issues that may be hindering the
growth of a healthy relationship.

Couple’s Counseling
Couple’s counseling is based on the premise that individuals and their problems
are best handled within the context of the couple’s relationship. Typically, both
partners in the relationship attend the counseling session to discuss the couple’s
specific issues (Will). Couple’s counseling aims to help a couple deal appropriately
with their immediate problems, to address the dysfunction in their relationship and
to learn better ways of relating in general.
Raising children and meeting family needs is becoming more and more complex
and complicated. The primary resources, such as extended families and community
supports no longer seem to be available. And thus, couples are feeling increasingly
isolated as they are expected to manage their lives on their own. Couples in our
present culture are less bound by family traditions and are freer than ever before to
develop relationships unlike those of the families that they were raised in (Carter B.,
McGoldrick M., 1989).
Couple’s counseling is a useful modality of help for couples who are experiencing
difficulties, such as repetitive arguments, feelings of distance or emptiness in the
relationship, pervasive feelings of anger, resentment and or dissatisfaction or lack
of interest in affection or in a physical relationship with one another (Center for
Addiction and Mental Health).
The effectiveness of couple’s counseling, in general, has shown that most couples
who try it receive good help. However, not all differences can be reconciled and
many still go on to dissolve their relationship. In a review of the literature through
mid-1996, Pinsof, Wynne, and Hambright (1996: Pinsof and Wynne, 1995)
concluded that significant data exists that support the efficacy of the family and
couples therapy and that there is no evidence indicating that couples are harmed
when they undergo treatment (Friedlander, M., 1997).
Research outcomes on couples counseling suggest the following (Wills, R.M
(2001)):
At the end of couple’s therapy, 75 percent of couples receiving therapy are
better off than similar couples who did not receive therapy.
About 65 percent of couples report “significant” improvement based on
averaged scores of marital “satisfaction.”
Most couples will benefit from therapy, but both spouses will not necessarily
experience the same outcomes or benefits.
Therapies that produce the greatest gain and are able to maintain that
gain over the long amount of time, tend to affect the couple’s emotional
310 Counseling: Theory, Skills and Practice

bonds and help the spouse’s work together to achieve a greater level of
“differentiation” or emotional maturity.
One of the main reasons why people do not seek counseling is because they
believe that that would be an admission that their marriage has failed. That scares
them and makes them feel like a failure. However, many couples seek counseling
to resolve difficult issues, to confront their own psychological problems within the
context of couples’ therapy, or to find a neutral space where they can work on their
relationship. Some marriage counselors may meet with the partners separately before
meeting with them together, or may even have individual counselors who meet with
the partners and then have a group session with all the counselors and the partners.
With the aid of a qualified clinician, couples can bring peace, stability and
communication back into their relationship, thus affecting their lives and the lives
of those most impacted by them and their relationship. The Internet has added new
dimensions to traditional face-to-face counseling. It is now possible to engage in
counseling sessions with therapists in other states or even other countries via web
cams, email, and the telephone.

Premarital Counseling
Premarital counseling and/or education is a therapeutic couple intervention that
occurs with couples who plan to marry. Premarital education is “a skills training
procedure which aims at providing couples with information on ways to improve
their relationship once they are married” (Senediak, 1990, p. 26). Premarital
counseling is a brief intervention, with programs averaging about four hours of
contact time with each couple (Silliman and Schumm, 1999).
Premarital counseling is a way to enrich a relationship so that it has every
opportunity to grow into a satisfying and stable marriage. Premarital counseling will
give a couple clearer pictures of themselves as individuals, and of their relationship
as a couple; they will learn their strengths and identify areas where growth is needed.
By learning more about themselves, they will be better able to spot problems
developing long before they become a serious threat to their relationship. Typically,
premarital counseling covers a variety of topics including conflict management,
friends, finances, spirituality, sexuality, children, gender roles, and expectations.
Individuals will have the opportunity to discuss the families in which they grew
up, and learn how their family experiences influence their couple relationship.
Premarital counseling will introduce them to effective ways to communicate and
solve problems together.
It has been found that couples are vulnerable during the early years, and the rate
of divorce is the highest during this time. Premarital counseling is quite beneficial as
the couples do not receive any formal training for marriage and family life. Whether
it be ‘arranged’ or ‘love’ marriage, it is true that one can never be totally prepared.
 Counseling in Special Situations 311

The goals of premarital counseling generally include the following: (a) To teach
couples information about married life, (b) To enhance couple communication
skills (c) To encourage couples to develop conflict resolution skills, and (d) To allow
the couple to speak about certain sensitive topics, such as sex and money (Senediak,
1990; Stahmann and Hiebert, 1997). Overall, Stahmann and Hiebert (1980) report
that “the goal of premarital counseling is to enhance the premarital relationship so
that it might develop into a satisfactory and stable marital relationship” (p. 11).
Recent research has found couples who participate in premarital education have
stronger marriages than those who get hitched without such preparation. Researchers
at Brigham Young University in Utah and the University of Minnesota analyzed
23 studies conducted over the past 30 years and found that couples who received
counseling scored 30 percent higher on tests that rated their level of communication
and overall satisfaction with their spouses.
Premarital education often includes teaching couples about conflict resolution,
marital roles, sexuality, and financial management. Premarital counseling is a
strength-based approach that focuses on a couple’s resources to develop a shared
vision for the marriage. Background information about premarital counseling and
solution-focused therapy provide the framework for the development of intervention
strategies that are grounded in the solution-focused approach (Murray & Murray,
2004).

Marriage Counseling
With increasing divorce rates and millions of couples who are simply unsatisfied
with their relationship, an intervention from a professional counselor can be the
necessary step for improving the relationship, helping everyone work on key issues
that are causing conflict, and working towards improvement (Theresa Anderson).
The field of marriage and family counseling has exploded over the past decade.
Counselors at all levels are work effectively with couples and families experiencing a
wide variety of issues and problems (Smith and Stevens-Smith 1992)
Marriage counseling is a type of psychological counseling where a married couple
seeks professional counseling to hopefully heal their marriage (wordiq.com). When
one of the partners is considering divorce, marriage counseling can be a type of
mediation aimed at conciliation. Some individuals who do go on to get a divorce
may use a similar process through divorce mediation to determine issues like custody,
spousal support and the division of property.
Marital counseling provides the opportunity for the couple to help discover
strengths in their relationship and thereby build a healthy, long-lasting relationship.
It provides them with the skills and strategies they need to manage life together
in a healthy way. Marriage counseling need not necessarily be for couples with
problems in their relationship. It can also be valuable in helping them enhance
312 Counseling: Theory, Skills and Practice

their relationship, providing them with fundamental tools and coping strategies to
improve communication, show respect for each other, and grow.
In some marriages the couples are held together by the smooth working of most
or all factors intrinsic to relationships––personality compatibility, communication,
conflict resolution, and sexuality. In others the marriage hinges more on external
elements, leisure activities, religious attitudes, financial management, children,
family and friends, and distress predominates.
The marriage starts breaking down generally when they are no longer able to
negotiate differences and resolve problems effectively. They need to gain a perspective
and work on ways to establish healthy boundaries during conflict. Instead of stepping
into a crisis mode each time a difficulty arises, marriage counseling works to prevent
negative behavior and attitudes, focusing instead on a results-oriented approach that
can benefit both parties (Theresa Taylor).
Many couples who would be benefited by counseling do not seek it thinking
that the problem will either go away with time or resolve itself. They might also be
under the impression that they have done everything possible, and there is nothing
that anyone can say or do any more. They do not realize that all they need is to talk
to a person who is qualified to help them, and it might just take a little nudge in the
right direction to start working on removing arguments and negative behavior form
a relationship. This process can help them resolve a crisis, improve communications,
and even help with healing after a difficult period or time of transition.
Marriage counseling provides resources and healthy strategies to cope with
challenges and stressors. Educating the couple in the channels of effective
communication such as listening, responding, empathizing, etc., is done in the
counseling setting. This provides the couple with a neutral setting to share their
feelings honestly and openly. The counselor provides the necessary unbiased
feedback, and helps discern and address the root cause of the problem.
There are a few techniques that counselors use like the genogram, the family
floor plan, reframing, tracking, communication skill-building techniques, family
sculpting, family photos, special days, mini-vacations, special outings the empty
chair, family choreography, family council meetings, strategic alliances, prescribing
indecision, putting the client in control of the symptom. Counselors customize
them according to the presenting problem, the individuals involved, the culture,
etc.

Family Counseling
Two people, two minds, two thoughts, two opinions. Imagine a family with many
minds. Conflicts therefore are common, even normal, with people living in close
proximity. But when normal conflicts magnify and family members begin hurting
each other emotionally (and sometimes physically) and a feeling of anger permeates
 Counseling in Special Situations 313

the household, then is the time to do something about it. Each family has its own
dynamics. And the inappropriate or unacceptable behavior of one or more members
of the family affects everyone else. While counselors work with those individuals to
try to help them with the cause of their actions, they also work with the entire family
so they can provide support for that person and for each other, and to learn how to
reduce the conflict (unlimitedinvestigations.com).
Families can be thought of as a system of interacting parts. We teach and learn
from one another. Children generally learn by observing their parents and other
adults in the family. They learn patterns of thinking, feeling, and behaving from the
families in which they grow up. Sometimes these are inappropriate or unacceptable.
And when these are not challenged and/or changed, they pass on that legacy to their
children and families.
Family counseling involves all the members of a nuclear and/or extended family.
It may help to promote better relationships and understanding within a family. It
may be incident specific, or may address the needs of the family when one family
member suffers from a mental or physical illness that alters his or her behavior or
habits in negative ways (wisegeek.com).
Ideally, family counseling should occur with all members of the family unit
present. However, some individuals may not be in a position to attend the session
(such as physical illness, business trip, etc.). Also these individuals may be the reason
the family is seeking counseling.
Family counseling works with individuals in intimate relationships to nurture
change and development. It tends to view change in terms of the systems of
interaction between family members. It emphasizes family relationships as an
important factor in psychological health (wikipedia). Regardless of the origin of
the problem, be it an individual or a few individuals seen as contributing to the
problem, family counseling tends to view the whole family as needing counseling.
Family relationships––the systems of interaction between family members––are the
most important factor in the psychological health of any member. Thus, involving
families in solutions, in whatever kind of intervention, is often beneficial to all those
involved, either directly or indirectly. Family therapy has been used effectively in the
full range of human dilemmas; there is no category of relationship or psychological
problem that has not been addressed with this approach.
This involvement may be in the form of direct participation in the counseling
sessions. The family therapist needs to influence conversations in a way that catalyzes
the strengths, wisdom, and support of the wider system.
Family counseling most often is based on family systems approach which regards
the family, as a whole, as the unit of treatment, understands the family to be a living
organism that is more than the sum of its individual members, and emphasizes such
factors as relationships and communication patterns as a whole, rather than traits
314 Counseling: Theory, Skills and Practice

or symptoms in individual members. It evaluates family members in terms of their

position or role within the system as a whole.
Relationship or family counseling may be particularly useful for the following:
Problems developing in one or more family members which affect all (i.e.,
children’s problems, anger, depression in one partner, etc.)
Family or relationship change, such as divorce, or children leaving home
Cultural and ethnic conflict within relationships
Sexual or cultural differences between the family and the larger
community
Finding the satisfaction you seek in relationships
Problems are treated by changing the way the system works rather than trying to “fix”
a specific member. Family systems theory is based on several major concepts:

The Identified Patient

The identified patient (IP) is the family member with the symptom that has brought
the family into treatment.

Homeostasis (Balance)
The concept of homeostasis means that the family system seeks to maintain its
customary organization and functioning over time. It tends to resist change.

The Extended Family Field

The extended family field refers to the nuclear family, plus the network of
grandparents, and other members of the extended family.

Differentiation
Differentiation refers to the ability of each family member to maintain his or her
own sense of self, while remaining emotionally connected to the family.

Triangular Relationships
Family systems theory maintains that emotional relationships in families are usually
triangular. Whenever any two persons in the family system have problems with
each other, they will “triangle in” a third member as a way of stabilizing their own
relationship.
The techniques used in family counseling are: communication theory,
psychoeducation, psychotherapy, relationship education, systemic coaching, systems theory,
 Counseling in Special Situations 315

and reality therapy. Apart from that the techniques that have been mentioned in the
earlier section also apply to family counseling.
Family counselors usually evaluate a family for treatment by scheduling a series
of interviews with the members of the immediate family, including young children,
and significant or symptomatic members of the extended family. Understanding
how each member of the family sees the problem, the family’s functioning, the level
and types of emotions expressed, patterns of dominance and submission, the roles
played by family members, communication styles, and the locations of emotional
triangles, assessing whether these patterns are rigid or relatively flexible is what the
counselor hopes to unearth and identify, then help the family to see the problem
objectively.

REHABILITATION COUNSELING

Rehabilitation is defined as “a holistic and integrated program of medical, physical,

psychosocial, and vocational interventions that empower a person with disability
to achieve a personally fulfilling, socially meaningful, and functionally effective
interaction with the world” (John Banja). Szymanski, (1985) defined it “as a
profession that assists persons with disabilities in adapting to the environment, assists
environments in accommodating the needs of the individual, and works toward
full participation of persons with disabilities in all aspects of society, especially
work”. Rehabilitation counseling as a process is “a comprehensive sequence of
services, mutually planned by the consumer and rehabilitation counselor, to
maximize employability, independence, integration, and participation of persons
with disabilities in the workplace and the community” (Jenkins, Patterson, and
Szymanski, 1991).
Rehabilitation counseling, aims to assist individuals with physical, mental,
developmental, cognitive, and emotional disabilities to achieve their personal, career,
and independent living goals in a systematic manner. The counseling process is like
any other, involving communication, goal setting, and initiating and augmenting
beneficial growth or change through self-advocacy, psychological, vocational, social
and behavioral interventions. The specific techniques and modalities utilized in
the rehabilitation counseling process may include, but are not restricted to the
following:
Assessment and appraisal
Diagnosis and treatment planning
Career (vocational) planning; job analysis and job development
Provide placement services, including assistance with reasonable
accommodations
316 Counseling: Theory, Skills and Practice

Individual and group counseling treatment interventions

Relationship counseling
Case management, referral, and service coordination
Care and program evaluation and research
Advocacy and interventions to remove environmental, employment and
attitudinal barrier
Provision of consultation about and access to rehabilitation technology
(Commission on Rehabilitation Counselor Certification 1994)

Rehabilitation Philosophy
The philosophy of rehabilitation rests on the premise that believes in the dignity and
worth of all people. The concepts of independence, integration, and the inclusion
of people, with and without disabilities, in employment and their communities
are valued without exception. It aims to integrate the people who are disabled or
differently abled into the least restrictive environment where they can not only
survive, but also flourish and grow as a person, as a productive member of society.
It involves a massive commitment, based on a model of accommodation, towards
equalizing opportunities for all to participate in all rights and privileges available to
and to providing a sense of equal justice. Rehabilitation counselors are additionally
committed to support the individuals in advocacy activities, in order to enable them
to achieve all the aforementioned rights which help them live with dignity and
pride; and also further empower themselves. The counselors and their clients work
together on this, by mutually planning and integrating various aspects of the client’s
life, roles and responsibilities, making it a comprehensive effort towards maximizing
independence and hence self-worth. This counseling encourages client choice and
empowerment. This implies that the individual takes full responsibility for his or
her choice for which they have to lose the victim persona and focus on their right
and ability to succeed as well as fail. They need to be taught to remember that life
does not come with a warranty or guarantee card. This is so for everyone, not only
peculiar to them. Every action is a calculated risk taken by individuals in the hope
(and prayer) that they will succeed. However, they must be prepared for failure too,
and deal with the disappointments in a mature manner as they come. Embedded
in this philosophy is the principle of informed consent, disclosure, and maintaining
the integrity and dignity of the person.
The terms disability and handicap are not synonymous. Disability describes
the attributes of the persons, and handicap––the sources of limitations, such as
attitudinal, legal and architectural barriers. The language chosen by the counselor
communicates a philosophical and attitudinal orientation at both a personal and
professional level. counselors must communicate clearly and respectfully. The terms
 Counseling in Special Situations 317

differently abled, challenged and special are to be used to describe the individuals.
Avoiding the use of term normal helps.

Definition of Disability
Disability is often described in terms of lack of ‘normal’ functioning of physical,
mental, or psychological processes. People who have problems in processing
information which reflects in their ability to learn, adjust socially and emotionally
are seen as having learning difficulties. this interfaces with a person’s normal growth
and development. The rehabilitation counselor should be aware of the various
definitions of disability, their varied uses, and the relationships among them.
1. Americans with Disabilities Act defines an individual with a disability as
a person who (1) has a physical or mental impairment that substantially
limits one or more of the major life activities of that person, (2) has a record
of such impairment, or (3) is regarded as having such an impairment (web.
pace.edu). Major life activities include caring for oneself, performing
manual tasks, walking, seeing, hearing, breathing, learning, and working.
Federal law, including the Rehabilitation Act of 1973 and the Americans
with Disabilities Act of 1990, as well as state and local laws prohibit
institutions of higher education from discriminating against students with
disabilities.
2. The Disability Discrimination Act (DDA) of UK defines a disabled person
as someone who has a physical or mental impairment that has a substantial
and long-term adverse effect on his or her ability to carry out normal day-
to-day activities (direct.gov.uk).
For the purposes of the Act
substantial means neither minor nor trivial
long term means that the effect of the impairment has lasted or is likely
to last for at least 12 months (there are special rules covering recurring or
fluctuating conditions)
normal day-to-day activities include everyday things like eating, washing,
walking, and going shopping
a normal day-to-day activity must affect one of the “capacities” listed in the
Act, which include mobility, manual dexterity, speech, hearing, seeing, and
memory.
The DDA 2005 amended the definition of disability. It removed the requirement
that a mental illness should be “clinically well-recognized.”
It also ensured that people with HIV, cancer, and multiple sclerosis are deemed
to be covered by the DDA effectively from the point of diagnosis, rather than from
the point when the condition has some adverse effect on their ability to carry out
their day to day activities.
318 Counseling: Theory, Skills and Practice

3. The Persons with Disabilities (Equal Opportunities, Protection of Rights

and Full Participation) Act, 1995 (India) (adapted from disabilityindia.org
and education.nic.in/).
The Persons with Disabilities (Equal Opportunities, Protection of Rights and
Full Participation) Act, 1995 has come into force on February 7, 1996. This law
is an important landmark and is a significant step in the direction of ensuring
equal opportunities for people with disabilities and their full participation in the
nation building. The Act provides for both preventive and promotional aspects of
rehabilitation like education, employment, and vocational training, job reservation,
research and manpower development, creation of barrier-free environment,
rehabilitation of persons with disability, unemployment allowance for the disabled,
special insurance scheme for the disabled employees and establishment of homes for
persons with severe disability, etc.
The definition of the term “disability” as per the provisions of the Persons with
Disability Act 1995 means
1. Blindness
2. Low vision
3. Leprosy cured
4. Hearing impairment
5. Locomotor disability
6. Mental retardation
7. Mental illness

Main Provisions of the Disabilities Act

1. Preventions and Detections of Disabilities
Prevention and early detection of disabilities.
Surveys, investigations, and research shall be conducted to ascertain the
cause of occurrence of disabilities.
Various measures shall be taken to prevent disabilities, staff at the primary
health centre shall be trained to assist in this work.
All the children shall be screened once in a year for identifying “at-risk”
cases.
Awareness campaigns shall be launched and sponsored to disseminate
information.
Measures shall be taken for prenatal, perinatal, and postnatal care of the
mother and child.
2. Education—“Right to free Education”
Every child with disability shall have the rights to free education till the age
of 18 years in integrated schools or special schools.
 Counseling in Special Situations 319

Appropriate transportation, removal of architectural barriers, and

restructuring of curriculum and modifications in the examination system
shall be ensured for the benefit of children with disabilities.
Children with disabilities shall have the right to free books, scholarships,
uniforms, and other learning material.
Special school for children with disabilities shall be equipped with vocational
training facilities.
Non-formal education shall be promoted for children with disabilities.
Teacher’s training Institutions shall be established to develop requisite
manpower.
Parents may move the appropriate fora for the redressal of grievances
regarding the placement of their children with disabilities.
3. Employment
i. 3 percent of vacancies in government employment shall be reserved for
people with disabilities, 1 percent each for persons suffering from:
Blindness or low vision
Hearing impairment
Locomotor disability and cerebral palsy
Suitable schemes shall be formulated for:
Training and welfare of persons with disabilities,
Relaxation of upper age limit,
Regulating the employment, and
Health and safety measures and creation of a non-handicapping
environment in places where persons with disabilities are employed.
ii. Government educational institutes and other educational institutes
receiving grant from government shall reserve at least 3 percent seats for
people with disabilities.
iii. All poverty alleviation schemes shall reserve at least 3 percent for the benefit
of people with disabilities.
iv. No employee can be sacked or demoted if they become disabled during
service, although they can be moved to another post with the same pay and
condition. No promotion can be denied because of impairment.
4. Non-discrimination
Public buildings, rail compartments, buses, ships and aircrafts will be
designed to give easy access to disabled people.
In all public places and in waiting rooms, toilets shall be wheel chair
accessible. Braille and sound symbols are also to be provided in lifts.
All the places of public utility shall be made barrier-free by providing
ramps.
320 Counseling: Theory, Skills and Practice

5. Research and Manpower Development

i. Research in the following areas shall be sponsored and promoted:
Prevention of disability
Rehabilitation, including CBR
Development of assistive devices
Job identification
On site modifications of offices and factories
ii. Financial assistance shall be made available to the universities, other
institutions of higher learning, professional bodies, and non-government
research units or institutions, for undertaking research for special education,
rehabilitation and manpower development.
6. Affirmative Action
i. Aids and appliances shall be made available to people with disabilities.
ii. Allotment of land shall be made at concessional rates to the people with
disabilities for:
House
Business
Special recreational centers
Special schools
Research schools
Factories by entrepreneurs with disability
7. Social Security
i. Financial assistance to non-government organizations for rehabilitation
of persons with disabilities.
ii. Insurance coverage for the benefit of government employees with
disabilities
iii. Unemployment allowance to people with disabilities registered with
the special employment exchange for more than a year and who could
not be placed in any gainful occupation.
8. Grievance Redressal
In case of violation of rights as prescribed in that act, people with disabilities may
move an application to
i. Chief Commissioner, for Persons with Disabilities in the Centre or
ii. Commissioner for Persons with Disabilities in the states.

Paradigms of Rehabilitation Practice

A conceptual model proposed by Hershenson (1990) provides a rationale for
distinguishing rehabilitation counseling from other helping disciplines involved in
rehabilitation, such as medicine or psychology. This system of categories considers
 Counseling in Special Situations 321

rehabilitation from the perspective of primary, secondary, and tertiary prevention

of disability:
Primary prevention is characterized by the provisions of interventions
directed toward preventing the onset of disease or disability. Professionals
from such fields as public health and occupational health and safety have
traditionally provided primary prevention.
Secondary prevention is characterized by the provisions of interventions
directed toward preventing or when that is not possible, limiting the effects
of the disease or disability in the persons, when primary prevention has
failed. Professionals from medicine, psychology, and similar curative fields
have traditionally provided this level of prevention.
Tertiary prevention is characterized by activities directed toward preventing
long-term residual conditions from having any greater disabling effects
than necessary, once the secondary prevention fields have done all they
can to cure of limit the disease/disabling process. Professionals from
rehabilitation counseling and allied fields have traditionally provided
tertiary prevention.

ISSUES RELEVANT TO THE MENTAL AND PHYSICAL

WELL-BEING OF WOMEN

Until recently, women’s specific issues were largely ignored. For too many years
research, counseling interventions, and public policy have neglected women’s voices
and stories. With persistence and vigilance we now see major changes in research
and practice that focus on women and their issues (Kopala and Keitel, 2003).
The majority of clients who seek counseling are women. As counselors we need to
combine traditional approaches with alternative approaches to counseling women,
gain information about the nature of psychological distress commonly experienced
by women, develop an awareness of the social and cultural basis of problems
commonly experienced by women, examine some specific problems women bring
to counseling, and learn about some strategies for helping women deal with distress
and problems.

Rape
Rape is when one person wants and pursues a sexual act on, to or inside another
person who does not want to participate, and who does not fully and freely consent
to take part in that act. Rape is forced, unwanted sexual intercourse. Rape, sometimes
also called sexual assault, can happen to both men and women of any age. We will
continue this discussion in the context of the victim being a woman.
322 Counseling: Theory, Skills and Practice

Rape is a life-altering event. Some women who are raped are affected by the
trauma for the rest of their lives. Survivors––those who have been raped prefer to
be called “survivors,” not victims––experience numerous psychological problems, in
addition to physical trauma (Norment, 2002).
Rape has a profound effect on how the survivor lives her life. The victim’s self-
esteem is all but shattered and the trauma changes the way she relates to the men in
her life. The feeling that men are dangerous develops very strongly and she finds it
very difficult to trust them. She feels very let down and sometimes even angry that
she was powerless and let it happen to her.
The figures of rape and sexual assault around the world vary. Inconsistent
definitions of rape, over reporting, under reporting and false reporting create
controversial statistical disparities, and lead to accusations that many rape statistics
are unreliable or misleading (wikipedia). According to USA Today reporter Kevin
Johnson “no other major category of crime––not murder, assault or robbery––has
generated a more serious challenge of the credibility of national crime statistics”
than rape (Johnson, 1998).
Society must be made aware of the severity and pervasiveness of the problem.
Consequently, schools, organizations, institutions, should take steps to educate
men, women, and the public about what rape is and, especially, how to prevent it.
Support systems for survivors must be fortified so that they won’t be victimized a
second or third time by misinformed or insensitive law enforcement agencies and
medical professionals. Counseling should be available to every survivor. And most
importantly, widespread myths about rape and sexual assault must be dispelled.
People must be made to understand what rape is and what is acceptable behavior
when it comes to sexual acts.
Many people still believe that rape is a crime of passion, and so the onus of
initiating it falls on the victim––her behavior, grooming, etc., are seen as stimulants.
They need to be educated on the fact that rape is a crime of violence. It is about
violence and control. Rape is about power, not sex. A rapist uses actual force or
violence—or the threat of it—to take control over another human being. Some
rapists use drugs to take away a person’s ability to fight back. Rape is a crime,
whether the person committing it is a stranger, a date, an acquaintance, or a family
member (kidshealth.org). It is hard for people to understand that point because rape
involves sexual contact the rapist is trying to gain control. That is also the case with
rape without penetration, sexual assault and sodomy. They all are violent, regardless
of whether there is penetration. No matter how it happened, rape is frightening and
traumatizing. People who have been raped need care, comfort, and a way to heal.
Earlier most rape incidents used to go unreported. But now, advocates and
counselors say, that more women are breaking the silence and speaking out. More
and more women are reporting rape to law enforcement officials and seeking medical
 Counseling in Special Situations 323

care immediately after an assault. For rape survivors, talking about it is the first step
to healing and getting on with their lives.
It is important for survivors to speak out and get counseling so they will
understand that what happened to them is not their fault, and consequently they
can get over the feelings of shame and guilt.
Rape Trauma Syndrome (RTS) is a form of psychological trauma and post
traumatic stress disorder experienced by a rape victim, consisting of disruptions to
normal physical, emotional, cognitive, behavioral, and interpersonal characteristics.
The theory was first described by psychiatrist Ann Wolbert Burgess and sociologist
Lynda Lytle Holmstrom in 1974. RTS also paved the way for consideration of
Complex Post Traumatic Stress Disorder, which can more accurately describe the
consequences of serious, protracted trauma than Post Traumatic Stress Disorder
alone (Bessel et al., 2005).
Victims of rape can be severely traumatized by the assault and may have difficulty
functioning as well as they had been used to prior to the assault, with disruption
of concentration, sleeping patterns and eating habits, for example. They may feel
jumpy or be on edge. After being raped it is common for the victim to experience
Acute Stress Disorder, including symptoms similar to those of post traumatic stress
disorder, such as intense, sometimes unpredictable, emotions, and they may find it
hard to deal with their memories of the event (Bryant et al., 1999).
Survivors of rape and sexual assault are prone to crying spells, depression, thoughts
of suicide, drug and alcohol abuse, and low self-esteem. They are at higher risk
for unhealthy behavior and difficulties with interpersonal relationships. By talking
about the rape, survivors uncover and address the psychological problems some
don’t even know they have or realize are related to the rape.
It is also important that rape and assault survivors have a supportive network of
family and friends. In the past, women were afraid to confide because they were
often criticized and made to feel it was their fault. Counselors say it is important for
loved ones to listen to survivors and emphasize to them that what happened is not
their fault.

Counseling About Puberty

The onset of puberty is a very important time in the life of a child. At this time,
the child needs all the help he or she can get. It is a traumatic time physiologically,
physically, and emotionally. Thus, parents, teachers, and counselors would do well
to provide the children with the support they need to overcome various problems
associated with the stage.
The issues to be addressed are listed below:
Abortion
Adolescent sexual development
Communicating about sexuality issues
324 Counseling: Theory, Skills and Practice

Contraception
Counseling skills
Healthy relationships
HIV/AIDS
Male involvement
Menstrual cycle
Ultrasound
Understanding youth culture
Options counseling
Reproductive anatomy and physiology
Risk taking
Sexual diversity
Sexuality
Sexuality and the media
Sexuality messages and the internet
Sexually transmitted infections (STIs)
Teen love and relationships

Menopause Counseling
Counseling of individuals, couples, and families involves issues related to mid-life
decisions and change, including marriage, divorce, and re-marriage, retirement
planning, “empty nest syndrome,” housing, sex, and health.
Counseling and therapies by a physician and nurse can help reduce one’s menopause
symptoms and restore balance in life. Some centers also offer hormone testing
and menopause typing, as well as hormone balancing with natural hormones and
herbs.
With appropriate counseling, managed care organizations and clinicians can
help women make the choices that are right for them. Information on methods for
managing symptoms and diseases of advancing age, such as coronary heart disease
and osteoporosis should be provided to women. The focus should be on informing
women about options for managing menopausal symptoms and for preventing
some of the diseases associated with aging. Answering questions women have about
treatment options, including the known benefits and risks of treatments, the strength
of the evidence on those benefits and risks helps women make decisions that are
best for them given their own health history, family health history, and personal
preferences and concerns. Because our knowledge base in this area is changing daily,
women’s needs for information are understandable. Professionals need to provide
high-quality informational materials, such as pamphlets, audiocassettes, videotapes,
or Internet-based media tools for use in combination with one-on-one counseling.
 Counseling in Special Situations 325

Pregnancy Counseling
Worry is caused by fear. And in the age of so much information (and misinformation),
pregnant women can hardly help but be fearful. They’re bombarded with advice
and warnings, most of which are unnecessary.
If reproductive systems were that fragile, we’d have become extinct years ago.
Pregnancy is a natural function, and like most of our other bodily functions works
correctly almost every time. Fetal development, in fact, is amazingly resilient.
Avoiding behaviors that are obviously dangerous and habits that are excessive
is smart, of course, but using common sense it is extremely likely that a healthy
pregnancy is possible. Radiation fallout from a blown nuclear reactor should be
avoided, but indicated X-rays or airport metal detectors should not. Smoking
two packs of cigarettes a day can have an effect on the growth of your baby, but
encountering a few minutes of second-hand smoke a day won’t.
Pregnancy is a joyous and wonderful thing. The more a woman understands
about her pregnancy, and what to do to make sure she and her baby stay healthy
and safe, the more she will enjoy her pregnancy and the happier and healthier she
and her baby will be. She would need counseling if she felt overwhelmed, isolated,
and in need of support.

Career Counseling for Women

Recently, career counseling has become prevalent because working life (career)
is becoming increasingly complicated. In other words, working has become the
dominant part of one’s life and it has become difficult to imagine living without
a job, and as a result, people’s work lives are becoming more complex and diverse.
People have more choices than before and each individual has to choose her own
“way of life” and take responsibility for that choice. Those who cannot do so, or
who are unaware of the choices they make, have no chance to improve their careers
and they encounter various difficulties at work. That is why many people seek advice
on their careers.

Are there any Special Considerations to Keep in Mind when

Counseling Women?
Until fairly recently, it was not all that common for women to have jobs, so women
have few role models to learn from. Some young women get discouraged, which is
why advisors need to help them relate to their role models and encourage them to
think constructively about their careers.
In addition, women have more hopes and ideals for their careers than men, and
they tend to be influenced by limited information as well. First of all, there is very
326 Counseling: Theory, Skills and Practice

little information on jobs and working life for women, and providing that kind of
information in a timely fashion is part of the role of job counselors, but it is not their
only function. It is more important for career counselors to provide women with
guidance on how to fit their jobs into their lives, and to encourage them to think.
Through this process, counselors can help women to find the meaning of work and
help them pursue careers of their own choice, although job seekers need to make
compromises to do that.
Career counselors need to focus on helping counselees recognize that taking a
job changes their lives. They need to look beneath the surface of the person who
is seeking career advice. At the same time, people who are serious about their
careers often focus too much on their own jobs and forget about the importance of
creating a good working environment. They need to help maintain a balance. When
counseling working women, it is important to fully bring out the values and ideas
of the counselee and help her make a satisfactory choice about the roles she wants
to enrich (as an employee, as a wife, as a mother, as a daughter, as a member of the
community, and so forth).

SOCIAL INJUSTICE ISSUE COUNSELING

Social injustice is a concept relating to the perceived unfairness of a society in

its divisions of rewards and burdens. Historically, writers have used literature to
denounce social injustice in their societies.
Human beings have universal rights, or status, regardless of legal jurisdiction, and
likewise other localizing factors, such as ethnicity and nationality. This is the premise
of human rights. The legal and political traditions of United Nations member states
have set norms which include the right to life, the right to an adequate standard
of living, freedom from torture and other mistreatment, freedom of religion and
of expression, freedom of movement, the right to self-determination, the right to
education, and the right to participation in cultural and political life. These are
incorporated into international human rights instruments.
Millions of women throughout the world, for reason no other than the fact that
they are women, live in conditions of abject deprivation of, and attacks against,
their fundamental human rights. Abuses against them are relentless, systematic, and
widely tolerated, if not explicitly condoned. Notwithstanding the very real progress
of the international womens’ human rights movement in identifying, raising
awareness about, and challenging impunity for women’s human rights violations,
violence against them and discrimination are still global social epidemics.
We live in a sad world. A world where women do not have basic control over
what happens to their bodies. Being forced to marry and have sex with men they
 Counseling in Special Situations 327

do not desire, not being able to make basic decisions about what happens to their
bodies are just some of the problems women face. The government also is unable to
protect them from physical violence in the home, sometimes with fatal consequences,
including increased risk of HIV/AIDS infection. Women in state custody face sexual
assault by their jailers. Women are punished for having sex outside of marriage or
with a person of their choosing (rather than of their family’s choosing). Husbands
and other male family members obstruct or dictate women’s access to reproductive
health care. Doctors and government officials disproportionately target women from
disadvantaged or marginalized communities for coercive family planning policies
(hrw.org).
Counseling for women who have been subjected to such atrocities follow the
pattern of any individual counseling.

ADDICTION COUNSELING

According to the current Diagnostic and Statistical Manual of Mental Disorders

(DSM-IV-TR), substance dependence is defined as:
“When an individual persists in use of alcohol or other drugs despite problems
related to use of the substance, substance dependence may be diagnosed. Compulsive
and repetitive use may result in tolerance to the effect of the drug and withdrawal
symptoms when use is reduced or stopped. This, along with substance abuse are
considered substance use disorders.”
A definition of addiction proposed by Professor Nils Bejerot:
“An emotional fixation (sentiment) acquired through learning, which
intermittently or continually expresses itself in purposeful, stereotyped behavior
with the character and force of a natural drive, aiming at a specific pleasure or the
avoidance of a specific discomfort.”
The American Society of Addiction Medicine recommends treatment for people
with chemical dependency based on patient placement criteria (currently listed in
PPC-2), which attempt to match levels of care according to clinical assessments in
six areas, including
Acute intoxication and/or withdrawal potential
Biomedical conditions or complications
Emotional/behavioral conditions or complications
Treatment acceptance/resistance
Relapse potential
Recovery environment
Drugs known to cause addiction include illegal drugs as well as prescription
or over-the-counter drugs, according to the definition of the American Society of
Addiction Medicine (Wikipedia).
328 Counseling: Theory, Skills and Practice

Stimulants:
ã Amphetamine and methamphetamine
ã Cocaine
ã Nicotine
Sedatives and hypnotics:
ã Alcohol
ã Barbiturates
ã Benzodiazepines, particularly flunitrazepam, triazolam, temazepam,
and nimetazepam
ã Methaqualone and the related quinazolinone sedative-hypnotics
Opiate and opioid analgesics:
ã Morphine and codeine, the two naturally occurring opiate analgesics
ã Semi-synthetic opiates, such as heroin (diacetylmorphine), oxycodone,
hydrocodone, and hydromorphone
ã Fully synthetic opioids, such as fentanyl, meperidine/pethidine, and
methadone
Drug addiction is when an individual is dependent on a drug. This dependence
can be emotional or physical, or both on the drug. Addiction causes intense cravings
for the drug and the need to use it again and again. When the individual stops using
the drug she/he may experience unpleasant physical or psychological discomfort.
Though the term is often reserved for drug addictions, it is also applied to other
compulsions, such as gambling and compulsive overeating. Factors that have been
suggested as causes of addiction include genetic, biological/pharmacological, and
social factors.
The medical community makes a careful theoretical distinction between
physical dependence (characterized by symptoms of withdrawal) and psychological
dependence (or simply addiction). However, the two kinds of addiction are not
always easy to distinguish. Addictions often have both physical and psychological
components.
There is also a lesser known situation called pseudoaddiction. The term
pseudoaddiction was first used in 1989 to describe the patient displaying behaviors
expressing inadequately treated pain (moaning, grimacing, increasing requests
for analgesics) which were wrongly interpreted by the physicians and nurses as
indicators of addiction. The patient exhibits drug-seeking behavior reminiscent of
psychological addiction, but they tend to have genuine pain or other symptoms that
have been undertreated. Unlike true psychological addiction, these behaviors tend
to stop when the pain is adequately treated.
 Counseling in Special Situations 329

Methods of Care
Diverse explanations: Several explanations (or “models”) have been presented to
explain addiction- those which stress biological or genetic causes for addiction
and those which stress social or purely psychological causes. Of course there are
also many models which attempt to see addiction as both a physiological and a
psychosocial phenomenon. It can affect anyone, from all walks of life. As a result
of their addiction, they suffer from disturbances in their mental health, personal
health, careers, or even their social abilities. As the problems are so widespread and
complex, helping an individual recover from drug addiction can be more difficult
than just the actual addiction itself.
Addiction treatment can be for a specific drug or for a broad range of drug
addictions. It can also vary depending on the characteristics of the individual.
Treatment needs to involve all aspects of their life. Counseling approaches generally
integrate psychotherapeutic and coping skills-training techniques. The primary goal
is to enhance and sustain patient motivation for change, establish and maintain
abstinence from all psychoactive drugs, and foster development of (non-chemical)
coping and problem solving skills to thwart and ultimately eliminate impulses
to “self-medicate” with psychoactive drugs. There is a combination of CBT,
motivational, and insight-oriented techniques. As the counseling process faces with
a lot of resistance from the client, confrontation and psychoeducation are widely
used.
Addiction counseling works to enhance the client’s motivation for change,
Teach the client how to break the addictive cycle and establish total abstinence
from all mood-altering drugs, teach the client adaptive coping and problem solving
skills required to maintain abstinence over the long term, and support and guide
the client through trouble spots and setbacks that might otherwise lead to relapse
(Washton, 1995).
Because every individual is unique, there is a wide range of addiction treatment
approaches available. Here are some of the top choices in addiction treatment:
counseling, inpatient, outpatient, and residential. The primary goal of each of
these methods of treatment is to assist the individual in stopping their drug use and
return them to their families and communities as productive functioning members
of society once again.
Residential treatment model has existed for over 40 years and has experienced
huge success when it comes to drug addiction recovery, also known as therapeutic
communities. This environment simulates the real world. The patient here is able to
see what life would be like drug-free and experience day-to-day life without turning
to drugs to solve problems that arise. With time he or she becomes able to handle
more and more responsibility. Additionally, they are able to connect with others
who share their same goal of addiction recovery 24 hours a day 7 days a week.
330 Counseling: Theory, Skills and Practice

Active efforts are made in counseling to involve significant others (such as family
and friends) in the treatment. The clients are encouraged to attend a family program
together with their significant other. The group then provides support, education,
and counseling where participants learn and practice specific problem-solving and
communication skills using guided role-play exercises, to enhance their ability to
cope adaptively with their loved one’s addiction and teaching them how to break
the vicious cycle of enabling and provoking behaviors that perpetuate the problem.
Couples and family therapy are also used to deal with problems that require more
individualized attention (Washton, 1995).

Treatment Modality Matrix

Behavioral Pattern Intervention Goals
Low self-esteem, Relationship therapy, client- Increase self esteem, reduce
anxiety, verbal hostility centered approach hostility and anxiety
Defective personal Cognitive restructuring, Insight
constructs, ignorance of including directive and
interpersonal means group therapies
Focal anxiety, such as Desensitization Change response to same
fear of crowds cue
Undesirable behaviors, Aversive conditioning, Eliminate or replace
lacking appropriate operant conditioning, behavior
behaviors counter conditioning
Lack of information Provide information Have client act on
information
Difficult social Organizational intervention, Remove cause of social
circumstances environmental manipulation, difficulty
family counseling
Poor social Sensitivity training, Increase interpersonal
performance, rigid communication training, repertoire, desensitization
interpersonal behavior group therapy to group functioning
Grossly bizarre behavior Medical referral Protect from society,
prepare for further
treatment
Adapted from: Lawson, Gary W., Lawson, Ann W., and Rivers, P. Clayton. (2001) Es-
sentials of Clinical Dependency Counseling.

COUNSELING JUVENILE DELINQUENTS

A juvenile delinquent is a juvenile who has been found guilty of a delinquent act.
Concept and causes of juvenile delinquency may be new, but the problem of children
 Counseling in Special Situations 331

is historically as old as children themselves. Every society has treated its children in
accordance with its religious, social, and political beliefs.
Several rapid socioeconomic changes, such as the breakdown of feudalism, rise of
industrialism, colonization, migration and urbanization, have influenced societies’
attitude to children. These attitudes had also been shaped by catastrophic events
such as epidemic, wars, depressions, and breakdown of the family system.

Concept of Juvenile Delinquency

The term “juvenile delinquency” has been differently interpreted but, generally
speaking, it refers to a large variety of behavior of children and adolescents which the
society does not approve and for which some kind of admonishment, punishment,
or preventive and corrective measures are justified in public interest. The word
“juvenile” has been derived from Latin term juvenis, meaning young. The term
delinquency has also been derived from the terms do (away from) and liquere (to
leave). The Latin initiative “delinquere” translates as “emit” in its original, earliest
sense. It was apparently used in times to refer to the failure of an individual to
perform a task or duty. The term “delinquent” describes a person guilty of an
offence against the customs. The concept of delinquency has been viewed differently
by various authors. According to Tappan, there are two kinds of delinquency: (a)
the adjudicated delinquents who have been processed through the courts and (b)
“in-official delinquents” who are handled officially by the police, courts, and other
agencies.
One of the most common symptoms of delinquency is truancy. Delinquents
commit petty crimes like thieving, shoplifting, etc. Most of them are emotionally
immature, and their behavior is a compensatory reaction. Sometimes it is an act of
gangsterism. The emotional upheaval and brittleness, caused by from rapid physical
growth and accelerated endocrinal functioning, result in extra energy seeking
expression in suitable outlets. There is also a greater need for recognition. Media
and books provide the adolescent with a convenient form for day dreaming and
self-identification. Counseling of such people is not easy.
Ruth Cavan describes delinquency as “A delinquent child is one who, by habitually
refusing to obey the reasonable and lawful commands of his parents or other persons
of lawful authority, is deemed to be habitually uncontrolled, habitually disobedient
or habitually wayward or who habitually is a truant from home or school, or who
habitually so deports himself as to injure or endanger the moral, health or welfare
of himself or others.”
The Second United Nations Congress on the Prevention of Crime and the
Treatment of Offenders, held in London in 1960, considered the scope of the
problem of juvenile delinquency. Without attempting to formulate a standard
definition of what should be considered to be juvenile delinquency in each country,
332 Counseling: Theory, Skills and Practice

the congress recommended (a) that the meaning of the term juvenile delinquency
should be restricted as far as possible to violation of criminal law and (b) that
even for protection, specific offences, which would penalize small irregularities or
maladjusted behavior of minors but for which adults would not be prosecuted,
should not be created.
In India, the concept of delinquency does not create any problem as juvenile
delinquency is confined to the violation of the ordinary penal law of the country so
far as the jurisdiction of the juvenile court is concerned. The term “ juvenile” has
been defined in clause (h) of Section 2 of the Juvenile Justice Act, 1986, as a boy who
has not attained the age of 16 years or a girl who has not attained the age of 18 years.
Offence under clause (n) of section 2 of the above Act means an offence punishable
under any law for the time being in force, which includes the Narcotics Drugs and
Psychotropic Substances Act, 1985. Reading the above two definitions, delinquent
juvenile means a boy below the age of 16 years and a girl below the age of 18 years
who has been found to have committed an offence punishable under any law for the
time being in force. Under the Juvenile Justice Act, 1986, separate provisions have
been laid down for the neglected and uncontrollable juveniles. They are dealt with
by the Juvenile Welfare Boards and not by juvenile courts. The juvenile courts in
India do not have jurisdiction in relation to the neglected juveniles as they have in
United States and England.

Theories of Juvenile Delinquency

Psychologists, psychiatrists, sociologists, lawyers, and philosophers have propounded
various theories to understand the deviant behavior of juveniles. Exploration of the
causes of juvenile delinquency is the major objective of these persons and their major
aim is to develop a body of generalizations, which amount to juvenile delinquency.
Most explanations, however, recognize that delinquency and crime cannot be
explained in terms of one single causal factor. Generally speaking, three major
approaches to juvenile delinquency have been identified: biological,psychological,
and sociological. Biogenic views stress faulty bidosy to be the reason for juvenile
misconduct. The psychologist takes a more individualistic, specific view of human
behavior and personal internal factors that contribute to criminality. The sociologist
takes a more general view, looking at the external environment in which the
individual lives. The sociologist is concerned with the distribution of crime within
the environment and the factors in the system that effect the crime rates.

Steps for Helping

Juvenile delinquents need parents who are loving, yet hold them responsible
for their actions.
 Counseling in Special Situations 333

Look closely for signs of substance abuse.

Consider the family. Are there a lot of fights? Violence? Are the parents
considering divorce?
Work closely with the school. Teachers and school counselors may have a
good idea about the child’s attitude, social group, and behavior problems.
Get the parents to be cooperative and not offer excuses.
If the child has been charged as a juvenile delinquent, help the parents hire
an attorney to represent child in court.
The counselor can liaise with police, probation officers, or juvenile officers
who are involved in the child’s case. Parents should be asked to be friendly
and cooperative.
Listen to the child. Pay attention to what he or she says and how he or
she acts. Try to have a conversation without accusing or reprimanding the
child. Ask the parents to do the same. Talk about the problems and ask
what you can do to help.
The parents need to express their love for the child in words and actions.
Make sure he or she understands that they will always love him or her even
if they don’t approve of specific things.
The parents can be counseled to think about all of their options. Maybe
their child would make some changes if he or she had stricter rules. Maybe
living somewhere other than at home would help. Perhaps consequences
for his or her actions are needed.

Tips and Warnings

Do not excuse your child’s criminal actions. This is a serious problem and
needs to be treated as such.
Understand that one possible result from court intervention is that your
child can be removed from your home and placed in foster care or a juvenile
facility. Obtain legal assistance to protect your family.

SUICIDE COUNSELING

India records over 100,000 suicides every year contributing to more than 10 percent
of suicides in the world. The suicide rate in India has been increasing steadily and has
reached 10.5 (per 100,000 of population) in 2006 registering a 67 percent increase
over the value of 1980. Majority of suicides occur among men and in younger age
groups. Despite the gravity of the problem, information about the causes and risk
factors is insufficient (maithrikochi.org).
334 Counseling: Theory, Skills and Practice

Suicide is a complex, multifaceted event precipitated by several cultural, social,

interpersonal, or philosophical factors. Even so, it is presently accepted that suicide
is always preceded by “pain of the mind” intensely felt by the individual. The World
Health Organization (WHO) estimates that each year approximately one million
people die from suicide.
After accidents and homicides, suicide is the third leading cause of death among
young adults aged 15–24 years. Men usually use violent means to commit suicide
than women who are more likely to attempt to commit suicide.
A suicide attempt is a “cry for help” from problems that seem overwhelming and
too difficult to handle and also a request for social support. The unendurable mental
pain introduces the idea of death––as a means to put an end to the pain forever, thus
making suicide appear as a serious option. It is very important to note that suicides
can be prevented. If the underlying mental pain can be alleviated the individual will
spring back to active life. It just requires someone who will spend time with them,
listen, take them seriously and help them talk about their thoughts and feelings.
Suicidal thoughts are troubling and can indicate serious illness. The critical
distinction is between a person’s thoughts regarding death and suicide, and actually
wanting to die. Suicidal ideation can be divided into two categories (emedicinehealth.
com):
1. Suicidal ideation can be active and involve a current desire and plan to
die.
2. Suicidal ideation can be passive, involving a desire to die but without a plan
to bring about one’s death.
There are several factors that may contribute to a person having suicidal thoughts.
These include the following (emedicinehealth.com):
Sudden, unexpected unpleasant change in life circumstances such as loss
of a loved one, breaking up with a boyfriend/girlfriend, moving to a new
town or school, failing an exam or course, not getting into one’s choice of
major, etc., can cause such thoughts in otherwise healthy people. These
major life changes can cause a person to feel unloved, depressed, isolated,
and lonely.
Suicidal ideation is part of many mental illnesses, including depression,
schizophrenia, PTSD, OCD, etc., as well as drug or alcohol abuse. In
the latter two the person may be reckless and impulsive and act on these
thoughts.
Sometimes a person may face problems which bring in immense pain, and
no matter what one does things just do not seem to get better. No one seems
to care or can help. This leads to feelings of hopelessness and helplessness,
Wanting to end unbearable pain/problems that are so overwhelming,
suicide may be considered as the only way out.
 Counseling in Special Situations 335

Negative feelings about oneself. A person who is suicidal experiences

feelings of worthlessness and of being a failure.
Sleep deprivation due to improper lifestyle or problems in going to sleep
can increase the risk of suicidal thoughts and attempts
In rare instances, suicidal thoughts may be associated with medication side
effects

Myths and Facts About Suicide

There are many myths about suicide.
Myth: Asking a person if he/she is thinking about suicide will put the idea into
his/her head.
Fact: Discussing the problem openly shows the suicidal student that someone
cares and wants to help.
Myth: Once someone decides to commit suicide, there is no way of stopping him/
her.
Fact: Even the most severely depressed person has ambivalent feelings about
suicide. They do not want to die, only to end their pain. If given proper
assistance, suicidal feelings might dissipate and the person returns to active
life.
Myth: Suicide happens without warning.
Fact: Suicidal persons give many clues and warnings––verbal and non-verbal,
behavioral, psychological––regarding their suicidal intentions.
Myth: Students who commit suicide are mentally ill.
Fact: Most people undergoing suicidal feelings are healthy individuals who
are upset, grief-stricken, depressed or despairing, but are not necessarily
suffering from mental illness.
Warning signs (ub-counseling.buffalo.edu, and webcache.googleusercontent.
com)

Psychological
History of a diagnosed psychiatric disorder
Depression (and depressive symptoms), despair, hopelessness
Anhedonia (extreme loss of interest)
Obsessive thinking (including death fantasies)
Mood swings (emotionally labile)
Extreme guilt or shame
Extreme anxiety (panic attacks)
Somatic symptoms (headaches, stomach aches, back pain, rashes, etc.)
336 Counseling: Theory, Skills and Practice

Behavioral (verbal and non-verbal signs)

Verbal indications: overt or subtle
ã “Instructors, classmates, families and friends do not care.”
ã “Life isn’t worthwhile.”
ã “People are better off without me.”
ã “Everything seems to be going wrong.”
ã “I don’t need this any more.”
Prior suicide attempts
Difficulty in making decisions
Acute loss of energy
Change of habits, reduction of pleasurable activities
Giving away prized possessions
Insomnia/Excessive sleep
Sexual dysfunctions
Withdrawal, alienation from support system
Lack of interest in personal appearance
Poor performance in school
Boredom, restlessness, and loss of concentration
Lack of interest in friends
Risk taking behavior: speeding, drunk driving, self mutilation
Frequent alcohol or drug abuse

Situational
Loss of significant other
Loss of health or functions/abilities
Loss of status and/or role
Threatened major change: family/marital status, job, home, security,
legalities
Sexual or physical abuse
Self-image changes
Trauma/accident
Isolation
Absent support system
Family history of abuse/suicide/violence/discord

What the counselor needs to do:

Never leave the person who is suicidal alone. Take action. If possible get
family and friends involved. Have them remove accessories which might
abet suicide––guns or stockpiled pills.
Become available. Show interest and support.
 Counseling in Special Situations 337

Be direct. Talk openly and matter-of-factly about suicide and the person’s
intention.
Listen well and treat it seriously. Allow expressions of feelings. Accept
feelings.
Be non-judgmental. Do not debate if suicide is right or wrong; feelings
are good or bad. Do not lecture over value of life. They will not believe
you anyway. For the suicidal person their perception of life may be that it
is “worthless”. You can, on the other hand reassure them that when they
are not depressed they will enjoy life again (webcache.googleusercontent.
com).
Offer hope that alternatives are available. Encourage the person to approach
support groups formed specially for suicidal people, persons or agencies
specializing in crisis intervention and suicide prevention.

FATIGUE AND TAKING CARE OF ONESELF

Many rehabilitation professionals just beginning their careers, have little preparation
for dealing with the extraordinary experience of having to be empathically available
through intensive counseling interactions with persons who have chronic mental
and physical disabilities. Thus, many rehabilitation professionals who maintain a
high level of empathy or compassion while helping others who have experienced
chronic pain, suffering, trauma, or loss may experience the secondary stressors or
parallel feelings of the individuals they serve.
Empirical studies support the theory that counselors who work with the trauma of
others have an increased likelihood of experiencing a change in their own psychological
functioning (Chrestman, 1995). Reactions may include avoidance of the trauma,
feelings of horror, guilt, rage, grief, detachment, or dread, and may possibly lead
to burnout and countertransference (Simpson and Starkey, 2006). Counselors
who are unaware of this stress response may implicitly convey an unwillingness to
hear the details of the client’s trauma, or be less likely to ask questions to facilitate
dialogue related to the event. This can result in a revictimization of individuals who
often have limited environments in which telling their story is safe and acceptable
(McCann and Perlman, 1990).
Compassion is an emotion whereby the counselor enters into the world of the
client, becomes aware of the suffering and, upon feeling the pain, takes action to ease
it. It is defined as a “feeling of deep sympathy and sorrow for another who is stricken
by suffering or misfortune, accompanied by a strong desire to alleviate the pain or
remove its cause,” (Webster’s Encyclopedic Unabridged Dictionary of the English
Language). The ability to be compassionate and have empathy is a desirable quality
338 Counseling: Theory, Skills and Practice

that contributes to establishing trust and therapeutic effectiveness with patients.

Ironically it is exactly this sensitivity that makes care professionals vulnerable. Over
time, this positive quality––compassion––can exact an emotional toll.
Compassion fatigue describes the emotional, physical, social and spiritual
exhaustion that overtakes a person and causes a pervasive decline in his or her desire,
ability and energy to feel and care for others. Such fatigue causes the sufferer to lose
the ability to experience satisfaction or joy professionally or personally. Compassion
fatigue is not pathological in the sense of mental illness, but is considered a natural
behavioral and emotional response that results from helping or desiring to help
another person suffering trauma or pain (Figley, Charles R. 1983, 1985).

What is Compassion Fatigue?

As a career, counseling is recognized as emotionally demanding. Therapists need to
be empathic, understanding, and giving, yet they must control their own emotional
needs and responsiveness in dealing with their clients. When engaging empathically
with a traumatized client, clinicians are at risk of experiencing a state of emotional,
mental, and physical exhaustion (Figley, 1995; McCann and Pearlman, 1990;
McCann and Saakvitne, 1995). The ancillary effects, frequently experienced by
those not directly traumatized, are often defined as secondary trauma or compassion
fatigue.
The concept and phenomenon of “compassion fatigue” was first introduced
by Joinson (1992) in the nursing literature. This concept was expanded in the
psychology and trauma stress literature by Figley (1995). Compassion fatigue is
defined as “a state of exhaustion and dysfunction––biologically, psychologically,
and socially––as a result of prolonged exposure to compassion stress” (Figley, 1995,
p. 253). This term describes the set of symptoms experienced by caregivers who
become so overwhelmed by the exposure to the feelings and experiences of their
clients that they themselves experience feelings of fear, pain, and suffering including
intrusive thoughts, nightmares, loss of energy, and hypervigilance (Panos). It can
be cumulative (from the effects helping many clients) or occur in response to a
particularly challenging or traumatic individual case. This extreme state of anxiety
and preoccupation with the suffering of those being helped becomes traumatizing
for the helper. For this reason it is sometimes called “vicarious traumatization” or
“secondary traumatization” (Figley, 1995). He said that it is identical to secondary
traumatic stress disorder (STSD) and is equivalent to post-traumatic stress disorder
(PTSD) in terms of its symptomatology. Within professional literature, compassion
fatigue is also known as secondary traumatization, secondary traumatic stress
disorder, or vicarious traumatization (Figley, 1995; McCann and Saakvitne, 1995).
Work that is focused on the relief of clients’ emotional suffering typically results in
the absorption of information about human suffering (Figley, 1995).
 Counseling in Special Situations 339

Many rehabilitation counselors are exposed to counseling-related activities

in which they must be empathically available to individuals and family members
who are survivors of a variety of chronic illnesses, traumatic, and life-threatening
disabilities (Stebnicki, 2000). Professional rehabilitation counselors are compelled
by ethical obligation to sometimes sacrifice their own needs for the needs of their
clients. The nature of beneficent actions by rehabilitation counselors are clearly
pronounced in the Code of Professional Ethics for Rehabilitation Counselors
(1987), which reads: “Rehabilitation counselors shall endeavor at all times to place
their clients’ interest above their own” (p. 27). As rehabilitation counselors are
compassionate and empathic in their service to others, there appears to be a state
of emotional, mental and physical exhaustion that may occur as the counselors’
own wounds are revisited by issues raised concerning their client’s life stories and
experience of disability (Stebnicki, 2000).

Burnout, Empathy Fatigue, and Compassion Fatigue

Burnout, a phrase first coined by Freudenberger (1974), has been described as
a syndrome of cumulative physical and emotional stress that is observed among
rehabilitation professionals who work in organizations that serve persons with
chronic and several disabilities (Blankertz and Robinson, 1996; Cranswick, 1997;
Gomez and Michaelis, 1995; Riggar, Godley, and Hafer, 1984;). The hallmark
of burnout syndrome, as Maslach (1982) notes, is a negative shift in the way
professionals view the people they serve. Burnout stems from dissatisfaction with
the work environment. There is a progressive loss of energy, idealism, and personal
accomplishment experienced among helping professionals as a result of their working
conditions. Pines and Aronson (1988) identified three basic characteristics within
the role and function of professional helpers that may contribute to burnout: (a) the
work they perform is emotionally draining, (b) they are characteristically sensitive
to the individuals they serve, and (c) they typically facilitate a client-centered
orientation. These characteristics are similar in nature to the role and function
of rehabilitation counselors who work with persons who have acquired or who
are survivors of traumatic illness and disability. Rehabilitation professionals who
work with these persons may have a similar vicarious experience coping with the
psychosocial aspects of adjustment and adaptation to disability (Stebnicki, 1998).
In contrast to burnout, which is a cumulative and sometimes unconscious process,
empathy fatigue is perceived to emerge as an acute reaction of physical, emotional,
and mental exhaustion. Consequently, rehabilitation practitioners may respond
with less compassion, genuineness, or unconditional positive regard for persons
they serve if the experience of burnout goes unrecognized or ignored. Historically,
considerable attention has been given to developing the skills of empathy as a
fundamental tool and resource for the preparation of masters-level rehabilitation
340 Counseling: Theory, Skills and Practice

counselors-in-training (Stebnicki, 1998). Empathy fatigue transcends the experience

of professional burnout. The experience of burnout emerges gradually within the
individual and results in cumulative emotional and physical exhaustion. Compassion
fatigue (Figley, 1995) or empathy fatigue, as described here, can emerge suddenly
with little warning as an unhealthy form of counter transference or STS.
Although there is no current measure to assess the emotional affects of empathy
fatigue, the most widely used measure to assess the associated experience of burnout
is the Maslach Burnout Inventory (Maslach and Jackson, 1981; 1986). Three factors
have been identified in the MBI: emotional exhaustion (feelings of being emotionally
overextended), depersonalization (an impersonal response style to consumers), and
reduced personal accomplishment (absence of feelings of competence and success
that occur because of job stress).

Countertransference
Countertransference, a term first described by Freud in 1910, is currently described
as a reflection of the counselor’s unresolved internal conflicts, which encompasses
reactions of thoughts, feelings, and emotions as it relates to his or her clients’
experience (Corey and Corey, 1993). When this phenomenon occurs, the counselor
may exhibit reduced feelings of warmth, acceptance, respect, or positive regard
for their clients (Rogers, 1961). Rando (1984) suggests that dying persons touch
counselors personally in at least three ways. They may (a) make them painfully aware
of personally losses, (b) contribute to apprehension regarding potential and feared
losses, or (c) arouse existential anxiety in personal death awareness. Rehabilitation
counselors, who are unaware of their unresolved personal issues during client–
counselor interactions, experience increased levels of countertransference, which
may manifest as the experience of empathy fatigue.
Responding empathically to client concerns can either enhance or diminish
countertransference within the therapist. Gelso and Hayes (1998) suggest that
therapists who convey deep levels of empathy will occasionally experience an
overidentification with their clients’ issues. They can manage this effectively
with an increased level of insight into their feelings and issues, as well as having a
greater capacity for empathy and understanding. The identification and awareness
of one’s emotional feelings and attitudes toward a client are important issues for
rehabilitation professionals because having this information can contribute to an
enriched client–counselor relationship (Marinelli and Dell Orto, 1999). Overall,
the literature suggests that countertransference in helping relationships must be
viewed as a natural by-product of caring for persons who have counseling needs.
The rehabilitation professional that has an increased level of self-awareness and
insight will likely deal more effectively with the phenomenon of empathy fatigue.
 Counseling in Special Situations 341

The personal impact of compassion fatigue (Source: Figley 1995, 2002)

Cognitive Emotional Behavioral
Diminished concentration Powerlessness Clingy
Confusion Anxiety Impatient
Loss of meaning Guilt Irritable
Decreased self-esteem Anger/Rage Irresponsibility
Preoccupation with trauma Survivor guilt Overwork
Trauma imagery Shutdown Withdrawn
Apathy Numbness Moody
Rigidity Fear Regression
Disorientation Helplessness Sleep disturbances
Whirling thoughts Sadness Appetite changes
Thoughts of self-harm or Depression Nightmares
Harm toward others Hypersensitivity Hypervigilance
Self-doubt Emotional roller coaster Elevated startle response
Perfectionism Overwhelmed Use of negative coping
Minimization Depleted (Smoking, alcohol or
other substance abuse)
Accident proneness,
Losing things, Self harm
behaviors, Frequent job
change

Spiritual Interpersonal Physical

Questioning the meaning of Withdrawn Shock
Life Decreased interest in Sweating
Loss of purpose Intimacy or sex Rapid heartbeat
Lack of self-satisfaction Mistrust Breathing difficulties
Pervasive hopelessness Isolation from friends Aches and pains
Ennui Impact on parenting Dizziness
Anger at God (protectiveness concern Impaired immune
about aggression) system
Questioning of prior Projection of anger or Lump in throat restless-
religious beliefs blame ness
Intolerance
Loneliness
342 Counseling: Theory, Skills and Practice

Performance Morale Relationship with

colleagues
Decrease in quality and Decrease in confidence Withdrawal from
colleagues
Quantity Loss of interest Impatience
Low motivation Dissatisfaction Decrease in quality of
Increase in mistakes Negative attitude relationship
Obsession about details Apathy Poor communication
Absenteeism Demoralization Subordinate own needs
Exhaustion Lack of appreciation Staff conflicts
Faulty judgment Detachment
Irritability Feelings of incompleteness
Tardiness

Preventing Compassion Fatigue, Increasing Resilience and

Promoting Compassion Satisfaction
Unrecognized and untreated compassion fatigue causes people to leave their
profession, fall into the throes of addictions or in extreme cases become self-
destructive or suicide (Panos). If professional helpers are not empathically available
to the persons they serve, then there should be little concern for the influences of
STS reactions or compassion fatigue (Figley, 1995). Counselor’s compassion, along
with the intensity of the work makes them very vulnerable to compassion fatigue.
Empathy fatigue is a natural artifact of working at an intense level with persons
with acquired chronic illnesses and disabilities. Rehabilitation counselors who may
or may not be aware of this parallel process must be open and invited to develop
healthy coping responses and strategies that lead to a decrease of the secondary
stressors associated with empathy fatigue.
Early recognition and awareness is crucial in being able to be resilient to
compassion fatigue. Counselors can take care of themselves and develop resilience
by taking days off, destress by involving themselves in enjoyable activities, eating
well, excercising, keeping body and mind in good shape. One is more vulnerable
physically and emotionally to the effects of distress. If one is disturbed enough that
it affects their ability to function effectively, it is important to get medical attention.
Therefore, keeping a healthy balance in your life is a requirement to prevent and
treat compassion fatigue. Caregivers that have a structured schedule that allow them
time to organize and do good self-care are more resilient (Panos, 2007).
In addition to caring for oneself personally, maintaining good relationships with
someone (personal or professional) with whom to safely and confidentially discuss
 Counseling in Special Situations 343

the distresses one is experiencing. Isolation is a symptom of compassion fatigue and

is ultimately dangerous. Such support and connection is absolutely necessary. In
addition to all that maintaining a journal, expressing feelings through music and
art, diversions and recreation providing mini-escapes from the intensity of the work,
turning thoughts “off” work builds resilience. Sometimes this involves developing
a little ritual at the end of the day to transition into your life outside of work, while
leaving your cares and stresses in the workplace (Panos, 2007).
The health professionals’ associations all over the world prescribe some guidelines.
Self care is mandatory for all practitioners. The following are the guidelines that are
utilized by members of the Green Cross.

Academy of Traumatology/Green Cross Proposed Standards

of Self Care (greencross.org)

Standards of Self Care Guidelines

I. Purpose of the guidelines: As with the standards of practice in any field,

the practitioner is required to abide by standards of self care. These guidelines are
utilized by all members of the Green Cross. The purpose of the guidelines is two-
fold: First, do no harm to yourself in the line of duty when helping/treating others.
Second, attend to your physical, social, emotional, and spiritual needs as a way of
ensuring high quality services who look to you for support as a human being.

II. Ethical principles of self care in practice: These principles declare that
it is unethical not to attend to your self care as a practitioner because sufficient self
care prevents harming those we serve.
1. Respect for the dignity and worth of self : A violation lowers your integrity
and trust.
2. Responsibility of self care: Ultimately it is your responsibility to take care
of yourself and no situation or person can justify neglecting it.
3. Self care and duty to perform: There must be a recognition that the duty
to perform as a helper can not be fulfilled if there is not, at the same time,
a duty to self care.

III. Standards of humane practice of self care:

1. Universal right to wellness : Every helper, regardless of her or his role or
employer, has a right to wellness associated with self care.
2. Physical rest and nourishment: Every helper deserves restful sleep and
physical separation from work that sustains them in their work role.
344 Counseling: Theory, Skills and Practice

3. Emotional Rest and nourishment: Every helper deserves emotional and

spiritual renewal both in and outside the work context.
4. Sustenance Modulation: Every helper must utilize self restraint with regard
to what and how much they consume (e.g., food, drink, drugs, stimulation)
since it can compromise their competence as a helper.

IV. Standards for expecting appreciation and compensation:

1. Seek, find, and remember appreciation from supervisors and clients:
These and other activities increase worker satisfactions that sustain them
emotionally and spiritually in their helping.
2. Make it known that you wish to be recognized for your service: Recognition
also increases worker satisfactions that sustain them.
3. Select one or more advocates: They are colleagues who know you as a
person and as a helper and are committed to monitoring your efforts at self
care.

V. Standards for establishing and maintaining wellness:

Section A: Commitment to self care
1. Make a formal, tangible commitment: Written, public, specific, and
measurable promises of self care.
2. Set deadlines and goals: The self care plan should set deadlines and goals
connected to specific activities of self care.
3. Generate strategies that work and follow them: Such a plan must be
attainable and followed with great commitment and monitored by
advocates of your self care.
Section B: Strategies for letting go of work
1. Make a formal, tangible commitment: Written, public, specific, and
measurable promise of letting go of work in off hours and embracing
rejuvenation activities that are fun, stimulating, inspiriting, and generate
joy of life.
2. Set deadlines and goals: The letting go of work plan should set deadlines
and goals connected to specific activities of self care.
3. Generate strategies that work and follow them: Such a plan must be
attainable and followed with great commitment and monitored by
advocates of your self care.
Section C: Strategies for gaining a sense of self care achievement
1. Strategies for acquiring adequate rest and relaxation: The strategies are
tailored to your own interest and abilities which result in rest and relaxation
most of the time.
2. Strategies for practicing effective daily stress reductions method(s): The
strategies are tailored to suit your own interest and abilities in effectively
 Counseling in Special Situations 345

managing your stress during working hours and off-hours with the
recognition that they will probably be different strategies.

VI. Inventory of self care practice—Personal:

Section A: Physical
1. Body work: Effectively monitoring all parts of your body for tension and
utilizing techniques that reduce or eliminate such tensions.
2. Effective sleep induction and maintenance: An array of healthy methods
that induce sleep and a return to sleep under a wide variety of circumstances
including stimulation of noise, smells, and light.
3. Effective methods for assuring proper nutrition: Effectively monitoring
all food and drink intake and lack of intake with the awareness of their
implications for health and functioning.
Section B: Psychological
1. Effective behaviors and practices to sustain balance between work and
play.
2. Effective relaxation time and methods.
3. Frequent contact with nature or other calming stimuli.
4. Effective methods of creative expression.
5. Effective skills for ongoing self care.
a. Assertiveness
b. Stress reduction
c. Interpersonal communication
d. Cognitive restructuring
e. Time management
6. Effective skill and competence in meditation or spiritual practice that is
calming.
7. Effective methods of self assessment and self-awareness.
Section C: Social/Interpersonal
1. Social supports: At least five people, including at least two at work, who
will be highly supportive when called upon.
2. Getting help: Knowing when and how to secure help––both informal and
professional––and the help will be delivered quickly and effectively.
3. Social activism: Being involved in addressing or preventing social injustice
that results in a better world and a sense of satisfaction for trying to make
it so.

VII. Inventory of self care practice—Professional:

1. Balance between work and home: Devoting sufficient time and attention
to both without compromising either.
346 Counseling: Theory, Skills and Practice

2. Boundaries/limit setting: Making a commitment and sticking to regarding

a. Time boundaries/overworking
b. Therapeutic/professional boundaries
c. Personal boundaries
d. Dealing with multiple roles (both social and professional)
e. Realism in differentiating between things one can change and accepting
the others
3. Getting support/help at work through
a. Peer support
b. Supervision/consultation/therapy
c. Role models/mentors
4. Generating Work Satisfaction: By noticing and remembering the joys and
achievements of the work.

VIII. Prevention plan development:

1. Review current self-care and prevention functioning
2. Select one goal from each category
3. Analyze the resources for and resistances to achieving goal
4. Discuss goal and implementation plan with support person
5. Activate plan
6. Evaluate plan weekly, monthly, yearly with support person
7. Notice and appreciate the changes

Understand precipitating factors

It is important that professionals continuously monitor their reactions, and not
minimize the potential negative reactions, in an effort to prevent the negative effects
of compassion fatigue and promote the positive reactions from doing crisis work,
called compassion satisfaction. Self-assessment is one method to monitor one’s level
of compassion fatigue.
As Super (1994) points out, individuals choose occupations that will allow them
to function in roles consistent with their self-concepts. Hence, work and the person’s
self-concept are interrelated and occupations are a way for individuals to express their
needs, talents and value systems.

Know the possible negative effects

The counselor needs to keep in mind the following symptoms of compassion fatigue
and burnout as you monitor your reactions:
Cognitive changes: decreased concentration and self-esteem, increased
confusion and forgetfulness, traumatic stress imagery, and apathy.
 Counseling in Special Situations 347

Emotional changes: increased sense of powerlessness and helplessness,

anxiety, guilt, anger or rage, numbness, fear, depression, hypersensitivity,
feeling overwhelmed.
Behavioral changes: increasingly impatient and/or irritable, withdrawal,
changes in sleep patterns and/or appetite, nightmares, elevated startle
response, increased use of negative coping methods, such as smoking,
alcohol and other substance use.
Spiritual changes: questioning the meaning of life, loss of purpose, anger
towards God or another higher power, questioning of prior religious or
spiritual beliefs.
Interpersonal changes: withdrawn, isolation, loneliness, increased
interpersonal conflicts.
Physical changes: shock, increased sweating, rapid heartbeat, feeling dizzy,
other somatic reactions.
Work performance changes: decreased sense of morale, avoiding certain
tasks, increased negativity and absenteeism, poor performance and
productivity, increased conflict among staff.
(Adapted from Figley, 2002; Yassen, 1995)

Develop an adaptive coping response to empathy fatigue

The following strategies are offered to individuals and organizations as an overall
approach to cope more effectively with the experience of empathy fatigue.
1. Participate in peer support groups which meet regularly. Peer support
groups are critical to allow professionals within the organization or agency
to ventilate their emotions regarding the secondary stress or grief reactions
felt while working at an intense level of service (Pearlman & Saakvitne,
1995). Structured or unstructured peer groups can be formed during
employee lunch breaks or after work.
2. Offer clinical supervision or mentoring to newer and less experienced
counselors. The clinical supervisor should monitor the counselor’s
emotional hardiness and resiliency and adaptive coping mechanisms for
dealing with the secondary stressors.
3. Shift the focus of rehabilitation treatment to team meetings. The team
(e.g., vocational rehabilitation counselor, psychologist, licensed professional
counselor, paraprofessionals) can validate the individual’s experience of
empathy fatigue.
4. Decrease the number of demanding and time-consuming clients.
5. Promote education and wellness programs for employees.
348 Counseling: Theory, Skills and Practice

SPIRITUALITY AND WELLNESS

Research has identified a counselor’s psychological well-being as a contributing factor

in the avoidance of compassion fatigue symptoms (Figley, 1995). When considering
what makes up psychological well being, the issue of spirituality is of key interest.
Graham, Furr, Flowers, and Burke (2001) reported on a survey conducted by the
American Counseling Association that indicates counselors view spirituality as
an important component of mental health. These authors conducted additional
research that examined the relationship between religion and spirituality in coping
with stress and found a positive correlation between spiritual health and immunity
to stressful situations (Graham et al., 2001).
Religion and spirituality has been increasingly supported as relevant to both
physical and mental health. When spiritual and religious involvements have been
measured, they have consistently been found to be positively related to health and
inversely related to physical disorders, mental disorders, and substance use disorders
(Cooper, 2003). The development of vicarious traumatization may be linked to
the counselor’s sense of spirituality and counselors with a “larger sense of meaning
and connection” are less likely to experience symptoms of vicarious traumatization
(Pearlman and Saakvitne, 1995; p. 161). Spirituality is fundamental to understanding
the ways in which a person finds purpose in life. It is thus, a unique, personally
meaningful experience, which is positively related to religiosity but is not reliant on
any given form of religion. Spirituality is a source of hope, meaning and purpose,
particularly during difficult times. (Simpson and Starkey, 2006).
According to Simpson (2005), cumulative reviews of studies have concluded
that there is a protective factor of spirituality to health. Similar results have been
found relative to mental health as spirituality has been associated with higher self-
esteem and lower depression (Koenig, 1998). According to Ellison and Pargment,
as reported by Simpson (2005), an increasing number of studies indicate that those
who are more spiritual experience a greater sense of well-being and life satisfaction,
cope better with stress, and are less likely to commit suicide.
We have seen in an earlier chapter how spirituality and health are related and how
spirituality should be integrated into the counseling practice. It is imperative for
counselors to incorporate spirituality into their daily practice. People want holistic
and wholesome care. Thus, all health care models are changing to incorporate
spirituality. Problems seem to have a spiritual origin, and integrating spirituality in
the solution only seems the right way to go. Counselees need to be encouraged to
explore their own spirituality and use it to assist in the healing process.
Spirituality and compassion (Swami Paramarthananda Saraswati)—
Human life has three components: gross matter which is the body, subtle matter
which is the mind and the cosmic matter which is the spirit. The needs of the spirit
 Counseling in Special Situations 349

have to be attended to. The issues have to be addressed. Because the spirit is the core
of the human personality. It is the journey of discovery. The discovery of oneness.
There are two levels of oneness.
Relative oneness is at the level of pluralism. Where we think, see ourselves
as different from others. We are physically different from others. We are
emotionally different from others. We are intellectually different from
others. At this level if we have to relate with others efficiently it is called
harmony.
But spiritually we are one. There is no difference. This is called Dharma.
This is the absolute level.
Why is this important? Why is this oneness important?
The three magnificent pillars on which the care professions rest are:
1. Empathy is identification with and understanding of another’s situation,
feelings, and motives.
2. Respect a positive feeling of esteem for another
3. Non judgmental is about being open-minded enough to understand that
other people have different points of view, and that in their worldview,
they may be correct.
4. Unconditional positive regard is acceptance and support of a person
regardless of what the person says or does.
All these require a feeling of spiritual oneness with the patient or client. This
feeling of non-separateness with another leads us to embrace the person and the
problem as if they were our own.
Many a time the health care professional is faced with certain spiritual concerns
of the patient like:
Loss
Mortality
Dignity
Hope
Isolation and connection
Existential meaning, purpose
Closure and legacy
After-death issues
And some common spiritual questions like:
Why me?
Why now?
What does this mean?
Is there hope?
Can I be forgiven?
What happens when I die?
How will I be remembered?
350 Counseling: Theory, Skills and Practice

There is not one practitioner who has not been at the receiving end of any one of
these questions. Both spiritual concerns and the questions arising out of them need
to be effectively addressed. Only spirituality can do that. The feeling of oneness with
the patient.

v Summary v
Counseling is not a one size fits all field. There are different kinds of
problems for which there are different counselors. Counselors who
have had experience helping people handle those specific problems.
Relationship counseling is the process of counseling the parties of a
relationship in order to try and reconcile differences. The relationship
involved may be between people in a family, between employees in
a workplace, or between a professional and a client. Relationship
counseling as a discrete, professional activity is a recent phenomenon.
Couple’s counseling aims to help a couple deal appropriately with
their immediate problems, to address the dysfunction in their relationship
and to learn better ways of relating in general.
Premarital counseling is a way to enrich a relationship so that it has
every opportunity to grow into a satisfying and stable marriage. The
goals of premarital counseling generally include the following: (a) To
teach couples information about married life, (b) to enhance couple
communication skills, (c) to encourage couples to develop conflict
resolution skills, and (d) to allow the couple to speak about certain
sensitive topics, such as sex and money (Senediak, 1990; Stahmann &
Hiebert, 1997).
With increasing divorce rates and millions of couples who are simply
unsatisfied with their relationship, an intervention from a professional
counselor can be the necessary step for improving the relationship,
helping everyone work on key issues that are causing conflict, and
working towards improvement (Theresa Anderson). Marital counseling
provides the opportunity for the couple to help discover strengths in
their relationship and therby build a healthy, long-lasting relationship.
It provides them with the skills and strategies they need to manage life
together in a healthy way.
Family counseling involves all the members of a nuclear and/
or extended family. It may help to promote better relationships and
understanding within a family. It may be incident specific, or may address
the needs of the family when one family member suffers from a mental
 Counseling in Special Situations 351

or physical illness that alters his or her behavior or habits in negative

ways.
Rehabilitation counseling, aims to assist individuals with physical,
mental, developmental, cognitive, and emotional disabilities to achieve
their personal, career, and independent living goals in a systematic
manner. The philosophy of rehabilitation rests on the premise that
believes in the dignity and worth of all people. the concepts of
independence, integration, and the inclusion of people, with and without
disabilities, in employment and their communities are valued without
exception. Until recently, women’s specific issues were largely ignored.
The majority of clients who seek counseling are women. As counselors
we need to combine traditional approaches with alternative approaches
to counseling women, gain information about the nature of psychological
distress commonly experienced by women, develop an awareness of
the social and cultural basis of problems commonly experienced by
women, examine some specific problems women bring to counseling,
and learn about some strategies for helping women deal with distress
and problems.
Rape Trauma Syndrome (RTS) is a form of psychological trauma
and post traumatic stress disorder experienced by a rape victim,
consisting of disruptions to normal physical, emotional, cognitive,
behavioral, and interpersonal characteristics. Victims of rape can
be severely traumatized by the assault and may have difficulty in
functioning.
The onset of puberty is a very important time in the life of a child. At
this time, the child needs all the help he or she can get. It is a traumatic
time physiologically, physically, and emotionally.
Counseling of individuals, couples, and families involves issues related
to mid-life decisions and change, including marriage, divorce, and re-
marriage, retirement planning, “empty nest syndrome,” housing, sex,
and health.
Counseling and therapies by a physician and nurse can help reduce
one’s menopause symptoms and restore balance in life. The more a
woman understands about her pregnancy, and what to do to make sure
she and her baby stay healthy and safe, the more she will enjoy her
pregnancy and the happier and healthier she and her baby will be. She
would need counseling if she felt overwhelmed, isolated, and in need
of support.
Recently, career counseling has become prevalent because working
life (career) is becoming increasingly complicated. People have more
352 Counseling: Theory, Skills and Practice

choices than before and each individual has to choose her own “way
of life” and take responsibility for that choice. Those who cannot do
so, or who are unaware of the choices they make, have no chance to
improve their careers and they encounter various difficulties at work.
That is why many people seek advice on their careers. Counseling for
women who have been subjected to such atrocities follows the pattern
of any individual counseling.
Drug addiction is when an individual is dependent on a drug. This
dependence can be emotional or physical, or both, on the drug.
Addiction causes intense cravings for the drug and the need to use it
again and again. When the individual stops using the drug she/he may
experience unpleasant physical or psychological discomfort.
Addiction counseling works to enhance the client’s motivation for
change, teach the client how to break the addictive cycle and establish
total abstinence from all mood-altering drugs, teach the client adaptive
coping and problem solving skills required to maintain abstinence over
the long term, and support and guide the client through trouble-spots
and setbacks that might otherwise lead to relapse.
A juvenile delinquent is a juvenile who has been found guilty of a
delinquent act. The counselor can liaise with police, probation officers,
or juvenile officers who are involved in the child’s case.
India records over 100,000 suicides every year contributing to
more than 10 percent of suicides in the world. Suicide is a complex,
multifaceted event precipitated by several cultural, social, interpersonal,
or philosophical factors. A suicide attempt is a “cry for help” from
problems that seem overwhelming and too difficult to handle and also
a request for social support. The unendurable mental pain introduces
the idea of death—as a means to put an end to the pain forever many
rehabilitation professionals who maintain a high level of empathy or
compassion while helping others who have experienced chronic pain,
suffering, trauma, or loss may experience the secondary stressors or
parallel feelings of the individuals they serve.
Unrecognized and untreated compassion fatigue causes people to
leave their profession, fall into the throws of addictions or in extreme
cases become self-destructive or suicide (Panos). Early recognition
and awareness is crucial in being able to be resilient to compassion
fatigue. In addition to caring for oneself personally, maintaining good
relationships with someone (personal or professional) with whom to
safely and confidentially discuss the distresses one is experiencing.
Religion and spirituality has been increasingly supported as relevant
to both physical and mental health. When spiritual and religious
 Counseling in Special Situations 353

involvements have been measured, they have consistently been found to

be positively related to health and inversely related to physical disorders,
mental disorders, and substance use disorders (Cooper, 2003).

References
Bessel A. van der Kolk, Susan Roth, David Pelcovitz, Susanne Sunday, and Joseph Spinazzola1.
Disorders of Extreme Stress: The Empirical Foundation of a Complex Adaptation to
Trauma. Journal of Traumatic Stress, Vol. 18, No. 5, October 2005, pp. 389–399.
Blankertz, L., & Robinson, S. 1996. Who is the psychosocial rehabilitation worker? Psychiatric
Rehabilitation Journal, 19(4), pp. 3–13.
Bryant, Richard A., Sackville, Tanya, Dang, Suzanne T., Moulds, Michelle, and Guthrie, Rachel (1
November. 1999. “Treating Acute Stress Disorder: An Evaluation of Cognitive Behavior
Therapy and Supportive Counseling Techniques”. Am J Psychiatry (American Psychiatric
Association) 156:1780-1786, November. 1999. (11): 1780. PMID 10553743.
Burgess, Ann Wolbert and Lynda Lytle Holmstrom. “Rape Trauma Syndrome”. Am J Psychiatry
131: pp. 981–986, September. 1974. doi: 10.1176/appi.ajp.131.9.981.
Carter B., McGoldrick M. 1989. The expanded family life cycle; Individual, family, and social
perspectives. Allyn and Bacon: Boston.
Center for Addiction and Mental Health. Couple therapy: Factors influencing a couple’s
relationship. Available at www.camh.net/about_addiction_mental_health/couple_
therapy_factors.html
Chrestman, K.R. 1995. “Secondary exposure to trauma and self reported distress among
therapists.” In B.H. Stamm (Ed.), Secondary traumatic stress: Self care issues for
clinicians, researchers, and educators: pp. 29–36. Lutherville, MD: Sidran Press.
Cooper, A.E. 2003. An investigation of the relationships among spirituality, prayer, and
editation, and aspects of stress and coping. Dissertation Abstracts International (UMI no.
3084474).
Corey, M.S., and Corey, G. 1993. Becoming a helper (2nd ed.). Pacific Grove, CA: Brooks/
Cole.
Cranswick, K. 1997. Burnout: A study of level of burnout and factors responsible for burnout in
rehabilitation workers. Journal of Rehabilitation Administration, 21 (2), pp.119–134.
Figley, Charles.R. 1995. Compassion fatigue: Coping with secondary traumatic stress disorder in
those who treat the traumatized. Bristol, PA: Brunner/Mazel.
Figley, Charles R. 1995. Compassion Fatigue: Secondary Traumatic Stress Disorders in Those Who
Treat the Traumatized (New York: Routledge,) and.
Figley,Charles R. 1983. “Catastrophes: An Overview of Family Reactions,” in Stress and the
Family: Coping with Catastrophe, eds Charles R. Figley and Hamilton I McCubbin, 3-20
(New York: Brunner/Mazel,).
file:///C|/My%20Documents/My%20Webs/Bronfnebrenner%20webquest/index.htm.
Freudenberger, H.J. 1974. Staff burnout. Journal of Social Issues, 30 (1), pp. 159–165.
Friedlander, M. 1997. The scientific basis of couples and family therapy research. Allyn and Bacon:
Boston.
Gelso, C.J., and Hayes, J.A. 1998. The psychotherapeutic relationship: Theory, research and practice.
John Wiley and Sons, Inc.
Gomez, J. S., and Michaelis, R.C. 1995. An assessment of burnout in human service providers.
Journal of Rehabilitation, 61 (1), pp. 23–26.
354 Counseling: Theory, Skills and Practice

Graham, S., Furr, S., Flowers, C. and Burke, M.T. 2001. Religion and spirituality in coping with
stress [Electronic version]. Counseling and Values, 46(1), pp. 2–14.
Hershenson, D. B., Smith, R. C., and Wright, G. N. 1990. Is rehabilitation counsellor education
effective? Bulletin of the Australian Society of Rehabilitation Counsellors, 1, pp. 11–14.
Hershenson, D.B. 1990. A theoretical model for rehabilitation counseling. Rehabilitation
Counseling Bulletin, 33, pp. 268–278.
http://education.nic.in/disab. 1995.pdf
http://en.wikipedia.org/wiki/Family_therapy
http://en.wikipedia.org/wiki/Substance_dependence#cite_ref-NIDA_3-0
http://kidshealth.org/teen/safety/safebasics/rape_what_to_do.html
http://ub-counseling.buffalo.edu/suicide.shtml
http://web.pace.edu/page.cfm?doc_id=5108
http://www.direct.gov.uk/en/DisabledPeople/RightsAndObligations/DisabilityRights/
DG_4001069 - © Crown copyrighthttp://www.disabilityindia.org/pwdacts.cfm
http://www.emedicinehealth.com/suicidal_thoughts/page2_em.htm- Copyright (c). 1996 –
2005. WebMD, Inc. All rights reserved.
http://www.greencross.org/index.php?option=com_content&view=article&id=184&Itemid=12
4.
http://www.hrw.org/en/category/topic/women
http://www.maithrikochi.org/india_suicide_statistics.htm
http://www.unlimitedinvestigations.com/counselling.html
http://www.wisegeek.com/what-is-family-counseling.htmhttp://www.wordiq.com/definition/
Marriage_counseling
Jenkins, W., Patterson, J. B., and Szymanski, E. M. 1998. Philosophical, historic, and legislative
aspects of the rehabilitation counseling profession. In R. M. Parker and E. M. Szymanski
(Eds.), Rehabilitation counseling: Basics and beyond (3rd ed., pp. 1–40). Austin: PRO-
ED.
Johnson, Kevin. 1998. Rape statistics not crystal clear. USA Today, November 19.
Joinson, C. 1992. Coping with compassion fatigue. Nursing, 22(4), pp.116–122.
Koenig, H.G. 1999. The healing power of faith. New York: Simon and Schuster.
Lawson, Gary W., Lawson, Ann W., and Rivers, P. Clayton. 2001. Essentials of Chemical
Dependency Counseling (Third Edition). Gaithersburg, MD: Aspen Publishers.@
http://www.wordiq.com/definition/Addiction.
Marinelli, R.P., and Dell Orto, A.E. 1999. The psychological and social impact of disability (4th
ed.). New York: Springer Publishing.
Mary Kopala and Merle A. Keitel (Eds). 2003. Handbook of Counseling Women. Sage Publications,
Inc.
Maslach, C. 1982. The burnout: The cost of caring. Englewood Cliffs, NJ: Prentice-Hall.
Maslach, C., and Jackson, S.E. 1981. The measurement of experienced burnout. Journal of
Occupational Behavior, 2(2), pp. 991–13.
Maslach, C., and Jackson, S.E. 1986. Maslach burnout inventory manual (2nd ed.). Palo Alto, CA:
Consulting Psychologists Press.
McCann, I.L. and Perlman, L.A. 1990b. Vicarious traumatization: A framework for understanding
the psychological effects of working with victims. Journal of Traumatic Stress, 3, pp. 131–
149.
McCann, I.L. and Saakvitne, K.W. 1995. Treating therapists with vicarious traumatization and
secondary traumatic stress disorders. In C.R. Figley (Ed.), “Compassion fatigue: Coping
with secondary traumatic stress disorder in those who treat the traumatized;” pp. 150–
177. New York: Brunner/Mazel.
 Counseling in Special Situations 355

Murray, Christine E and Murray, Thomas L Jr. 2004. Helping Couples Build A Vision For Their
Marriage, Journal of Marital and Family Therapy @ http://findarticles.com/p/articles/
mi_qa3658/is_200407/ai_n9436867/.
Nils Bejerot in Theories of Drug abuse, Selected contemporary perspectives, pp. 246–255, NIDA.
1980.
Norment, Lynn. 2002. Rape and recovery: survivors speak out - Statistical Data Included.
Ebony.
Panos, A (February. 2007. Promoting resiliency in trauma workers. Poster presented at the 9th
World Congress on Stress, Trauma, and Coping, Baltimore, MD.
Pines, A. and Aronson, E. 1988. Career burnout: Causes and cures. New York: Free Press.
Panos, Angela. Preventing Compassion Fatigue - A Handout for Professionals. - http://www.
selfgrowth.com/articles/Preventing_Compassion_Fatigue_-_A_Handout_For_
Professionals.html
Pearlman, L.A. and Saakvitne, K.W. 1995. Treating therapists with vicarious traumatization and
secondary traumatic stress disorders. In C.R. Figley (Ed.), Compassion fatigue: Coping
with secondary traumatic stress disorder in those who treat the traumatized; pp. 150–
177. New York: Brunner/Mazel.
Pines, A.M., and Aronson, E. 1988. Career burnout: Causes and cures. New York: Free Press.
Rando, T. A. 1984. Grief, dying and death: Clinical interventions for caregivers. Champaign, IL:
Research Press Company.
Riggar, T.F., Godley, S.H., and Hafer, M. 1984. The relationship of work environment and
client control to burnout in mental health professionals. Journal of Counseling and
Development, 27, pp.151–60.
Rogers, C. 1951. Client Centered Therapy. New York: Houghton Mifflin.
Rogers, C.R. 1961. On becoming a person. Cambridge, MA: Riverside Press.
Rogers, C.R. 1980. A way of being. Boston, MA: Houghton Mifflin Company.
Senediak, C. 1990. The value of premarital education. Australia and New Zealand Journal of
Family Therapy, 11, pp.26–31.
Silliman, B., and Schumm, W. R. 1995. Client interests in premarital counseling: A further
analysis. Journal of Sex and Marital Therapy, 21, pp. 43–56.
Simpson, Laura R and Starkey,, Donna S. 2006. Secondary Traumatic Stress, Compassion Fatigue
and Counselor Spirituality: Implications for Counselors Working with Trauma. VISTAS
. 2006. 0nline @ http://counselingoutfitters.com/Simpson.htm.
Smith, Robert L. - Stevens-Smith, Patricia. 1992. @ http://www.ericdigests.org/1992-1/basic.
htm.
Simpson, L. R. 2005. Level of Spirituality as a Predictor of the Occurrence of Compassion Fatigue
among Counseling Professionals in Mississippi. University of Mississippi.
Stahmann, R. F. 2000. Premarital counseling: A focus for family therapy. Journal of Family
Therapy, 22, pp.104–117.
Stahmann, R. F., and Hiebert, W. J. 1997. Premarital and remarital counseling: The professional’s
handbook (2nd ed. rev.). San Francisco, CA: Jossey-Bass.
Stahmann, R. R, and Hiebert, W. J. 1980. Premarital counseling. Lexington, MA: Lexington
Books.
Stebnicki, M.A. 1998. Clinical supervision in rehabilitation counseling. Rehabilitation Education,
12, pp. 137–159.
Stebnicki, Mark A. 2000. Stress and Grief Reactions among Rehabilitation Professionals: Dealing
Effectively with Empathy Fatigue. Journal of Rehabilitation, Jan-March @ http://
findarticles.com/p/articles/mi_m0825/is_1_66/ai_61424232/.
356 Counseling: Theory, Skills and Practice

Szymanski, E. M., and Danek, M. M. 1985. School to work transition for students with disabilities:
Historical, current and conceptual issues. Rehabilitation Counseling Bulletin, 29(2), pp.
81–89.
Szymanski, E. M., Rubin, S. E., and Rubin, N. M. 1988. Contemporary challenges: An
introduction. In S. E. Rubin and N. M. Rubin, (Eds.), Contemporary challenges to the
rehabilitation counseling profession, pp. 1–14. Baltimore: Brookes.
Theresa Anderson @ http://family-marriage-counseling.com/
Theresa Taylor @ http://family-marriage-counseling.com/marriagecounseling.htm
Washton, A.M., ed. Psychotherapy and Substance Abuse: A Practitioner’s Handbook. New York:
Guilford Press. 1995. from http://archives.drugabuse.gov/ADAC/ADAC13.html.
Webster’s Encyclopedic Unabridged Dictionary of the English Language (NY: Gramercy Books.
1989. 229.
Will, Misty @ http://family-marriage-counseling.com/mentalhealth/couples-counseling.htm.
Wills, R.M. 2001. Effectiveness of therapy. Available at http://www.marriagetherapy.org/
dssbhmarriage127.html.
Yassen, J. 1995. Preventing secondary traumatic stress disorder. In Figley, Charles R. (Ed.),
Compassion fatigue: Coping with secondary traumatic stress disorder (1st ed., pp. 178-
208). New York:Brunner/Mazel.
 13
Modern Trends in
the Field of Counseling

Chapter Overview
� Life coaching
� Mentoring
� Consulting
� Training
� Convergence of approaches and thinking
� Stress release scenario in India today

M
any Indians know about counseling as an intervention field but now the
whole approach to counseling is changing into mentoring, coaching,
training, consulting, etc., as the postmodern generation emerges.

LIFE COACHING

Coaching can be seen as a human development process that involves structured,

focused interaction and the use of appropriate strategies, tools and techniques
to promote desirable and sustainable change for the benefit of the coachee and
potentially for other stakeholders. The International Coaching Federation defines
coaching as partnering with clients in a thought-provoking and creative process that
inspires them to maximize their personal and professional potential. Life coaching is
a professional service providing clients with feedback, insights and guidance from an
outside point of view. People hire a coach when they are making a career transition,
starting a new business, ending a relationship, feeling dissatisfied, re-evaluating life
choices or simply looking for personal and professional breakthroughs (inbalance.
358 Counseling: Theory, Skills and Practice

org.uk). The coach acts as a catalyst and facilitator of individual development. Life
coaching is aimed at helping clients determine and achieve personal goals. It is
action oriented and quite specific in the sense that it tends to set specific goals and
focus on its achievement.
Coaching is a recent phenomenon and gaining in popularity. However, there is
very little documented history of life-coaching. Some experts say that life coaching
has its roots in executive coaching, which itself drew on techniques developed in
management consulting and leadership training, offered by companies to help
improve the performance of their employees. Coaching came into its own in the
1980s, fed by the human potential movement, counseling and therapy, business and
organizational consulting (Brain). Writing for the International Journal of Coaching
in Organizations, Patrick Williams (2007) states:
It is helpful to understand that both coaching and therapy have the same roots.
Coaching evolved from three main streams that have flowed together:
1. Helping professions such as psychotherapy and counseling.
2. Business consulting and organizational development.
3. Personal development training, such as EST, Landmark Education, Tony
Robbins, Stephen Covey seminars, and others.
Life coaching also draws from disciplines such as sociology, psychology, positive
adult development, career counseling, mentoring and other types of counseling.
Coaching then spread beyond the business world with people from all walks of
life hiring coaches to assist them in achieving a variety of personal and professional
goals.
Life coaching works on the philosophy that people limit themselves and cap their
potential due to self-defeating beliefs and patterns. A life coach is someone who
believes in the clients’ abilities and helps them to identify and set clear goals towards
achieving the life they want; helps them to prioritize them and then encourage
clients to believe that they really are achievable. Coaching encourages, motivates,
supports and sometimes challenges the coachees to move forward.
Coaching also shares similarities with other disciplines such as organizational
consulting, management development, and training. Differentiating these can be
difficult, for whilst some consultants and management trainers play the expert
role, many others adopt a primarily facilitative role not unlike that of the coach
(Bluckert).
The Chartered Institute of Personnel and Development (CIPD) lists some
characteristics of coaching in organizations that are generally agreed on by most
coaching professionals (.brefigroup.co.uk):
� It consists of one-to-one developmental discussions.
� It provides people with feedback on both their strengths and weaknesses.
� It is aimed at specific issues/areas.
 Modern Trends in the Field of Counseling 359

� It is a relatively short-term activity, except in executive coaching, which

tends to have a longer time frame.
� It is essentially a non-directive form of development.
� It focuses on improving performance and developing/enhancing individuals
skills.
� It is used to address a wide range of issues.
� Coaching activities have both organizational and individual goals.
� It assumes that the individual is psychologically healthy and does not
require a clinical intervention.
� It works on the premise that clients are self-aware, or can achieve self-
awareness.
� It is time-bound.
� It is a skilled activity
� Personal issues may be discussed but the emphasis is on performance or
work.

Coaching and counseling share certain common features

Practitioners in both fields work towards bringing about behavioral change and
helping people to understand how their cognitive and emotional reactions can
interfere with personal effectiveness, performance, and well-being.
In both areas practitioners establish a strong trusting relationship with their
clients, and some of the core skills such as deep listening and questions which raise
awareness are the same.
The underlying philosophies also overlap like embracing a client-centered,
collaborative partnership that encourages clients to acknowledge their creativity and
find their own unique solutions.

Difference between coaching and counseling

In the US, the Society of Counseling Psychology (Div. 17 of the American
Psychological Association) views counseling psychology in this manner:
“Counseling psychology is unique in its attention both to normal developmental
issues and to problems associated with physical, emotional, and mental disorders.”
(Div. 17 website) Counseling psychology works with clients who require therapy to
address issues (which can range from mild to severe).
Anthony Grant (2006) defines “coaching psychology” this way:
“Coaching psychology can be understood as being the systematic application
of behavioural science to the enhancement of life experience, work performance
and well-being for individuals, groups and organizations who do not have clinically
significant mental heath issues or abnormal levels of distress.” Coaching Psychology
is a discipline that has a theoretical base stemming from facilitating life skills training,
social work and professional counseling.
360 Counseling: Theory, Skills and Practice

Whereas counseling focuses on healing, coaching aims at actualizing one’s

potential. In other words, the ‘coachees’ are healthy individuals who have specific
goals they want to achieve in their personal or professional life. The focus is on
movement and taking action, not on insight and understanding. Another way to
look at the two fields is that counselees need counseling, whereas coachees want to
work with a coach.
In counseling the whole person is addressed and that includes his or her past
influences, present experiences and future aspirations. Self awareness leading to
personal evolution is the aim. The counselee discusses emotional matters, thought
patterns, behaviors, unresolved issues, relationships, spirituality and personal
growth.
Coaching as has been mentioned is action oriented, task oriented, setting
specific, drawing plans and making it happen. The work of the coach is that of an
‘accountability partner’ to who one has to check in with periodically and update, let
them know the actions that have been taken, and the overall progress made. If there
are emotional issues the coach needs to refer the coachee to a counselor.
There are three key differences between the ways of coaching and therapy,
namely:
Orientation: Coaching focuses on the present and future whilst therapy deals
with the past. In therapy, the focus is on helping clients deal with the past; whereas
in coaching, the focus is on the future and it is assumed that one is ready and able
to pursue a fulfilled, authentic life.
Goals: Coaching is geared to highly functioning people whilst therapy exists for
troubled people with painful, unresolved issues or who have some form of pathology.
Therapy aims to “fix” problems, or at least makes them less debilitating; coaching
aims to help create new opportunities and get more out of life.
Relationships: The therapist–client relationship is often based on an expert–patient
model, whereas in coaching, the two are more like partners (Sally Anne Law).
There are other ways in which counseling differs from coaching. The intentions of
coaching and therapy are different as sometimes the coach guides individuals toward
increased awareness and insights regarding how one’s thoughts and emotional
reactions lead to problematic behaviors in a particular setting (maybe work).
Counseling shares this goals of improved personal effectiveness and increased
awareness. However, the difference is that counseling also addresses non-work
aspects of the individual’s life. It involves in-depth explorations of the client’s
history, and their key relationships with parents and other family members, issues
that may be only tangentially related to business effectiveness. Counseling also leads
to deep and intense emotional experiences that demand skilful guidance from an
experienced practitioner.
 Modern Trends in the Field of Counseling 361

The training, skill sets, and experience of coaches and therapists are quite different.
In order to take on the deeper self-exploration common to the therapeutic situation
counselors and therapists require an extensive training typically far in excess of coach
training. This is far more demanding than current coach training offerings which
typically vary from a few days to a full year.

Other Differences
Most corporate coaching exists within a three-way contract involving the coachee,
the organization and the coach. The company which is footing the bill expects
results. Thus coaching tends to be more results and action-focused than therapy
The delivery of coaching may also involve processes very rarely used in therapy
such as structured feedback from bosses, peers, and subordinates. Therapy allows for
greater privacy with two-way confidentiality.

Length of sessions: Therapy is often conducted within the hour or 50-minute

frame. Coaching sessions tend to last longer and be spaced at longer intervals.

Place of sessions: Therapy tends to take place in the therapist’s consulting

rooms whereas coaching can occur in the manager’s office, a hotel syndicate room,
or by telephone.

Socialization rules: Therapists do not have contact with clients socially and
are very careful about boundary issues. Coaches regularly accept invitations by cli-
ents to attend corporate hospitality and may invite clients to their own events.

Corporate culture: also plays an important part in coaching and the executive
coach must learn how to handle the complexities of organizational life.
Fee rates are also a significant point of difference and can vary enormously between
coaching and therapy. Typically, coaching rates can be as much as quadruple those
of therapy.

Qualifications: A therapist will also have malpractice insurance, whereas a life

coach, in most cases, will not.
In the recent book by Skiffington and Zeus, Behavioral Coaching (2003), the
authors outline a number of commonly asked questions about this subject. They
include the following:
� How long should a coach allow the coachee to talk about or ventilate
negative emotions?
� How does the coach know when a coachee should be referred to therapy?
362 Counseling: Theory, Skills and Practice

� How long should the coach allow a coachee to talk about and ventilate
negative emotions?
� How does the coach know when a coachee should be referred for therapy?
Most coaches are not trained to diagnose these conditions and this is one of the
reasons why coaches need to be in professional supervision to discuss their concerns
with another senior colleague, get support, reassurance, and guidance. Fortunately
these issues are the exception, but the professional coach does need to recognize that
there may be occasions when referral is the soundest thing to do.
Many different models of coaching now exist. These include:
1. GROW model which is the acronym for GOAL, REALITY, OPTIONS,
WILL (or WRAP-UP) (Whitmore 1996; 2004).
2. ACHIEVE model which represents: Assessment of current situation;
Creative brainstorming of alternative to current situation; Hone goals;
Initiate options Evaluative options, Validate action programme design;
Encourage momentum (Dembkowski and Elridge, 2003).
3. POSITIVE model represents Purpose, Observations, Strategy, Insight,
Team, Initiate, Value and Encourage. (Libri (2004) OSKAR a solution
focused coaching model which represents Outcome, Scaling, Know-how
and resources, Affirm and action, Review Jackson and McKergow, (2007).
4. Cognitive behavioural and rational emotive models of coaching include
Albert Ellis’ well known ABCDE model (Ellis et al., 1997; Palmer 2002)
which stands for Activating event or situation, Beliefs, Consequences,
Disputation of the beliefs, Effective and new approach to dealing with the
issue or problem.
5. SPACE model which represents Social context, Physical, Action, Cognitions
and Emotions was developed by Edgerton (Edgerton and Palmer, 2005).
6. Problem-solving models have also been developed for training, counseling,
stress management and coaching (for, e.g., Wasik, 1984; Palmer and
Burton, 1996; Palmer, 1997 a, b) and used within cognitive-behavioural
coaching (see Neenan and Palmer, 2001 a, b) and coaching psychology
(Palmer and Szymanska, 2007).
7. PRACTICE model which is an acronym for Problem identification,
Realistic, relevant goals, Alternative solutions generated, Consideration of
consequences, Target most feasible solution(s), Implementation of Chosen
solution(s), Evaluation.
8. PIE: Problem definition; Implement a solution; Evaluate outcome.
9. STIR: Select problem; Target a solution; Implement a solution; Review
outcome.
A growing number of psychologists and mental health professionals are
transitioning into coaching using life-coaching to aid clients with transitions in their
personal life, and in the process of self-actualization. The coach, applies mentoring,
 Modern Trends in the Field of Counseling 363

values assessment, behavior modification, behavior modeling, goal-setting, and

other techniques in assisting clients. Coaching can also help the individual who has
completed therapy and now feels she/he is ready to move on and set goals for the
future, unencumbered by old symptoms from the past. Coaching is thus, a process
by which an individual (the coach) helps another to remove internal barriers towards
an achievement and helps to learn, perform and achieve. Coaches tend to specialize
in one or more of several areas: career coaching, transition coaching, life or personal
coaching, health and wellness coaching, parenting coaching, executive coaching,
small business coaching, systemic coaching and organizational or corporate coaching.
Life coaching can help coachees reach individual goals, enhance relationships with
parents, partners and children, or with team members and managers.
The coach gives clear, concise directives, which stimulate creative ideas by which
one can move forward to achieve goals. The coach facilitates focus, maintains hope,
and builds motivation. They help the coachee figure out why their life is not working
the way they want it to. They help them clarify what they actually want from their
life and design inspiring yet believable goals for a new life. The coach works with
the client to turn problem statements into solution statements, to develop plans to
move them toward goals, and to maintain focus and positive motivation to get them
there.

MENTORING

Mentoring is the process by which an experienced person provides advice, support,

and encouragement to a less experienced person. A mentor is a teacher or advisor
who leads through guidance and example. A mentor provides guidance, wisdom,
knowledge, and support in a manner in which a protégé can receive it and benefit
from it.
Origin of word/concept Mentor: The original mentor is a character in Homer’s
epic poem “The Odyssey.” When Odysseus, King of Ithaca, went to fight in the
Trojan War, he entrusted the care of his kingdom to Mentor who was described
by Homer as the “wise and trusted counselor.” Athena, in the guise of the mentor,
became the guardian and teacher for Odysseus’ son Telemachus. Mentor served as
the teacher and overseer of Odysseuss’ son, Telemachus.
“Mentoring is to support and encourage people to manage their own learning
in order that they may maximise their potential, develop their skills, improve their
performance and become the person they want to be.” Eric Parsloe, The Oxford
School of Coaching and Mentoring.
Mentoring is a life educational model based on the principle of a more experienced
mentor guiding his or her student, often called a protege or mentee. It encourages
364 Counseling: Theory, Skills and Practice

a one-on-one level interaction. It can also be seen as a partnership between two

people normally working in a similar field or sharing similar experiences. It is a
helpful relationship based on mutual trust and respect (mentorset.org). A mentor is
a guide who is more experienced or more knowledgeable and helps a less experienced
and less knowledgeable mentee to find the right direction, and who can help him/
her to develop solutions to career issues. Mentors rely upon having had similar
experiences to gain an empathy with the mentee and an understanding of their
issues. Mentoring provides the mentee with an opportunity to think about career
options and progress.
The concept of mentoring can be traced back to the ancient Indian gurukula
(learning from the master [guru] by staying with him for several years) system. In
India, we have an unbroken tradition of teaching with regard to the learning of the
scriptures, and also of language, logic, music, dance, sculpture, architecture, and so
on. This tradition of teaching and learning was carried on in a gurukula. A student
seeking knowledge in a given discipline lived with the teacher of the respective
discipline for a length of time to learn and master the subject matter. In this type of
teaching, the teacher had the advantage of knowing the student well, inasmuch as the
student lived with the teacher for the entire period of the learning. Whatever be the
subject matter involved in this type of learning, the teacher saw to it that the student
grew up as a person of culture, committed to a life of dharma or righteousness.
So was the case in Greece where philosophers such as Socrates routinely took on
the role of mentor to young men who demonstrated great leadership potential. In
return, their proteges agreed to continue the mentoring relationship with their own
students. Master craftsmen would accept promising students as apprentices, guiding
them through all aspects of the craft (wisegeek.com).
The need and utility of a mentor is now recognized more and more at all
places, especially in the educational institutions and the corporate organizations.
Apart from imparting training, the mentor transmits the knowledge and a general
understanding of the profession, the mentor also guides the mentee through the
various ways in which different situations in life can be handled.
It is the job of the mentor to help the mentee to believe in the self and boost
confidence. To this end the mentor generally asks questions and challenges the
mentee, while providing guidance and encouragement. Mentoring allows the
mentee to explore new ideas in confidence. It gives the mentee a chance to look
more closely at one self, related issues, opportunities and what she/he wants out of
life. Mentoring is about becoming more self aware, taking responsibility for your life
and directing your life in the direction you decide, rather than leaving it to chance
(mentorset.org).
For the relationship to be fruitful, the mentor must be a person that the mentee
looks up to, trusts and respects. The mentor must also possess all the skills and
attitude of a counselor. In order to serve two important functions they are expected
 Modern Trends in the Field of Counseling 365

to namely providing guidance pertaining to career as well as providing psychological

support, the mentees must perceive their mentors as a guide who would lead them
to greater knowledge and success. Thus, the relationship between the mentor
and mentee needs to one of affection and mutual respect. It is necessary that the
mentee is confident of the trust, sincerity and integrity of the mentor. Only then
can they share a relationship that would optimize the goals. The mentor should
be committed to the role, accessible and approachable. Unconditional acceptance,
knowledge about the subject, good communication and interpersonal skills and
sensitivity to the shortcomings of the mentee are other qualities of a good mentor.
And last but definitely not the least, as the mentor and the mentee are in the same
field, same organization, professional jealousy may erupt in spite of the mentor
being at a higher level. It is paramount that the mentor should not at any time be
competing with the mentee.

Mentoring Techniques
A study of mentoring techniques most commonly used in business was published in
1995 under the title Working Wisdom (Aubrey and Cohen, 1995). These are:
1. Accompanying: Taking part in the learning process by taking the path the
learner takes.
2. Sowing: Preparing the learner before she/he is ready to change.
3. Catalyzing: When change reaches a critical level of pressure, learning can
jump. Here the mentor chooses to plunge the learner right into change,
provoking a different way of thinking, a change in identity or a re-ordering
of values.
4. Showing: Showing or making something understandable, or using own
example to demonstrate a skill or activity.
5. Harvesting: Create awareness of what was learnt by experience and to draw
conclusions.

Process common to both coaching and mentoring

(Megginson & Clutterbuck)
1. Establishing and managing the coaching or mentoring relationship
2. Setting goals
3. Clarifying and understanding situations
4. Building self-knowledge
5. Understanding other people’s behavior
6. Dealing with roadblocks
7. Stimulating creative thinking
8. Deciding what to do
9. Committing to action
366 Counseling: Theory, Skills and Practice

10. Managing the learner’s own behaviors

11. Building wider networks of support, influence and learning
12. Review and ending the coaching and mentoring relationship
13. Building one’s own techniques

Possible pitfalls of mentoring: While mentoring is picking up due to it’s

efficacy in providing guidance to the mentees, it is not always the case. This relation-
ship can be disadvantageous, even detrimental to the mentees. Some of the reasons
why this may happen are as follows:

“Mismatch” between mentor and proteges

The mentor and the protégé may be totally mismatched. This can lead to failure of
the relationship. In such a situation one or both members of the relationship may
feel uneasy with the other, hindering the achievement of that level of friendship
necessary for elevation and rich communication. It becomes imperative then to
closely monitor the mentor-mentee relationship, detect and identify such issues,
and assign the young entrepreneur to a different mentor. If the problem is identified
during the first six months of the relationship the change can usually be made in
an amicable way with no hard feelings on either side. If this is done by the mentor,
then well and good. However, it requires a very high level of objectivity, backed by
experience and the ability to do that.

Unrealistic expectations
Unrealistic expectations of the mentee in terms of the time and space of the mentor
can lead to problems. The mentor may not be able to, ready to or even willing to
give as much support as the mentee requires or wants. It is important, therefore, that
expectations are clearly defined from the beginning. The protégé should not expect
the relationship to meet every need, nor for it to continue indefinitely. The mentor
must also take good care to see that a sense of dependency is not allowed to develop
in the mentee.

Breaches of confidentiality
Mentors are bound by a duty of confidentiality. This duty is applicable irrespective
of the position of the mentor or mentee in the organization. Exemptions may include
information relating to any illegal act, harm to self or others. The mentor should
ensure that the mentee is informed that they are unable to maintain confidentiality.
The commitment to confidentiality continues after the mentor and mentee have
concluded their mentoring contract.
This is very important to facilitate the development of the type of relationship
in which the mentor can be effective. Maintaining the confidences of the mentee is
 Modern Trends in the Field of Counseling 367

step one in being perceived as trustworthy. A high level of trust is essential in order
that an effective relationship develops and breaching confidentiality is a sure way
to harm the process. Codes of conduct regarding confidentiality issues should be
clearly defined and understood by both parties at the beginning of every mentoring
relationship.

Mentors doubling up as counselors

It is common in India for all and sundry, involved in helping others, to call themselves
counselors. As mentioned in earlier chapters, as there is no regulating body of
registration and licensing for educationally and professionally qualified counselors,
this practice is still on. A HR manager, English teacher, a general physician, a lawyer,
a social worker or even a paramedic says that counseling is part of their job. This can
prove to be harmful to the person being counseled and the healing process itself.
It is therefore important to recognize that mentoring, or coaching for that matter
should stay within the limits of their definition, and refer their coachees or mentees
to a professionally trained counselor when there are deeper emotional issues.

CONSULTING

A consultant (from the Latin consultare means “to discuss” from which we also
derive words, such as consul and counsel) is a professional who provides advice in
a particular area of expertise like law, management, medicine, etc. The consultant
is usually an expert in the field with a wide knowledge of the subject matter. This
individual is usually self-employed or works for a consulting firm. s/he works with a
number of clients who need access to deeper levels of expertise than would be feasible
for them to retain in-house. The client has the additional advantage of purchasing
only as much service as they require.
This consultant provides advice to clients, may be individuals or companies, in
a particular field or specialty. They may work on-site or off-site (home or office).
The clients may go to the consultant or have the consultant over, depending on the
nature of the advice required.
Business consultants as people are generally (managementconsulted.com):
1. Knowledgeable about the topic at hand
2. Well-connected within the industry
3. Have a reputation and/or brand (based on experience, publications, etc)
4. Effective communicators
368 Counseling: Theory, Skills and Practice

What is the difference between consulting, coaching

and counseling (McKinley)?
One very good way to bring about the differences among the three is:
1. Counseling is helping. Counselors ask the “why” questions. It is the
application of mental health, psychological or human development
principles, through cognitive, affective, behavioral or systemic intervention
strategies, that address wellness, personal growth, or career development,
as well as pathology. The therapist is there to alleviate pain and loosen
pressure. The counselor has to determine where the problem is, what is
blocking ones efficacy in functioning, what is causing pain, and help in
routing it out/alleviating it. The process is all about finding out why an
individual is hurting, identify patterns that originated and maintain the
pain, and then assist in making the corrections.
2. Coaching is educating. Coaches ask the “what” questions. What motivates
them, what they want, what they want to be? Then the skilled coach guides
the coachee toward realizing those dreams. Through various conversations
and interactions, the coachee realizes that what she/he has is not enough,
or is not what she/he wants. The coach then provides the conversation that
empowers the coachee to live more intentionally. Coaching enables learning
and development to occur whereby performance improves, proceeds in the
direction of fulfillment of dreams and achievement of goals.
3. Consulting is the expert giving advice or guidance. While the client relies on
the consultant to solve and fix the problems consultants help organizations
initiate and increase functionality and efficiency. Consultants mainly deal
with the “how” questions that the client may have. They show the client
how things/processes can be done better, how to fix, how to improve, etc.
The consultant identifies the problem and tells the client how to put things
back together the right way. In order to do this well, the consultant must
possess knowledge and experience in the field that the client services.

The following table describes differences in the three disciplines:

COUNSELING COACHING CONSULTING

Relationship Cooperative Partnership Expert
Goal Healing Changing Fixing
Methods Redirecting Questioning Telling
Focus Pain Desires Problems
 Modern Trends in the Field of Counseling 369

TRAINING

The term training refers to the acquisition of knowledge, skills, and competencies
as a result of the teaching of vocational or practical skills and knowledge that relate
to specific useful competencies (wikipedia.org). Every individual must be trained
to possess a core competency. However, the trend today is to continue the training
beyond that, to maintain, upgrade, and update the knowledge and skills throughout
their working life. In addition to the HR department in various concerns, the
department of Training and Development is gaining focus and significance. This
department takes care of ‘on-the-job’ as well as ‘off-the-job’ training programs for
the employees.
Training has very specific goals: improving one’s capability, capacity and
performance. Training emphasizes growth and development of the individual in an
organization. Most of the organizations are starting to invest in the development of
the skills of their employees so they can increase their productivity. Both the new as
well as old employees need to be trained, the former to induct them into the culture
of the concern, the latter to enhance their knowledge and skills.
Reasons for emphasizing the growth and development of personnel include
(bizmove.com):
� Creating a pool of readily available and adequate replacements for personnel
who may leave or move up in the organization.
� Enhancing the company’s ability to adopt and use advances in technology
because of a sufficiently knowledgeable staff.
� Building a more efficient, effective and highly motivated team, which
enhances the company’s competitive position and improves employee
morale.
� Ensuring adequate human resources for expansion into new programs.
It is obvious to see how training, if done well, helps an organization ‘stay in
shape’. It helps in the following ways:
� Increases productivity
� Reduces employee turnover
� Increases employee efficiency and thus resulting in financial gains
� Decreases need for supervision
The training design starts with elucidating the organizational objectives. Then
the department conducts a needs assessment survey in order to find out what both
the employees as well as the employer need to be done in order to increase efficiency.
A SWOT analysis can be done to bring out the gaps or the blockades. Then the
department forms the training objectives. The next step is to match the training
with the employee and selecting the trainees for a particular program according to
the need and requirement of the staff. Training methods and mode are developed
370 Counseling: Theory, Skills and Practice

and the training program is conducted. It is important to evaluate the efficacy of the
program, and an assessment procedure is identified, developed and implemented.
The most important of all the above steps is to identify the training needs.
Training needs can be assessed by analyzing three major human resource areas: the
organization as a whole, the job characteristics and the needs of the individuals. This
analysis will provide answers to the following questions:
� In which area/department/field is training needed?
� Specifically what must an employee learn in order to be more productive?
� Who needs to be trained?
As mentioned earlier the training department must begin by assessing what the
current status of the concern is, its strengths and weaknesses in terms of capabilities
of the employees. Goals for the organization as well as individual employees must
be charted out both long term as well as short term. As training is gaining in
significance, organizations are willing to commit financially to supporting them.
Conduct internal audits to detect where (and what kind of training) is most needed.
A skills inventory can help determine the skills of the employees, both individually
as well as in general. This exercise will also help the organization determine what
skills are available now and what skills are needed for future development. In such
a competitive, market-driven, customer centered economy, it will also help to get
feedback from the customers as to what they think your strengths and failings are.
The next step would be to focus on the content of the program. The program
should be designed and developed keeping both the trainees (their ability level,
personality and motivation) as well as their jobs in mind. Improvement not only
of their knowledge pertaining to their jobs should be developed, but also their soft
skills, as well as their attitude. Each and every employee must benefit, otherwise it
is de-motivating for the rest to say the least. Selecting the right trainees is important
to the success of the program. Specific goals and objectives should be set and all
must work towards their achievement. These goals must relate to the needs that
emerged from the assessment process. Objectives should clearly outline the specific
behavior or skill that will be the focus of the training program. This specificity helps
evaluate the training program and also motivate the employees. Allowing employees
to participate in setting goals increases the probability of success.
Effective training and development includes using sound principles of
performance management and good, basic training techniques. A basic systematic
approach is (managementhelp.org):
1. Analyze the organization’s needs and identify training goals which, when
reached, will equip the learners with knowledge and skills to meet the
organization’s needs. Usually this phase also includes identifying when
training should occur and who should attend as learners.
2. Design a training system that learners and trainers can implement to meet
the learning goals; typically includes identifying learning objectives (which
 Modern Trends in the Field of Counseling 371

culminate in reaching the learning goals), needed facilities, necessary

funding, course content, lessons and sequence of lessons.
3. Develop a training “package” of resources and materials, including, e.g.,
developing audio-visuals, graphics, manuals, etc.
4. Implement the training package, including delivering the training, support
group feedback, clarifying training materials, administering tests and
conducting the final evaluation. This phase can include administrative
activities, such as copying, scheduling facilities, taking attendance data,
billing learners, etc.
5. Evaluate training, including before, during and after implementation of
training.
There are basically two types of training programs (bizmove.com):
On-the-job training is delivered to employees while they perform their regular
jobs. On-the-job techniques include orientations, job instruction training,
apprenticeships, internships and assistantships, job rotation and coaching. A
timetable should be established with periodic evaluations to inform employees
about their progress.
Off-the-job techniques include lectures, special study, films, television conferences
or discussions, case studies, role playing, simulation, programmed instruction and
laboratory training.
Success of the training program decides the future of such execises. There are a
few steps that the trainer can do to ensure that (humanresources.about.com):
Provide information for the employee about exactly what the training session will
involve, prior to the training. This tells the participant what they can expect and
reduces anxiety pertaining to it.
Make clear to the participant that the training is their responsibility and she/he
needs to take the employee training seriously. Only then will she/he apply themselves
to program fully, before, during and after the program. This includes completing
pre-training assignments, actively participating in the sessions, and applying new
ideas and skills that have been learnt upon returning to work.
Preparing pretraining assignments in the form of reading materials or activities
or self-assessments is an important part of any training program development. This
saves time for interaction and new information.
Start the training from upper levels of management and proceed to the lower
levels. They need to have learnt the skills and gone through the program in i-order
to understand where their juniors are coming from after they back from the training
program. This helps to maintain the learnings and proceed from there. This also
helps as the supervisor will model the appropriate behavior and learning, provide
an environment in which the employee can apply the training, and create the clear
expectation that she expects to see different behavior or thinking as a result of the
training.
372 Counseling: Theory, Skills and Practice

It will help if the supervisors who have undergone the training meet with the
would-be participants prior to the training session, iscuss any concerns he may
have about applying the training in the work environment and determine what key
learning points are important for the organization in return for the investment of his
time in the training. After the training session a meeting can be held to discuss the
learnings and their application. It helps to identify any obstacles the employee may
expect to experience as he transfers the training to the workplace. This will make the
training very practical and context based.

CONVERGENCE OF APPROACHES AND THINKING

Many counselors, clinical psychologists, and management trainers have gone

into consulting and coaching taking with them their understandings, skill sets,
and professional norms. New models of coaching have been constructed on the
proposition that coaching is an amalgam of these different disciplines (pbcoaching.
com).
In Greene and Grants’ Solution Focused Coaching (2003), we find a model that
incorporates counseling, consulting, training, and mentoring (from ww.pbcoaching.
com):

This model developed out of the Solution Focused Brief Therapy model of
counseling. Solution focused brief therapy (SFBT), often referred to as simply
‘solution focused therapy’ or ‘brief therapy’ which focuses on what clients want
to achieve through therapy rather than on the problem(s) that made them to seek
help. The approach does not focus on the past, but instead, focuses on the present
and future. The counselor invites the client to envision their preferred future and
then both the therapist and client start focusing on the skills and behavior needed
to achieve that (wikipedia.org).
Another recent book on leadership development coaching by West and Milan,
2001 is premised on the view that the development coach draws primarily on two
 Modern Trends in the Field of Counseling 373

related disciplines—consulting and counseling—and synthesizes these into his or

her practice. Their model, which they refer to as a “marriage of two disciplines,”
looks like this: (from ww.pbcoaching.com).

Hersey and Blanchard(1985) developed the Situational Leadership theory. This

theory again draws from counseling, coaching, consulting and training to facilitate
growth, both personal as well as professional in the individual. The fundamental
concept of the Situational Leadership Theory is that there is no single “best” style of
leadership. Effective leadership is task-relevant and that the most successful leaders
are those that adapt their leadership style to the maturity of the individual or group
they are attempting to lead/influence. That effective leadership varies, not only with
the person or group that is being influenced, but it will also depend on the task, job
or function that needs to be accomplished.
They characterized leadership/mentoring style in terms of the amount of task
behavior and relationship behavior that the leader provides to their followers which
differ from each other in terms of the amount of supportive and directive behavior
each encompasses:
Hersey and Blanchard characterized leadership style in terms of the amount of
task behavior and relationship behavior that the leader provides to their followers.
They categorized all leadership styles into four behavior types, which they named
S1 to S4:
1. S1: Telling is characterized by one-way communication in which the leader
defines the roles of the individual or group and provides the what, how,
why,when, and where to do the task.
2. S2: Selling is that at the same time that the leader is still providing the
direction, he is now using two-way communication and providing the
socio-emotional support that will allow the individual or group being
influenced to buy into the process.
3. S3: Participating is now shared decision making about aspects of how the
task is accomplished and the leader is providing less task behaviors while
maintaining a high relationship behavior.
374 Counseling: Theory, Skills and Practice

4. S4: Delegating is where the leader is still involved in decisions; however,

the process and responsibility has been passed to the individual or group.
The leader stays involved to monitor progress.
The Hersey-Blanchard Situational Leadership Theory identified four levels of
Maturity M1 through M4:
1. M1: They generally lack the specific skills required for the job in hand
and are unable and unwilling to do or to take responsibility for this job or
task.
2. M2: They are still unable to take on responsibility for the task being done;
however, they are willing to work at the task.
3. M3: They are experienced and able to do the task but lack the confidence
to take on responsibility.
4. M4: They are experienced in the task, and comfortable with their own
ability to do it well. They are able and willing to not only do the task, but
to take responsibility for the task.
According to Ken Blanchard, “Four combinations of competence and
commitment make up what we call ‘development level.’” (Blanchard, Zigarmi, and
Zigarmi, 1985).
1. D4: High competence and high commitment
2. D3: Moderate to high competence and variable commitment
3. D2: Some to low competence and low commitment
4. D1: Low competence and high commitment
In order to make an effective cycle, a leader needs to motivate followers
properly.
(see http://en.wikipedia.org/wiki/Situational_leadership_theory#cite_ref-0 for
more details). At each level the individual being mentored needs a different
monitoring style to maximize growth (careerdevelopmentplan.net). The mentoring
process can be regarded as the growth of the individual being mentored and his self-
concept through goal-directed behavior. The mentee is guided from one goal to a
more complex one). The sense of achievement leads to the enhancement of a sense
of self-worth. After achieving the goal, it is vital that the mentor assists the individual
being mentored to reflect on the achievement. Through reflection (which implies
honest feedback) self-analysis, and self-evaluation, growth of the self-concept of the
individual being mentored is facilitated (Career Expert, 2005).
 Modern Trends in the Field of Counseling 375

STRESS RELEASE SCENARIO IN INDIA TODAY

India is in a very interesting place right now, in terms of its culture, values, and
integration with Western society. Indian people are now working longer and harder
than they have ever done, and facing unprecedented levels of challenges and stresses.
It is absolutely and perfectly placed to embrace coaching and all that coaching can
offer. As India is such a family-based society, Indians could really take coaching to
their hearts and embrace it fully.
In India, there are many retreats budding on the outskirts of big cities and
towns providing design, aesthetics, and service and comfort levels, modeled after
exclusive and luxurious small hotels. They have a small number of rooms spread
across different plantations, gardens, and fields where a few people are unobtrusively
tended to as they go about their daily agendas in complete privacy and quiet.
These are places where one can come in touch with the rich and vibrant Indian
spiritual tradition that encourages one to search for meaning and purpose of their
existence by looking into the depths of their souls. Numerous processes derived
from the tradition of Yoga and a range of self discovery modules allows guests to
truly recharge their body and mind energies and set about resetting their priorities
and goals. This is all provided in a private, serene, and spiritual environment
(shreyasretreat.com).
In the Indian tradition, all-round excellence is the manifestation, which is the
purpose for which our lives have been given to us. This is inherent within us and is
to be achieved through harnessing, refining, and purifying our body/mind energies
and spiritualizing our actions and emotions, thereby allowing the divine qualities
376 Counseling: Theory, Skills and Practice

within to shine forth. The retreat centers help to achieve this by catalyzing the
thinking process with inputs from the Indian spiritual tradition.
Apart from these retreat centers, there are many ashrams, or spiritual retreat
centers, which have existed for a long time, run by various trusts, and cater to
spiritual aspirants from various fields. These people get authentic spiritual guidance
in these ashrams. Of late more and more people seem to be flocking to these retreat
centers, which run various camps and workshops. With the stresses attributed to
technological advances and the resultant mechanized lifestyles, people’s thirst for
self-knowledge and self discovery is increasing by leaps and bounds.

What is the “Journey of Self-Discovery”?

As we have seen earlier in the Indian tradition, life is considered to be a journey of
experiences that leads us to discover the excellence inherent within us. People are
nowadays looking to spend some time reflecting and connecting with their inner
core, and the retreat centers provide a sacred space and structure their stay with
dedicated yoga classes, rejuvenation, and relaxing massages, light, but wholesome
vegetarian food, guided meditation sessions, mouna (silence) and karma yoga
(working with a selfless attitude) hours, and scriptural classes.
Yoga classes are based on classical hatha yoga and are combined with Pranayama
(breathing related) and pratyahara (internalization) processes drawn from the Yoga
sutras, an ancient yogic doctrine that aims to integrate our body, mind, heart, and
souls for complete living. The programs and yoga classes are dedicated to applying
the wisdom of the Vedas and Indian spiritual tradition to enrich the professional and
personal lives the people.
Some retreat centers also include nature-based activities that one can experience,
for example, the opportunity to spend time in the herbal and agricultural fields.
This seems to be an immensely therapeutic experience in itself, with their stresses
disappearing as they were working in the fields.

How do These Activities Help?

From a spiritual perspective, it can be said that the laws governing external nature are
identical to the laws governing our psychophysical personalities. Through observing
nature and mindfully participating gardening or farming activities, one can learn a
lot about the self.
Another significant therapeutic experience that these retreat centers provide the
guests is an opportunity to participate in many community-based activities organized
by them like serving meals to village school children, renovating the village school
or other essential structures, reading to the villagers or organizing recreational
programs for the villagers. This gives them the chance to interact and experience
 Modern Trends in the Field of Counseling 377

the real India. This exercise, which is known as “Seva” or service, is the chemistry
needed to transform negative emotions such as arrogance into humility, sympathy
and indifference into empathy and compassion, and anger into love. Vedanta says
that qualities such as empathy and a genuine desire to give––for the sake of giving
and not for the sake of personal aggrandizement is superimposed by the layers of
our selfish ego personality that is readily seen. This personality needs to be harnessed
and employed in our daily work and personal life. and seva helps us do that. ‘Seva is
an effective medium through which the self can encompass and accommodate the whole
world’. The capacity to give without hesitation is accomplishment; and the way to
accomplishment is deliberate will-based giving. Daanam, giving and sharing is a
mark of growth. (Swami Dayananda Saraswati).
Nature walks and agricultural and medicinal herb gardens farming provide the
necessary physical stress relief. Yoga classes, wellness, and “stress management”
modules, regular yoga retreats where individuals can learn from the physical,
physiological, and therapeutic benefits of a simple yoga practice, stress management
packages, and retreats for psychosomatic ailments like asthma, high blood pressure,
back, neck, and hand pain, etc., seem to be the order of the day in these places.
Meals served are vegetarian, and thoughtfully planned to complement the lifestyle
one will be experiencing at the retreats.
According to yoga, almost all psychosomatic disorders are caused by “stress,”
an inability of the body/mind system to cope with the demands made on it both
professionally and in personal life. While western medicine and psychiatry deals
with stressthrough medicine that induces the release of “feel good” hormones, this
does not eliminate the problem.
Vedanta says that the root cause of stress lies in our inability to see the world as
one unbroken stream of consciousness flowing through everything and everyone.
This is maya or illusion, this mistaking ourselves as being separate from the world.
Thus we compete with the world for our happiness and that leads to a lot of stress.
Yoga is referred to as a holistic healing science as it encourages us to deal with stress
at the physical (with proper diet and asanas [physical postures]), physiological (with
pranayama [breathing practices]), mental and intellectual level (with meditation)
India undoubtedly is the World capital of Yoga. Besides, a rich and diversified
culture much of Indian life is simple and inspired by yogic principles. Yoga holidays
in India are especially desirable as many of them are built around authentic yoga
instructions. Many retreat centers offer massages, which are designed to remove
knots of stress out of the muscles. Yogic practices, such as yoga nidra or deep yogic
sleep practices to tackle insomnia, light meals at night, avoiding intoxicants and
meditation, various yoga postures that help stretch, relax and strengthen the spine
as well breathing and meditation practices to alleviate back pain are just some of the
relief that one can expect from the retreat centers.
378 Counseling: Theory, Skills and Practice

Thus, the Indian tradition provides the individual with the opportunity to grow
and develop healthily, not only physically, physiologically, but socially, emotionally
as well as spiritually. It takes care of all aspects of the human being in order that we
live a happy, fruitful and contented life.

v Summary v
Many Indians know about counseling as an intervention field but now
the whole approach to counseling is changing into mentoring, coaching,
training, consulting, etc., as the postmodern generation emerges. Coaching
is a recent phenomenon and gaining in popularity. Both coaching and
therapy have the same roots. Coaching evolved from three main streams
that have flowed together: 1) Psychotherapy and counseling. 2) Business
consulting and organizational development. 3) Personal development
training. In addition it draws from disciplines such as sociology, psychology,
positive adult development, career counseling, mentoring and other
types of counseling, also sharing similarities with other disciplines, such as
organizational consulting, management development, and training. It works
on the philosophy that people limit themselves and cap their potential due
self-defeating beliefs and patterns.
Mentoring is the process by which an experienced person provides
advice, support, and encouragement to a less experienced person. A
mentor is a teacher or advisor who leads through guidance and example. A
mentor provides guidance, wisdom, knowledge, and support in a manner
in which a protégé can receive it and benefit from it. It is a life educational
model based on the principle of a more experienced mentor guiding his or
her student, often called a protege or mentee. The concept of mentoring
can be traced back to the ancient Indian gurukula (learning from the master
(guru) by staying with him for several years) system. The need and utility of
a mentor is now recognized more and more at all places, especially in the
educational institutions and the corporate organizations. It the job of the
mentor to help the mentee to believe in the self and boost confidence. To
this end the mentor generally asks questions and challenges the mentee,
while providing guidance and encouragement.
A consultant is a professional who provides advice in a particular area
of expertise like law, management, medicine, etc. the consultant is usually
an expert in the field with a wide knowledge of the subject matter. This
consultant provides advice to clients, may be individuals or companies, in a
particular field or specialty.
The term training refers to the acquisition of knowledge, skills, and
competencies as a result of the teaching of vocational or practical skills
and knowledge that relate to specific useful competencies the trend today
 Modern Trends in the Field of Counseling 379

is to continue the training beyond that, to maintain, upgrade, and update

the knowledge and skills throughout their working life. The training design
starts with elucidating the organizational objectives. Then the department
conducts a needs assessment survey in order to find out what both the
employees as well as the employer need to be done in order to increase
efficiency. Goals for the organization as well as individual employees must
be charted out both long term as well as short term goals.
Many counselors, clinical psychologists, and management trainers have
gone into consulting and coaching taking with them their understandings,
skill sets, and professional norms. New models of coaching have been
constructed on the proposition that coaching is an amalgam of these
different disciplines.
India is in a very interesting place right now, in terms of its culture, values,
and integration with Western society. Indian people are now working
longer and harder than they have ever done, and facing unprecedented
levels of challenges and stresses. It is absolutely and perfectly placed to
embrace coaching and all that coaching can offer. In India, there are many
retreats budding on the outskirts of big cities and towns providing design,
aesthetics, and service and comfort levels, modeled after exclusive and
luxurious small hotels. Apart from these retreat centers, there are many
ashrams, or spiritual retreat centers, which have existed for a long time, run
by various trusts, and cater to spiritual aspirants from various fields. These
people get authentic spiritual guidance in these ashrams.

References
Bluckert, Peter @ http://www.pbcoaching.com/article-coaching-and-therapy.php
http://www.inbalance.org.uk/ShowService.asp?ServiceID=44
Brain, Sharon @ http://www.julietaustin.com/article-coaching-counseling.html
Grant, A.M. 2006. A personal perspective on professional coaching and the development of
coaching psychology. International Coaching Psychology Review, 1(1), 12-22.
Society of Counseling Psychology. About counseling psychologists. Retrieved from http://www.
div17.org/students_defining.html.
http://www.brefigroup.co.uk/coaching/coaching_and_mentoring.html.
www.mentorset.org.uk/pages/mentoring.htm.
Bob Aubrey and Paul Cohen. 1995. Working Wisdom: Timeless Skills and Vanguard Strategies
for Learning Organizations Jossey Bass, page 23.
David Megginson and David Clutterbuck. 2005. Techniques for coaching and mentoring.
Elsevier Butterworth-Heinemann.
Williams, Patrick. 2007. The Potential Perils of Personal Issues in Coaching The Continuing
Debate: Therapy or Coaching? What Every Coach MUST Know! The International
Journal of Coaching in Organizations. @ http://psychology.wikia.com/wiki/Life_
coaching#cite_note-0.
380 Counseling: Theory, Skills and Practice

Sally Anne Law @ http://www.sallyannlaw-lifecoach.co.uk/Guide/Difference.htm.

http://www.wisegeek.com/what-is-a-mentor.htm.
McKinley, Someone Hand Me The Screwdriver - Understanding the differences between
consulting, counseling, & coaching @ www.mckinleyconsultinggroup.com.
http://managementconsulted.com/consulting-jobs/management-consulting-and-the-consulting-
industry-101/
http://en.wikipedia.org/wiki/Training
http://www.bizmove.com/personnel/m4d.htm.
http://managementhelp.org/trng_dev/basics/isd.htm
http://humanresources.about.com/od/trainingtransfer/a/training_work_2.htm
http://www.pbcoaching.com/article-coaching-and-therapy.php
http://en.wikipedia.org/wiki/Solution_focused_brief_therapy
Dembkowski, S. and Eldridge, F. 2003. Beyond GROW: A new coaching model. The International
Journal of Mentoring and Coaching, 1, 1, Nov.
D’Zurilla, T. J. 1986. Problem-solving therapy: a social competence approach to clinical
intervention. New York: Springer.
D’Zurilla, T. J., and Goldfried, M. R. 1971. Problem solving and behavior modification. Journal
of Abnormal Psychology, 78, 107-126.
D’Zurilla, T.J. and Nezu, A. 1999. Problem-Solving Therapy. 2nd ed. New York: Springer.
Edgerton, N. and Palmer, S. 2005. SPACE: A psychological model for use within cognitive
behavioural coaching, therapy and stress management. The Coaching Psychologist, 1,
2, 25-31.
Ellis, A., Gordon, J., Neenan, M. and Palmer, S. 1997. Stress Counselling: A Rational Emotive
Behaviour Approach. London.
Cassell Greene, J. and Grant, A. M. 2003. Solution-focused coaching. Harlow, UK: Pearson
Education.
Jackson, P.Z. and McKergow, M. 2007. (2nd Edition). The solutions focus: Making coaching
and change SIMPLE. London: Nicholas Brealey.
Libri, V. 2004. Beyond GROW: In search of acronyms and coaching models. The International
Journal of Mentoring and Coaching, II, 1, July.
Neenan, M. and Palmer, S. 2001 a. Cognitive Behavioural Coaching. Stress News, 13, 3, 15-18.
Neenan, M. and Palmer, S. 2001 b. Rational Emotive Behaviour Coaching. Rational Emotive
Behaviour Therapist. 9, 1, 34-41.
O’Connell, B. 2003. Introduction to the solution-focused approach. In B. O’Connell and S.
Palmer (eds) Handbook of Solution-Focused Therapy. London: Sage.
O’Connell, B. and Palmer, S. 2007. Solution-focused coaching. In S. Palmer and A. Whybrow
(eds), Handbook of Coaching Psychology: A Guide for Practitioners. London:
Routledge.
Palmer, S. and Burton, T. 1996. Dealing with People Problems at Work. Maidenhead: McGraw-
Hill.
Palmer, S. 1997 a. Problem focused stress counselling and stress management: an intrinsically
brief integrative approach. Part 1. Stress News, 9, 2, 7-12.
Palmer, S. 1997 b. Problem focused stress counselling and stress management training: an
intrinsically brief integrative approach. Part 2. Stress News, 9, 3, 6-10.
Palmer, S. 2002. Cognitive and organisational models of stress that are suitable for use within
workplace stress management/prevention coaching, training and counselling settings.
The Rational Emotive Behaviour Therapist, 10, 1, 15- 21.Palmer, S. (2007 a). Cognitive coaching
in the business world. Invited inaugural lecture of the Swedish Centre of Work Based
Learning held in Gothenburg on 8th February. 2007.
 Modern Trends in the Field of Counseling 381

Palmer, S. 2007 b. PRACTICE: A model suitable for coaching, counselling, psychotherapy and
stress management. The Coaching Psychologist, 3, 2, 71-77. Article can be downloaded
from: http://www.bps.org.uk/coachingpsy/publications/the-coaching-psychologist/
tcp—vol-3—issue-2— aug-07$.cfm
Palmer, S. and Szymanska, K. 2007. Cognitive behavioural coaching: an integrative approach.
In S. Palmer and A. Whybrow (eds), Handbook of Coaching Psychology: A Guide for
Practitioners. London: Routledge.
Palmer, S., Grant, A. and O’Connell, B. 2007. Solution-focused Coaching: Lost and Found.
Coaching at Work, 2, 4, 22-29.
Wasik, B. 1984. Teaching parents effective problem-solving : A Handbook for professionals.
Unpublished manuscript. Chapel Hill: University of North Carolina.
Whitmore, J. 1996. Coaching for performance. (2nd Edition). London: Nicholas Brealey
Publishing.
Whitmore, J. 2004. Coaching for performance: Growing people, performance and purpose. (3rd
Edition.). London: Nicholas Brealey Publishing.
http://www.pbcoaching.com/articles/article-coaching-and-therapy.pdf
L. West and M. Milan, ‘The Reflecting Glass - Professional Coaching for Leadership’. 2001.
Hersey, P. 1985. The Situational Leader. New York, NY: Warner Books.
Blanchard, Kenneth H., Patricia Zigarmi, and Drea Zigarmi. Leadership and the One Minute
Manager: Increasing Effectiveness through Situational Leadership. New York: Morrow,
1985. Print.
http://www.careerdevelopmentplan.net/WT_Chapter8_d_Mentoring_Couching_Councelling.
html).
Career Expert. 2005. Mentoring, Coaching, Counseling @www.careerdevelopmentplan.net/
wt_chapter8_d_mentoring_couching_councelling.html.
www.shreyasretreat.com/Shreyasfaqs1.htm.
 Case Studies

Hypothetical Case Examples for Which a Counselor’s

Intervention May be Sought
1. A couple is constantly bickering and expressing anger towards each other.
The least comment is taken as an insult or an allusion to the other’s
failures. In the presence of others, their behaviour is definitely better, but
they cannot get along with each other.
2. A man suddenly experiences a series of negative events. He loses his job,
his wife and children leave him, and he is diagnosed having cancer. He
starts to feel crushed, and depressed.
3. A 20 year old male who is brought by his mother for evaluation. According
to her, he had been very agitated for the past few hours. She suspects he
is using drugs. She also states that his behaviour has changed over the last
four months; he is frequently absent from home and has been taking money
from her wallet.
4. A couple lost their three-year-old child due to leukemia approximately one
year ago. The mother still does not seem to be able to cope with everyday
living. Either she is crying all day … or too tired to do anything … She is
not interested in anything that had earlier given her happiness.
5. A nine-year-old boy says he has these difficulties:
(a) Not enough time to copy from the board
(b) When the teacher checks his work she finds lots of mistakes
(c) He is not able to read cursive writing
(d) He can’t see the words on the whiteboard. They move around and
sometimes he sees two words the same.
384 Counseling: Theory, Skills and Practice

Case-1: Couples Counseling

Anand and Sangeetha had been seeing each other since their third year of
undergraduation. During the final year they had decided to put off getting married
until they were both settled in a job. They both then went on to do their post
graduation in different places and then found themselves a job in Chennai. They
were very confident of their relationship as it had survived their separation during
their post graduate years. They had maintained a long good distance relationship.
Finally Sangeetha’s parents started to ask her to get married. There was no objection
from either family even though they belonged to different communities. All went
well. They got married and once the honeymoon phase was over and the routine of
life started a few irritations started to erupt.
They were both IT professionals and the odd working hours, the stress of
maintaining a functioning home, the lack of time with each other, the expectations
from their parents-in-law, all added up until both were either fighting everyday or
would maintain an angry silence in each other’s company. The recession also had
an impact on their sense of internal security. Both of them had to deal with some
pretty complicated feelings.
One day Sangeetha announced that it was not working and she wanted to move
out of the relationship. Anand was not totally surprised at this. But he did not want
to give up. He tried to talk her out of it, argued with her, insisted that they take a
holiday to rekindle the fire… but that only made Sangeetha more angry. She felt
that Anand was not listening to her and was behaving like he was the good one
trying to save the marriage and she was the bad one wanting to break it.
However as luck may have it, a close friend (one who was trusted by both of
them) suggested counseling. When I saw them first I wondered what they hoped
to get from the sessions. They seemed to have two very different goals in coming to
see me. I needed to understand more about each of their personal goals in coming
to see me.
As is wont I spoke to each of them personally. I found out that I was right.
Whereas Anand wanted to save the marriage at all cost, Sangeetha had lost the will
to do it. I also noticed that Anand was not as stressed as Sangeetha. We needed to
explore that. A couple of sessions with Sangeetha brought out all her frustrations with
Anand as a husband … how different he was from Anand the boyfriend. Similarly
a couple of sessions revealed the frustration of Anand’s expectations of his wife
vis-à-vis his girlfriend. This had led to the complete breakdown of communication
between the two.
At this point, my job had been defined. They needed to understand that they
still loved each other and should find ways to express that. They needed to rekindle
their commitment to their relationship as people and then as husband and wife.
 Case Studies 385

They also needed to explore the expectations of each other—how they had changed/
remained the same. They needed to re-script their roles and responsibilities.
However, as I sensed a lack of motivation on Sangeetha’s part to work on her
marriage, I requested her to meet me for a couple of more sessions. Thankfully she
agreed. She then talked about her pressures and stresses and grief in her life. Then she
talked about her married life. How it was different from her years with him before
that. She felt that she had lost her identity. That she was a wife now to Anand, not
Sangeetha. She did not feel special anymore. And that was the crux of it.
When we told Anand all that he just stared at us for a few minutes. He had not
realised it.
In couples counseling, it is usually the case that both partners have a hand in
creating their dynamics. I decided at this point to focus on Anand in order to learn
why Sangeetha might feel this way. Then Sangeetha had to talk about how she had
changed after her marriage. In a couple of more sessions they decided to work on
their expectations and communication pattern.
A follow-up call two months later revealed that both of them felt the relationship
was more secure than it ever had been and felt that our session had been largely
responsible for the change.

Group Counseling (Cognitive Therapy)

This group counseling involved eight sessions, which lasted for two hours for each
session.

Session 1: During this session the focus was on preparing the right environment
for group counseling. Attitudes such as empathy, warmth and respect were discussed
as being very important to conditions for worth. Relationship building was stressed
upon as the key to make progress. The family background of each was discussed
both individually and in the group. A couple of activities on emotions and their role
in our lives served to ease the tension due to unfamiliarity in the group.

Session 2: This session was focused on Psycho-education. The role played by

one’s view of reality, worldview and perception on emotions and decision-making
was discussed. The significance of objectivity was brought out.

Session 3: The five Laws of Living (explained in Chapter VII) were explained in
detail.

Session 4 and 5: These sessions were the intervention phases. During these ses-
sions, the group members were encouraged to talk about their personal experiences
or problems. The members then deduced alternate ways to perceive their situation
386 Counseling: Theory, Skills and Practice

(using the five Laws) were elicited. The members were guided to understand the
subjective nature of their perceptions. They looked at various episodes in their lives
where their perceptions led to the problems they were experiencing. This helped
them to have an objective insight into their personal experiences in their respec-
tive environment. They were able to assess things/situations/events that led to their
problems. These were pretty emotional sessions.

Session 6 and 7: The sixth and seventh sessions were the goal setting phases.
These focused on action plans and support strategies. The group members were
guided to develop a more optimistic attitude and have realistic visions and objectives
for the future in short, medium and long term.

Session 8: This was the termination session. Closure exercises were done. Feed-
back was collected. As this was a short time group it was taken care to see that the
members did not become too dependent on each other.
A follow up telephone call and email was sent at three and six months to find out
how their therapy learnings were holding up.

Case-2: Psycho-Spiritual Counseling

When Shravan Ahuja was admitted to the hospital with pancreatic cancer, he was
quite alone. He had all of his close family members and a few friends visit him
everyday. However, with every passing day he became more and more reticent. He
would keep to himself, not respond to the visitors and even withdrew from his wife
and daughter who were there the whole time attending on him. He seemed to have
isolated himself from those around him after his diagnosis.
Daily visits of the counselor was not helping or leading anywhere. He would
sit in silence the whole time that she was there. The few questions asked by the
counselor would be met with monosyllabic or gestural responses. There would be
no interaction at all. This happened for a few days … until one day…
Shravan was not particularly a religious person. However an unexpected visit from
his wife’s spiritual Guru proved enjoyable and helpful for him. Their conversations
helped him understand the significance of religion and spirituality in all our lives.
He acknowledged his relationship with God and began to realise the connection
between relating to God and relating to others. He cried a lot … something that he
had not done since the diagnosis.
The next day when the counselor came in, he greeted her with a smile. He
voluntarily talked about his fears and trepidations. They discussed end of life issues,
organ donation and DNR (do not resuscitate). He was helped to make plans for his
 Case Studies 387

daughter’s wedding as well as his wife’s sustenance after his death. He also worked
on some regrets and restitutions (karma, prarabdha and parihara) leading to inner
healing and the healing of some broken relationships. Along with the cognitive
course of therapy the importance of prayer was stressed. He had never prayed
before. The reciting of Hanuman Chalisa and the Vishnu Sahasranamam brought
him a lot of comfort and assurance. All this helped in his journey toward spiritual
reconciliation. He was then at peace.
He then wanted to go home. He did not want to die in the hospital. The
counselor liaised with his attending physician and he was discharged. On that day
he declared to the counselor, “Now madam, I am ready to die. Please help my family
get through this tough time. Make them as unafraid as I am!”

Case-3: A Case of School Refusal

Anagha was referred to the counselor by her school authorities. It was a month
since school had reopened and the child was still having trouble coming to school.
Everyday she would come in late. So the matter was referred to the principal and the
child’s parents were asked to meet with the school counselor.
Anagha was an only child. During the first session she proved to be a very
cheerful little girl, very warm and affectionate even towards strangers. She had no
trouble talking to the counselor freely. She talked about how much she liked school
and how much she liked her class teacher. But when it came to talking about her
to refusing to go to school every morning, she prevaricated and tried to change the
topic. When her mother tried to get her to talk confronting her with some details
she shut up and refused to talk. But to get her to talk again did not take much time.
As long as her school refusal was not talked about she was okay.
Anagha’s mother was visibly disturbed. She talked quite a lot about how she was
scared that her daughter would never attend school. She was also feeling guilty,
being the only parent taking care of her. Her father was a software engineer who
worked away in the UK. The mother and daughter lived with her grandfather in
Chennai. She said that her husband was quite participative even though he was
quite far away. He did not hold his wife responsible but she did feel that way.
Anagha had been toilet trained by the time she was one-and-a-half years old. But
then she started bed-wetting three months after she started going to the previous
school. She would have nightmares and wake up crying. She would insist on sleeping
very close to her mother. Even if her mother turned the other way, she would wake
up and then insist on her mother’s turning towards her.
From the time Anagha woke up she would dawdle and cry, repeating over and
over again there she did not want to go to school . Her mother had tried everything
388 Counseling: Theory, Skills and Practice

from scolding to bribing to actually accompanying her child to school. This was a
new school that Anagha was attending. It was because of the school refusal problem
in the last school that they had actually changed schools this year. Now it was a
month into this academic year in the school and the child was still refusing to go
to school.
Anagha’s grandfather was very supportive. He was not at all worried. He felt that
there was no serious problem and that this situation would get better with time.
He felt that his daughter worried unnecessarily and that the teachers at school were
making too big an issue out of this. He was a homeopathic physician who had seen
many children in his time. He had prescribed his granddaughter some medication,
which would make her less nervous before she went to school.
Interview with the child, her mother and her grandfather revealed that Anagha’s
previous school experience had a lot to do with her present condition. The child was
a naturally talkative girl, and so would catch her teacher’s attention all the time. She
had been punished quite a few times. The punishments, which started off mildly
with impositions and standing up or even standing out of class, started becoming
more and more harsh. The teacher would send her out and ask her to kneel on the
ground under the hot sun. Sometimes a teacher would ask her to hold out her hand
and beat her palm with the end of scale. She also got beaten on her knuckles. Thus
the normally and naturally bright and cheerful child started going more and more
into her shell. She would come home crying. And then she started refusing to go to
school.
The mother and the grandfather did go to school to find out what was happening.
The teachers elaborately explained the child’s condition and defended their actions.
A talk with the principal also got them nowhere. Thus by February they obtained
a transfer certificate from the school and the decided to put her in a well reputed
high-end school.
The present school had less number of students. The teacher-student ratio was
low. Each child got personal attention. The teachers were quite co-operative and
friendly. The principal took personal care in the Anagha’s case, as she had seen her
outside school during a party. She had seen that the child was actually very bright
and cheerful. The stark difference between the reports she got from the teachers,
and the affable child in front of her made her think seriously. That was when she
called the mother and referred her to a counselor.
During the first session Anagha was given a paper and pencil and asked to draw
her classroom. She drew the picture of children sitting down and books open. The
teacher was standing with her back to the black board facing the children. What
caught the counselor’s attention was a very large stick in her hand. When asked
about it the child did not respond. Though she talked 19 to the dozen about her
 Case Studies 389

classmates and friends and books, she refused to talk about the stick. The teacher
had no hair unlike the children. When asked about that the child responded with
“I don’t know”.
On the other hand she talked very fondly about her family. Father, mother,
grandfather, uncles, aunts and friends. But even when she was shown the picture of
a little teddy bear taking a bag to school she did not mention school.
When the counselor asked her to write the alphabets and the numbers from 1-50
she obliged readily. Her handwriting was neat and she took pains to see that she was
doing a good job. And she seemed to enjoy writing. But when her mother handed
over her schoolbooks, surprisingly there were very untidy, filled with shabby work.
Many of the pages were torn, and many assignments were marked incomplete,
untidy, poor work etc.
Again when Anagha was confronted about this, and shown the contrasting works,
she did not respond. When asked if she liked her school books, she just shrugged.
Then she left the room and refused to come back.
This was a classic case of school refusal by a child who was terrified of going to
school. Negative and unpleasant experiences in her previous score had rendered her
very anxious and afraid of school and if anything to do with school. Though she was
going to a different school this year, her memories of her last school superimposed
on her present experiences. She was carrying over her, thoughts and emotions about
her previous school to the present.
It had become something of her self-fulfilling prophecy. She was afraid of her
teachers. She would not do her work well. Her teachers would scold her. She would
be afraid of them all over again.

Counseling Sessions with the Child

The child came in with her mother and grandfather for about five to six sessions.
She would come in to the room happy and cheerful. She would be given some
paper, crayons, pencil and eraser. She would then sit and draw, or write her school
works, as she sang the different rhymes and poetry that she was taught in school. She
would even complete her school assignments without help from her mother. Thus
she was actually being desensitised slowly to her fear of books and school material.
During the third session she happily told the counselor that she had packed her
own bag. And by the fourth session she had started going to school without any
apprehensions. At the end of her sixth session it was decided that the child no longer
needed the counselor’s help. She was going to school very happily now. She was
making friends. And she even got elected the group leader.
390 Counseling: Theory, Skills and Practice

Counseling Sessions with the Mother

Counseling was done more with the mother with the child. The mother needed help
handling the child. The counselor had to give the mother a strategy. The mother
had to follow it and if needed, seek the help of her class teacher too.

Verbatim of the Counselor’s Instructions to the Mother

I understand that this is such a difficult situation. But changing schools often is not a
good option. Let us work together to find the best way of coping with the situation.
It is important to see that we all face uncomfortable, unhappy distressing things
in life. Learning to cope with them effectively builds resilience. Most importantly,
children when they are ably supported and can acquire the skills to cope, they can
prevent this happening again. Avoidance for safety is always an option; but you have
already tried that by moving schools. So we now need to focus on enabling her to
feel safe at this school, especially as she seems to have a very supportive principal.
However, before you give attention to my suggestions that follow there is
something you should address. How anxious are you about her emotional safety?
The answer to this question should guide you to determine whether or not you
are unwittingly and unconsciously contributing to his refusal to go to school.
Children many times pick up their mother’s emotions and automatically play to
it, also unconsciously. If this might be an issue, you will need to work on that. The
more upset you are the more anxious you get, Anagha is going to pick it up and
respond to that. So if I were you I would try to relax and calm down first. This will
automatically bring down the level of stress for your daughter.
Ok, with that out of the way:
She needs to understand that she has no options as far as going to school is
concerned. Going to this school. And you need it to work for her. Both you, your
husband and your father need to make her feel safe and happy about going to school.
We can work with her so that she also thinks about what she can do to make school
work for her. It is her problem and she does not need you to take over but to support
her and enable her to cope.
The first step is not to talk but just listen to her. This requires great self control
(coping with your own feelings), and skill. The key is for her to feel she can talk with
you about how she feels and what is happening in her young life.
You make it into a story. What you do is tell her you are going to write / tell a
story (your aim is for her to fill in the gaps). Create a special time to have together.
Little by little every day you try to elicit her feelings and thoughts
 Case Studies 391

Example
I have a story to tell you ... about a young girl (give her a name) who ... and you
describe her, first as baby, then as a little girl and her first days at pre-school/
kindergarten, school, etc. Then go on to all the important stages, times, teachers,
friends, fun times etc. leading into the current year and describe a young girl getting
sad and afraid, ... then, ... as you continue the story ask questions: (never why),
using what, when, where, which, how, who … as appropriate, to prompt her to tell
about how this young girl could have felt in these sad and unhappy times ... and
JUST LISTEN. If you make the girl in the story not her but someone else who she
can feel empathy with, she can then start her sharing her own story and linking it
into the young girl’s story. You’ll have to pitch the level of sophistication of this
approach as appropriate for her.
Do a little every day ... gives her time to think about this girl and what she should
do and add her bits into the story.
It is important that you don’t make the link between your daughter and the girl
in the story, ... let her make that link if she so wishes. Just accept anything she says
here.
Telling this girl’s story (not exactly the same as your daughter’s but similar
enough for her to feel empathy with this young girl), is enabling her to think about
it in safety, without anxiety, and be able to try and help this girl—a bit like having
a puppet friend or a doll, who you talk to; and who isn’t you but experiences what
you do and you can help. In this way you are encouraging her to take steps to correct
the situation, which you can then support. This will also help you to maintain the
self-discipline necessary to allow her to own and deal with the problem herself.
As the story unfolds and the girl faces unhappy situations, you can start asking
questions such as ... What do you think she should do? Who do you think would
help her deal with this or that situation? Slowly enable your child to start looking at
ways of solving this problem. Don’t ever tell her what to do. Just tell the story, ask
questions, get her involved, and you will find what is really happening and how she
is feeling—it will all come through the third person—this other young girl who is
sad and hurting at school.
Your aim is to enable your child to find ways of coping with this situation. She
needs to feel empowered so she isn’t a victim anymore and can learn to deal with
negative feelings about school herself. She has to learn ways to cope, to be able to
say to herself, “I can deal with this!” she needs also to know that at times school can
be tough on a person. A new school is always tough on a kid.
392 Counseling: Theory, Skills and Practice

I suggest you tell her teacher what you are doing—keep her in the loop. She can
do things from her side e.g. for the others in her class not to see her as a possible
victim. She must also enable her ... NOT rescue her, which keeps her in the victim
role. Also she needs to keep an eye on any students who may be victimising or
harassing her and sanction that behaviour behaviour—zero tolerance.
I hope this helps ... you are very upset yourself. That’s okay ... but you need to
manage that so you can support your child and enable her to cope. Everything you
do in this way will hold her in good stead for the rest of her life.
It is important that pediatric counselors realise that they need to teach the
parents/teachers how to handle their children. The counselor is there just to assess
and identify the problem.

Case-4: Counseling the Mother of a

Mentally Retarded Child
This mother was referred to the counselor by a special educator. She had just learnt
that her child was mentally challenged. She was totally broken and angry. She was
depressed to the extent that she would not go near a child. Lalitha came from a
lower middle-class background. She married late at the age of 28. Her husband
worked as a clerk in a private company. This child was their only child.
Her husband and she had been trying to have a child for 4-5 years. Finally at
the age of 33 she had a boy child. She did not have any complications during her
pregnancy. She had a normal delivery. They did not notice that something was
wrong. The child’s delayed milestones were explained by her in-laws as something
quite natural. As they were living in a joint family system she could not entertain her
worries. Whenever she brought up the topic of going to a pediatrician her husband
would consult his mother and they would decide against it. She was quite frustrated
but was quite helpless to do anything.
Finally when her child could not walk even at 18 months they all got quite
anxious. It was then that they decided to consult a pediatrician. The pediatrician
immediately saw that there was something wrong and referred them to a Special
school for assessment.
The child was assessed and declared to be mentally challenged. The family could
not take the news. Slowly they all started blaming Lalitha. She started to become
more and more depressed. And then she started to become very angry with her
child. Slowly she moved away from her child emotionally and physically.
When she came to the counselor she was very defiant and exhibited a lot of
suppressed anger. Initially she would not talk at all. It was three sessions before she
began to talk to the counselor. The first session she came in with her mother-in-law.
 Case Studies 393

The second session she came in with her husband. The third session she came in
with her mother. It was then that she actually began to talk.
She talked about many things. She talked about how difficult it had been for her
to get married. How difficult it had been after she had got married to be in a joint
family. There were so many adjustments that she had had to make. So many insults
she had had to endure before she finally got pregnant. Her pregnancy was a time
that she remembered fondly. Everybody around her kept her happy.
With the birth of her child she thought her worries were finally over. But then
the delay of each and every milestone caused concern to her and her parents. But
as her in-laws were not taking her seriously, she had been helpless to do anything.
Now she feels so guilty that she had not attended to her son earlier. She could have
fought her way. She could have done something. But now she feared that she was
too late. Maybe if she had seen a doctor earlier there could have been something that
was done to rectify the problem.
It was this guilt and anger towards her own self that caused her to move away
from her son. She felt that she had wronged him. Maybe it was something she ate, or
did not eat. Maybe it was because she had intercourse during her pregnancy. Maybe
it was because she did not take enough care of herself. Maybe ….
There were so many maybes that she was torturing herself with. She could not eat
or sleep properly. She had gone into her shell and refused to talk to anyone. All their
insults were hurting her. But most of all she was hurt by her son’s condition.

Counseling
You have just learned that your child is retarded. You have a lot of questions. You
are worried and a little afraid. The most prominent emotion I see is that of guilt.
The best thing you can do to help your child (and yourself, too) is to learn more
about mental retardation. Read about it. Understand the condition. If you did do
anything to contribute then you must make peace with yourself and move on. If you
did not then, you need to stop beating yourself up about it. Now all that needs to
be done is helping your son lead a dignified life.
Sometimes it helps to read about a problem to understand it better. Your doctor
and the other people who evaluated your child can help you find books, magazines
and other information about mental retardation. Some libraries offer videotapes on
this topic. If you have access to a computer, you can find many organizations that
offer information on the Internet.
Talk with other parents. When we talk to others who are going through similar
problems often it helps. We may get ideas about how to help your child learn. Also
if your child has some behaviour problems, they may have useful hints about things
that worked well for them.
394 Counseling: Theory, Skills and Practice

Support groups are rare in our country. However if a few of you parents want
to meet regularly that may be a good idea—a support group of parents in your area
who also have children with special needs. Talk to your family doctor and other
professionals such as nurses, social workers, therapists, teachers and psychologists
who are committed to helping children with special problems and their families.
Don’t be afraid to ask for help or explanations. They may have ideas to share with
you and they may recommend reading materials, videos and other sources for
information and support.
The husband was also educated about the child’s problem. He admitted that his
reaction to the whole situation was unjustified and irrational. It was his mother who
was instigating the animosity towards his wife. He was helpless when it came to
dealing with his mother as he felt this duty to take good care of her. He agreed that
his wife was not at fault and that it was at this time that she needed him to take care
of her. Only then can the two of them take care of their son.
During the session it came to light that their son was in the moderate range on
the IQ scale. He was trainable. The implications were not very bad. Both husband
and wife were relieved. They were more hopeful and less afraid. Also, visits to the
special school helped them see that there were other parents who were in the same
boat as them. After that his attitude towards his wife has changed for the better.
He promised that he would take care of his wife when it came to dealing with his
mother.
Initially the mother-in-law was very resistant to any suggestions. She was totally
heartbroken that her only son’s child was not normal. She did not think that it
was her daughter-in-law’s fault; but could not help getting angry with her. Two
sessions with her failed to see any improvement. After that she refused to even come
to see the counselor. But a few weeks later she came of her own accord to meet the
counselor. It was heartening to see the improvement in her attitude.

Follow up
The counseling sessions are still in operation. It is expected that both the husband
and wife will need long-term therapy. Also they will need the support of the
counselor until they settle into their special school.

Case-5: Bullying in the Workplace

Pragyan is a 35 year old man who was one of two project leaders in a software
company. He had excellent qualifications and 10 years experience as an IT
professional. However, ever since he joined this company, he had been having lots
of personal attacks against him from the other leader, Vijay, who had been there
 Case Studies 395

for about 5 years. Vijay openly ridiculed Pragyan at meetings about his lack of
organisation, poor communication and writing skills and lowering staff morale on
the team. Using his familiarity with his boss, he would miss no opportunity to pull
up Pragyan’s shortcomings, not giving him time to settle and orient himself to his
new workplace.
Vijay’s cheap shots and belittling led to confusion and despair which finally
resulted in poor performance…for which he was pulled up quite often by his boss.
He was finding it difficult to leader his group which did not respect or trust him.
All this led to his not being able to spend quality time with his family which added
to his stress.
Pragyan did not want to return to work again. His family was devastated and
his wife threatened to leave him with their child because she has had enough of his
depressive behaviour. No longer able to cope with all of this stress Pragyan attempted
suicide. Fortunately he survived and was then referred to the counselor.
The counselor had to use a multi-pronged approach to help Pragyan. He was first
sent out for psychiatric evaluation and the psychiatrist put him on a very mild anti-
depressant. The counselor then met with his wife and child to discuss the situation.
Pragyan and his wife spoke to each other in the presence of the counselor. They
both realised that there was a lot of love between them. It was just that Pragyan was
so preoccupied with his work problems that he had completely shut his wife out
of his emotional space. This first led toanger and then insecurity in her and hence
her decision to move out. She then promised to work with him on this and that
encouraged Pragyan to combat his problem. He went for the Art of Living course
conducted in his neighbourhood and the meditation calmed him. After 10 days he
was allowed to discontinue his medication.
The counselor then worked with Pragyan focusing on the meaning of life and
humans’ responsibility and freedom of choice for deciding their fate. He understood
that humans cause problems for themselves by what they think and believe; and
discovered how his own thought patterns and worldviews were contributing to his
problems.
He started to understand how he could take charge of the situations and how his
behaviour needed to change. He saw how being ridiculed and put down in front of
others did not reflect his actual capacities. He re-learned to trust himself and think
of himself as a worthy leader.
Simultaneously there were a few sessions with Vijay. These sessions brought to
light his insecurities and reasons to feel intimidated by Pragyan. Pragyan was more
qualified and skilled, and therefore selected for this job. Vijay on the other hand had
moved up in the ladder because his boss had moved on. Hence the bullying.
When they were both ready, the counselor arranged a couple of sessions where
they talked to each other. It was finally agreed upon that though they may never be
the best of friends, it was important to respect each other.
396 Counseling: Theory, Skills and Practice

A follow up session with both after three months showed that things were fine.
Though there still existed a very heavy competition between the two to prove
themselves the better one, neither tried to deliberately harass the other.

Case-6: Counseling a Tsunami Survivor

After the Tsunami hit the coast of Tamil Nadu, India, many camps were conducted
by counselors to administer Psychological First Aid. Here is the story of Lakshmi, a
30 year old married woman with two surviving children. She had lost one daughter
during the tsunami. Her husband accompanied her to the counselor and related
that she was always angry and suspicious of others. Ever since that fated day she
began to worry a lot, for very small issues. She became increasingly unhappy and
was constantly crying. She could not sleep at night and complained of body pain
all the time. She was finding it very difficult to do the household chores. Her hands
trembled and she was very easily startled. At night she would sit in front of her
daughter’s picture and talk to it. “Why did you go away from me? Are you angry
with me that I did not save you? Why did God have to leave me behind?...I do not
believe God exists!”
Lakshmi told the counselor that for a number of months she had been
experiencing intrusive, repetitive thoughts, which centred on her children’s safety.
She frequently imagined that various, serious accidents has occurred and could not
put these thoughts out of her mind. For example, on one occasion she imagined
that her son had a broken leg playing football at school and actually ran all the way
to school to see if he was all right. Even after learning that he was fine, she admitted
being somewhat surprised when he arrived home unharmed.
Even though she was afraid for her children she did not have the energy to take
care of them properly. Guilt was building up on that account too. She began to
feel that they were getting out of control. Any disobedience on their part and she
attributed it to the fact that they might be blaming her for the loss of their sister.
Lakshmi started to feel that perhaps she was not a good person and therefore was
being punished. Therefore she kept to herself mostly, and avoided almost all social
interactions. Even when people came to see her she was quite. And then slowly they
started to avoid her…which made her feel worse.
A few weeks ago, the depression got worse, Lakshmi cried and slept every free
moment just trying to escape the sadness. If she wasn’t sad, she was extremely angry
with most everyone for various reasons. At times she would think of how other
people were mistreating her and doing her wrong. She thought the world was unfair
and rude and she began to react by withdrawing even more into her own shell.
Lakshmi was encouraged to talk to the counselor about her fears and phobias.
She talked about her life being very tiring, having to look after her children, her
 Case Studies 397

husband as well as her mother. She was quite sick of all her chores that she had no
help with. She felt quite spent. She talked about her guilt at being alive and that she
could not save her daughter. Now she felt that she would not be able to take care of
her two sons. She believed that her husband was angry with her as she was neither a
good wife nor was she a good mother.
For three whole sessions the counselor allowed her to talk. Surprisingly she
did not hesitate to talk about the day of the Tsunami or her frantic search for her
daughter who had gone out to borrow a book from her friend. She cried a lot during
the sessions. It was discovered that the most guilt she felt was about her not being
able to spend quality time with her children, play with them, listen to their school
stories and she was also learning English from her younger son! She was also afraid
that her husband might leave her as she was not being a ‘good wife’.
The counselor decided to first help her deal with the more practical aspects of her
life, which could be changed, so that she could have a breather to take care of herself.
A timetable was charted to make the process more concrete. She was encouraged to
maintain a daily routine, activities and clear structure. With her children she was
asked to make clear her expectations of them, making consistent rules and sticking
to a disciplining behaviour. This little bit of planning and organising helped to lift
up her burdens one by one so she could begin to deal with her innermost feelings.
She now felt that she had more time on her hands and could spend time with her
boys being with them while they did their homework or other assignments. She was
able to rest more. She then made it a point to spend some time with her husband
while having dinner and after. All this made her feel slightly better. Her husband
and children were also responding positively to her endeavors, which encouraged
her.
She was now emotionally stronger and ready to work on her guilt and the
consequent suicidal tendencies, fear of the public, and fear of sickness and fear of
her children’s death.
 Index

A Communication 154, 178–183

Accommodation 93 Compassion fatigue 293, 339
Acting out 84, 85 Compensation 85
Addiction counseling 327 Concrete operations 92
Affiliation 85 Conditioned response 94
Aim inhibition 85 Conditioned stimulus 94, 95
Altruism 85 Conscious mind 81
Animism 92 Conservation 92
Art therapy 37 Consulting 357, 361, 367, 368
Assimilation 93 Contextualist worldview 78
Attending skills 129 Continuous reinforcement 98
Avoidance 1, 85 Conventional morality 102
Counselee characteristics 145,
B 169–170
Backward conditioning 95 Counselee expectations 145, 170–171
Behavior genetic model 98 Counselee perceptions 145, 172
Bereavement—stages 252 Counselee 145, 146, 169
C Counseling
and culture 55
Career counseling 139, 203, 216
and developmental psychology
Career theories 203, 219
74–76
Catharsis 39, 85
characteristics 169–170
Centration 92
counselor role 7, 151
Chronosystem 103
definitions 2–6, 23
Cognitive behavior therapy 41
duration 25
College counseling 115, 214
eastern approach 48, 65
400 Index

emergence, history 10 Egocentrism 92

focus 25 Emotional maturity 191
Indian scenario 48, 51 Empathy 157–160
indigenous models 1, 15, 48 Equilibrium 93
multicultural 15–17 Erikson’s psychosocial theory of
objectives 24 development 86
personality 150-151 Eros 83
problems 7, 29 Ethical considerations 132, 145
resistance 26 Existential 44
setting 26 Exo system 103
transference 26 F
Counselor supervision models 126
Family counseling 116, 311, 312
Countertransference 340
Fixed interval schedule 98
Couples counseling 308, 309
Fixed ratio schedule 98
Cultural issues 29, 164
Forward conditioning 95
Cultural mediation 101
Free association 43, 82, 85
D
G
Dance therapy 38
Gestalt 34, 45, 78
Decentering 92
Grief counseling in India 257
Defense mechanisms 83
Grief counseling 247
Denial 84
Developmental psychology 74, 76 H
Dialectical behavior therapy 42 Humanistic approach 43
Displacement 84 Humor 85
Drama therapy 39
I
Dream analysis 85
Id 82
E Indigenous model of counseling 177,
Eclectic 45 187
Ecological systems theory 103 Insight 85
Ego identity 86 Intellectualization 84
Ego psychology 86 Intermittent schedules 98
Ego quality 86 Internalization 100
Ego strength 86 Introjection 84
Ego 82 Intuitive thought 92
 Index 401

J Pain management counseling 265

Juvenile delinquency counseling 330 Parapraxes 85
Passive aggression 85
K
Piaget’s theory of cognitive
Kohlberg’s stages of moral development 90
development 102 Play therapy 38
L Positive reinforcement 97
Lev Vygotsky’s social contextualism Post conventional morality 102
100 Preconscious mind 82
Life coaching 37, 65, 105, 357 Preconventional morality 102
Life structure theory 104 Pregnancy counseling 325
Listening 154-160 Premarital counseling 310
Preoperational thought 92
M
Primary circular reactions 91
Macrosystem 103 Projection 84
Marriage counseling 311, 312 Projective test 85
Mechanistic worldview 79 Psychoanalysis 43
Menopause counseling 324 Psychoanalytic theory 79
Mental healthcare movement in Psychological first aid 284
India 49
Psychosexual development 79
Mentoring 363, 366, 378
Psychosocial crisis 86
Mesosystem 103
Psychosocial stages 87 - 90
Microsystem 103
Psychotherapy
Moral anxiety 84
definition 23
More knowledgeable other 100
duration 25
Music therapy 37
focus 25
N objectives 25
Negative reinforcement 97 origin 27-29
Neurotic anxiety 84 resistance 26
setting 26
O
transference 26
Omission 97 Puberty counseling 323
Organismic worldview 77, 93 Punishment 97
P R
Pain cycle 268 Rape counseling 321
402 Index

Rational emotive behavior therapy 41 Sublimation 84

Rationalization 84 Suicide 333, 335
Reaction formation 85 Superego 82
Reality anxiety 84 Suppression 84
Reality therapy 42 Symbolic functioning 92
Regression 84
T
Rehabilitation counseling 119, 244,
275, 315 Temporal conditioning 95
Relationship counseling 308 Terminally ill counseling 259
Repression 84 Thanatos 83
Resistance 85 Theories of development 76
Responding 152-154 Training 369
Response cost 97 Transference 26, 85
Response extinction 96 Transpersonal psychology 48, 57–59
Reversal conditioning 96 U
Reversibility 92 Unconditioned response 94
S Unconditioned stimulus 94
School counselor 203, 205 Unconscious mind 82
Seasonal cycles 104 Unpaired conditioning 95
Secondary circular reactions 91 V
Secondary conditioning 96 Values 145, 161-170
Sensorimotor period 90 Variable ratio schedule 98
Serialization 92 Variable interval schedule 98
Simultaneous conditioning 95
Spiritual approach 48, 56, 57 W
Spiritual coaching 37 Workplace counseling models 229,
Spirituality and wellness 348 230
Stimulus discrimination 96 Z
Stimulus generalization 96 Zone of proximal development 100
Stress models 236
 Author’s Profile

Dr Radhika Soundararajan is a practising pediatric counselor

with over 23 years of experience. She is currently working as
a psychologist at Saveetha University, Chennai. Her work
exemplifies a Vedantic approach to psychological therapy.
She consults with schools as a psychologist conducting
training programs for teachers, parents and students.
For the past 15 years she has been associated with Vidya
Sagar (formerly the Spastics Society of India), teaching
educational psychology. She has been training the students
in counseling skills. Apart from counseling she teaches psychology to medical,
dental, paramedical students and practitioners. She is also involved in curriculum
development for several undergraduate, graduate and doctoral programs. She has
published several articles on adolescence in The Hindu.