The client, Helen, is 56 years old. She has been happily married for 32 years to Barry, who works for the local council.  Helen and Barry’s first child, a boy, was stillborn. Helen fell pregnant again very quickly to help get over the loss. They now have two adult daughters, Vicky and Sharon. Vicky, the eldest daughter, is married with two children and lives interstate. Unfortunately, Helen doesn’t get to see them very often because of the distance.

Sharon, the youngest, has been living with her partner, Graham, for over five years.  Sharon and Graham decided early on in the relationship that they would not have children and would not marry. Graham’s parents died in a car accident some years ago and consequently Graham and Helen have become very close.

A few months ago, Sharon found out that she was pregnant. She had been taking antibiotics for a chest infection and did not realise that they could affect the contraception pill.

Sharon terminated the pregnancy even though Graham had asked her to wait because he was having second thoughts about their decision not to have children. This situation led to the breakdown of their relationship and they have now separated. Graham has moved away and neither Sharon nor Helen have heard from him for over three weeks.

Helen has come to see you because she is feeling very angry with her daughter Sharon. She blames her for the break-up and thinks that Sharon was very selfish not to consider Graham’s feelings. She envies her friends who can visit their grandchildren regularly and is missing Graham very much. He has been like a son to her.

As Helen’s counsellor, how would you approach this case?

(click on the comments link below to view responses)

Related Dilemmas: Family Therapy and Adolescent Counselling, Family Therapy and Adolescent Counselling, A Complex Family Situation

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Allen (2001) explains that the essence of time management is completing decisions and determining action steps about the things that capture our psychological and physical space. To cope with everyday demands, Allen has suggested a processing sequence of work and tasks:

1. Collect all situations, projects and tasks that need to be done, including those that keep flowing in on a regular basis.
2. Process them and work out what actions need to be taken.
3. Organize the resultant tasks and projects.
4. Review them and look at options for action.
5. Do what has been decided.

Allen’s approach can be described as ‘from the ground up’. He feels that there are still too many people who cannot, despite all their best intentions, thrive on a goal oriented approach to time management. In fact, he believes that setting lofty goals may impose more need for change on people and therefore more demands on their daily schedule.

Certainly, coaches need to be alert for clients chasing unrealistic goals or clients not being content with what they have. However, goal setting is seen as a forte in coaching for helping drive clients through their barriers and strive towards an end result.

Morgenstern (2005) has developed a simple approach to sorting out the things that need to be completed. This is known as the “WADE” formula.

Write it down
Add it up - estimate how long it will take
Decide what to do about these items. This can include the 4 Ds of time management - Delete, Delay, Delegate or
Diminish into smaller tasks.
Execute the plan of action decided on.

It may help a client to visualise how they process their incoming work. This system incorporates the 4 Ds of time management - Delete, Delay, Delegate or Diminish into smaller tasks. The Diminish stage is where something is seen to require more than two minutes to be completed and is added to a “Plans and Projects” stage where it is broken down into manageable steps.

Sorting out tasks with constant reference to goals and ideals is a key to time management from a counselling perspective. There are perhaps various ways of going about this.

An approach (The Life Organisation Exercise) is suggested below:

1. Have your client sit with their written goals and objectives handy.
2. Invite your client to complete an inventory of all their unfinished actions/tasks.
3. Have them write down everything they can think of. Write one item for every two or three lines on a page; in other words have them leave space to add notes.
4. Invite your client to get together at home and in the office all the physical things that need doing.
5. Work with them to assess what time these actions will take and incorporate this in their lists. While completing this task they can be grouping items into categories. For example: home, office, children, car, etc.
6. Invite your client to compare this list against their goals and see if the time they will take is justified. They might also see whether or not the actions are justified at all.
7. Apply the four Ds: Delete, Delay, Delegate or Diminish into smaller tasks.

The tasks that maintain priority should be allocated places in the diary or calendar system used by the client. Don’t be surprised if a client starts to go through some fatigue and/or emotions while completing an exercise such as this.

Note that your presence with them while they do this exercise is one of the reasons it will work as it will help them work through some mental barriers as they confront a whole mass of incomplete, unfinished business in their life.

Some clients may try to ‘escape’ the exercise. They will come up with various things that demand their attention, and reasons why they can’t sit down and get through it. Without being unkind, guide your client through to completion of this or a similar exercise.

Please note: This is a suggested routine; you may have a variation of this and the client may prefer to sketch plans using diagrams and colour. The important thing is to get the person through what they might not otherwise get through so that they start to get on top of the barriers to personal organisation. 

Source: www.counsellingacademy.com.au

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When communicating with clients, flexibility and responsiveness are two of the most beneficial skills a counsellor can have. Different mindsets and emotional states require a particular approach; and the counsellor’s ability to adjust to a client’s needs normally dictates the outcome of that relationship.

In order to better exemplify the diversity of mindsets which clients may approach counseling with, we’ve created five generic client profiles – along with strategies to help improve the relationship and enhance client-counsellor rapport.

Profile 1: an emotionally unstable client

The client is emotionally unstable and finding difficulty in expressing him/herself.

Emotionally unstable clients normally require a client-centred approach which enforces the need to establish rapport and trust, and to ensure the client is aware that he or she is in a safe and friendly environment. The client will normally have difficulty in expressing him/herself because he/she is unable or not ready to deal with emotions.

Counselling strategies to establish rapport would include: using self-disclosure to relate to the client’s situation and create an emotional link; creating goals and accountability in order to encourage action from the client; providing transparency and positivity through communication.

Profile 2: an involuntary or skeptical client

The client has been forced to attend to counselling (e.g. legally mandated).

This type of client may be difficult to deal with in the early stages of the relationship. Normally, he or she will be skeptical about the process, and may not acknowledge any need to change. It is important for the therapist to gain respect from the client, and use that respect to establish trust.

One of the most common strategies to gain respect and create responsiveness from the client is to outline the process of counselling: what he or she is there for; what is the structure of the relationship; what are the rights and duties of the client; what might be the expected positive outcomes. Solution-focused strategies are a good way to create a sense of accountability and need for change.

Profile 3: the child

The client is a young child or adolescent.

Dealing with children is always challenging as there is a perceived ‘bigger’ communication gap. The goal for the counsellor is to establish trust using humour; engaging in activities such as games; encouraging a collaborative approach; using self-disclosure and; role-playing. Expressive therapies are also utilised by many therapists to help improve communication with young clients.

Profile 4: the uncommitted client

Lack of commitment can be a challenging problem in the counselling setting. Normally, a client with little or no commitment has a specific agenda which justifies their attendance at a counselling session (an example would be a husband who was asked by his wife to attend counselling in order to preserve their marriage).

Framing and re-framing are good tactics to re-model the way the client perceives the counselling relationship: shifting from the ‘helping’ mode to the collaborative approach. Creating goals and structuring will also motivate the client to go through the necessary stages for change, collect the rewards, and move on with his/her own life.

Profile 5: the demanding client

A demanding client will normally believe that the counsellor will provide answers to his/her problems. They will come to counselling without much resolve to act upon their current situation, and will normally create very unrealistic expectations regarding the counselling relationship and the counsellor.

Again, encouraging accountability, managing expectations and establishing well-planned goals is a good approach. The client should be encouraged to realise that change can only occur from within. Using role-playing, narrative therapy skills, and/or a solution-focused approach to empower and encourage the client may be the key for deriving motivation.

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The main purpose of all counselling and therapeutic endeavours is to bring about change. When a person joins a counselling group, it is usually to learn new ways of being, interrelating, and interacting. In a therapeutic small group the specific goals for each member can be varied but would include the expectation that change will occur (Conyne, 1997b). 

In both types of groups it is expected that members will become more functional and less distressed. Often groups are called by names that indicate their purpose. For example, both therapists and counsellors run communication groups, assertiveness groups, life-skills groups, and decision-making groups.

The general goals of these respective groups are to improve communication skills, to increase assertiveness, to provide experience in life skills, and to allow experience in a decision-making process.

If the theme of the group is self-awareness, then one goal for the group members would be to become more aware of various aspects of themselves - how they behave in different situations, how they react to certain stimuli, and how others react and behave in return.

A second goal would be for the members to use this new awareness to gain a better understanding of themselves and, based on this understanding, to effect some change in their behaviour directed at achieving or eliciting more productive outcomes.

Immediately the question arises, “What happens in groups that enable members to change?” Or, as Kottler (1994a) asks “What is this magic that cures people of their suffering?” (p. 50).

Perhaps the magic, in part, is based on the phenomenon described by Kurt Lewin who is credited with the observation that “it is usually easier to change individuals formed into a group than to change any one of them separately” (Rosenbaum & Berger, 1975, p. 16).

In commenting on the value of groups, Finlay (1999) states “Groups hold individuals’ sense of personal and social identity. Through action and interaction, participants acquire skills, attitudes, and ways of behaving as they respond to the expectations of others and adopt different roles” (p. 26).

Although a person does not experience the same one-to-one attention in a group as she or he would receive during individual counseling or therapy there are other factors that contribute to the success of groups as a therapeutic modality.

Rudestam (1982) discusses five elements that he considers to be advantages of using groups to facilitate bringing about change.

First, Rudestam likens a group to a “miniature society” in which members can lose their feelings of alienation and, temporarily at least, experience feelings of belonging, thus meeting one of the basic needs of humankind (Maslow, 1968). Within the group setting, members can experience every-day life situations such as peer pressure, social influence, and the need to conform.

In this microcosm of society, members can relate their behaviour in the group to their behaviour in social groups outside the group. When these experiences occur in a learning environment, such as a group, the changes that occur are usually transferable to the outside world (Posthuma, 1972; Waldinger, 1990).

The second element in favour of the group-treatment setting is the opportunity to be among others with whom common problems can be shared. It offers the chance to learn new skills and behaviours in a supportive environment. Through group interaction one can receive feedback and caring, experience trust and acceptance, and learn new ways of relating to others.

Because most groups comprise a cross-section of members of society at large, this affords each group member opportunities to cope with give-and-take situations similar to those existing in the world outside. In one-to-one therapy the client experiences only one other point of view and one source of feedback, that of the therapist.

Even though such viewpoints and feedback may be valid, they are limited in breadth and experience by virtue of coming from only one person (Ferencik, 1992). In a group the client may experience several points of view and varied feedback (Echabe & Castro, 1999)… all of which can be presented in different ways. By evaluating this assortment of information, the group member is able to select what he feels could be of personal value and assistance.

Hopefully, because of this mixture, group members will get a broader view of themselves, and become more aware of the subtle nuances of their behaviour. Also, the integration of information is likely to produce a combination of supportive and confrontive messages that can soften any good-bad or right-wrong dichotomies. The more supportive feedback serves as a sort of cushion for the more confrontive.

In essence, this multifeedback situation creates an environment in which members are more receptive and feel less need to be defensive and block out negative feedback (Campbell, 1992). They are more apt to listen, to take in, and to consider what they hear and hence benefit from the process. Conversely, it is also true that there is strength in numbers.

It is easier to disregard feedback that comes from one source only with a “what-does-he-know?” attitude. However, it is close to impossible to ignore feedback from five or more persons if they share the same perceptions and are all giving the same messages or information. 

Third, the individual is able to observe the problems, struggles, behaviours, interaction styles, and coping mechanisms of the others in the group.  He is then able to use this information as a yardstick for comparing his own behaviours.  From this a group member can assess his own abilities and disabilities and consider possibilities for personal change.

Closely linked with the third advantage is the fourth, which is facilitation of the individual growth process. The support of the group can be an enhancing factor in self-exploration and introspection (Lieberman, 1990b; Posthuma & Posthuma, 1972).  Feeling, caring, and respect from others can go a long way in promoting the self-confidence necessary to attempt new and different ways of behaving.

The final advantage of the group format for both counselling and therapy is the obvious one of economics.  Having several clients meet together with a group leader rather than meeting individually with a therapist or counsellor saves time and money (Davies & Gavin, 1994).

References

1. Campbell, L.F. (1992). An interview with Arthur M. Horne. Journal for Specialists in Group Work, 17, 131-143.
2. Conyne, R.K. (1997b). A developing framework for processing experiences and events in group work. Journal for Specialists in Group Work, 22, 167-174.
3. Davies, P.L., & Gavin, W.J. (1994).  Comparison of individual and group/consultation treatment methods for preschool children with developmental delays.  American Journal of Occupational Therapy, 48, 155-161.
4. Echabe, A.E., & Castro, J.L.G. (1999). Group discussion and changes in attitudes and representations. Journal of Social Psychology, 139, 29-43.
5. Ferencik, B.M. (1992). The helping process in group therapy: A review and discussion. Group, 16, 113-124.
6. Finlay, L. (1999). When action speaks louder: Groups in occupational therapy. Groupwork, 11, 19-29.
7. Kottler, J.A. (1994a). Advanced group leadership. Pacific Grove, CA: Brooks/Cole.
8. Lieberman, M.A. (1990b). Understand how groups work: A study of homogeneous peer group failures. International Journal of Group Psychology, 40, 31-52.
9. Posthuma, B.W., & Posthuma, A.B. (1972). The effect of small-group experience on occupational therapy students. American Journal of Occupational Therapy, 26, 415-418.
10. Posthuma, B.W. (1972). Personal development and occupational therapy. American Journal of Occupational Therapy, 26, 88-90.
11. Rosenbaum, M., & Berger, M.M.(1975). Group psychotherapy and group function (Rev. ed.). New York: Basic Books.
12. Rudestam, K.E. (1982). Experiential groups in theory and practice. Monterey, CA: Brooks/Cole.
13. Waldinger, R.J. (1990). Psychiatry for medical students (2nd ed.). Washington, DC: American Psychiatric Press.

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For some time I had considered studying counselling before the AIPC Diploma in Professional Counselling came to my notice. I had baulked at the thought of a study timetable that would not offer flexibility around work, family and friends.

In my field of work I have very busy periods that allow no time or head space for outside activities. Equally, there are easier periods where I do have time available for more leisure or external study. This course offered me a way to structure it to my needs. After viewing the course outline I decided that this was the best way for me to pursue counselling study.

When starting any new field of study, the language, concepts and theory can be challenging. I found the tutorials always clear and concise. They assisted with my motivation when my work commitments broke up the continuity of the study.

Practical sessions were again well directed and informative. Students involved were a most supportive group. Each was finding their own practical application for their studies. 

The support and encouragement offered by Robert Carrigan and his team was extremely professional. Even when there was the occasional ‘Not Yet Competent’ on the top of the assignment, you always received clear assistance for work that needed further clarification or reworking.

I continue on the path to be a fulltime counsellor. This year I am involved as a voluntary counsellor and while I learn more as each day passes, I sense and value the course work I undertook with AIPC even more. It has made a difference for me and it is exciting that through this work I am, in a small way, making a difference for others.

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