Section 4: Counselling Practice

Before we go any further, let’s review the core features of ethical practice, which should always be at the centre of a counsellor’s work. These are:

• Respect for the client’s individuality, values and beliefs.
• Respect for the client’s autonomy (self-determination and independence).
• Safeguarding your client’s well-being (within the boundaries of the counselling relationship).
• Ensuring that you are a competent counsellor by a continual process of self-reflection and self-development. This may involve regular supervision and professional development.
• Acknowledging the limits of your competency and referring your client to someone more suitable in these situations.

You learned about these core features of ethical practice in CHCCSL001 Establish and confirm the counselling relationship. In that module, you also learned about a number of legal and ethical features of counselling practice:

Counsellors need to be mindful of their legal and ethical responsibilities throughout their work with clients. You will learn more about these considerations later in this section of the module. For now, let’s learn about how counsellors can evaluate and monitor their practice to ensure that it is ethical.

Check your understanding of the content so far!

Read the following extracts from the Australian Counselling Association’s Code of Ethics and Practice before responding to the questions that follow.

“Counsellors work with clients in ways that affirm both the common humanity and the uniqueness of each individual. They must be sensitive to the cultural context and worldview of the client, for instance, whether the individual, family or community is taken as central.

Counsellors are responsible for working in ways that respect and promote the client's ability to make decisions in the light of his/her own beliefs, values, and context.

Counsellors have a responsibility to consider and address their own prejudices, stereotyping attitudes, and behaviour. They are to give particular consideration to ways in which these may be affecting the counselling relationship and influencing their responses.” (Adapted from ACA, pp. 7-8)

Ethics in Counselling

The professional ethical code will give guidelines to the counsellor regarding his behavioural norms. The counsellor has to internalise the values provided by the professional code. Code of ethics will not solve all the problems. It only gives guidelines with which the counsellor has to resolve his professional problems.

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A key principle of effective and ethical counselling centres on respect for the client’s human rights and individuality. The Australian Counselling Association (ACA) requires that “counsellors work with clients in ways that affirm both the common humanity and the uniqueness of each individual. They must be sensitive to the cultural context and worldview of the client, for instance whether the individual, family or the community is taken as central” (ACA, 2013, p. 7).

In order to ensure counsellors are upholding client human rights and not responding in a discriminatory manner, they need to examine their own value system and consider how their personal beliefs may impact the counselling relationship.

Counsellors also need to ensure that they are competent and fit to practice. The ACA requires that “counsellors must have achieved a level of competence before commencing counselling and must maintain continuing professional development as well as regular and ongoing supervision” (ACA, 2013, p. 12).

In order to become aware of biases and values that may be affecting the client-counsellor communication process, counsellors need to first identify when this may be happening. Additionally, in order to improve their counselling practice, counsellors need to identify where there are gaps in their knowledge or skills base. These aims can both be achieved through a process of self-reflection.

Self-reflection is the process of learning from one’s own experience and is a critical part of effective counselling practice. It involves thinking about what thoughts and emotions a counsellor has experienced and the choices and actions that have taken place during a client session. Self-reflection can be conducted in a structured way to help counsellors:

• Develop self-awareness by offering an opportunity to consciously reflect on own values and personal factors that may have impacted the communication process. For example, helping counsellors examine the assumptions that they bring to their practice.
• Evaluate their performance in order to identify opportunities for professional development as well as self-development. For example, deciding to take a cultural competency course to better understand the cultural context of clients.
• Examine their motivations and rationale for their counselling choices and decisions. For example, deciding which communication techniques are appropriate during the counselling session.

One effective and common method to reflect on and evaluate a counsellor's work with clients is journalling. You may want to explore this method and incorporate it into your own workflow when you begin counselling.

Becoming a counsellor - Self-awareness and Self-reflection

The presenter in this video explains the benefits of developing good self-awareness and self-reflection and shares five ways to cultivate self-awareness including keeping a journal, practicing listening and using a mood tracker.

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The Reflective Practice Cycle provides a structure for self-reflection that counsellors can use to reflect on their counselling sessions with clients. This cycle is explained here and depicted in the figure that follows.

Step 1: Select

The first step is to identify and select the issue or situation requiring reflection.

Step 2: Describe

The second step is to describe the circumstance, situation, concern or issue related to the topic that has been selected in step one. Who, what, when, and where questions are then asked here (for example, who was involved (the client)? What was the context, circumstance, concern, or issue requiring reflection? When and where did the event occur?).

Step 3: Analyse

The third step in the process of reflection involves analysing and assessing the situation (i.e., to ‘dig deeper’). This step explores ‘why’ and ‘how’ the action was taken or ‘why’ and ‘how’ the decision was made.

Step 4: Appraise

The fourth step requires the counsellor to appraise or evaluate their behaviour by interpreting the situation and evaluating its appropriateness and impact. This is where self-assessment actually occurs.

Step 5: Transform

The final step is transformation. This step requires counsellors to shift from analysis and reflection into action. What changes can be made to your approach to practice? Has this made any shifts in your practice framework? What differences do you expect to see in the way you approach clients?

If using a journal, possible questions you could ask yourself during self-reflection to identify any possible biases you may hold may include:

• Whose frame of reference was I working from during the session? My own or my clients?
• What techniques did I use that allowed the client to fully express their perspective?
• What thoughts come up for me as I think about the client’s culture? What bias might these indicate?
• What can I ask in clinical supervision that will help me to recognise potential bias I may hold?
• How did I ensure I worked in a non-discriminatory manner with this client?

There are various areas for improvement that you may identify through this process, usually around becoming aware of biases and values and addressing gaps in knowledge and skills. For example, you may realise that you perhaps:

• Used a communication technique inappropriately. For example, used a challenging technique as a way of venting your frustration with a client rather than as a tool for growth and development.
• Were influenced by your own personal issues. For example, perhaps you distracted your client when he was experiencing a strong emotional reaction or discouraged him from emotional expression because you were uncomfortable.
• Communicated judgement of a client through verbal or non-verbal communication. For example, frowned or shook your head and said, “OK, if you think that’s a good idea”, in a tone that implied that you did not agree with his or her choice.
• Had a gap in knowledge or particular skills that might reduce the effectiveness of the client-counsellor communication. For example, if your client is heavily involved in competitive skateboarding, you might want to find out a bit more about it. Or if your client is an adolescent and you haven’t counselled adolescents before, you might seek advice or information about how to communicate effectively with young people.

You could then decide to make changes to your future practice that may include:

• Identifying and exploring why you felt so frustrated with the client. Reviewing and practiccing the appropriate use of specialist communication skills.
• Exploring why your client’s strong emotional reaction made you feel uncomfortable and perhaps use attending behaviour, responding skills or silence instead of avoidance next time you experience a similar issue.
• Being aware of your own values and how you may be unconsciously conveying judgement. Deciding to monitor your verbal and non-verbal communication in future client communication.
• Seeking advice and information from an expert. Carrying out independent research or doing more formal professional development, such as attending a course.

Post Counselling Session Reflection - Breaking Through Barriers

In this video, the counsellor reflects on a clients progress, breaking through barriers and self sabotaging behaviour.

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Self-reflection plays an important part in ethical practice. By exploring personal values, evaluating motivation and the effectiveness of the counselling strategies chosen, counsellors are more likely to communicate with clients in a way that is respectful, effective, and ethical (i.e., in line with the codes of conduct required by the ACA). You can use the self-reflection process to evaluate whether your practice has been in-line with general ethical principles, including:

• Respecting the client: Are you imposing your values onto your client? Do you have prejudices or biases that are affecting your ability to communicate effectively with a client? Has the client been involved in the decision-making process, or have you decided what is important to focus on? Have you advised a particular course of action or told the client what to do?
• Duty of care and disclosure: (i.e., safety and well-being of client and others): Are there any safety concerns that require action?
• Practitioner/client boundaries: Have you taken care to remain in a professional role and maintained appropriate client-counsellor boundaries?
• Privacy and confidentiality: Have you discussed your client with anyone who isn’t a supervisor or line manager? Is your office soundproof? Can others overhear your conversation?
• Competence and professional development needs: What gaps have you become aware of that you can address through supervision or professional development? Are you out of your depth? Do you need to get the help of an expert or manager?

It is important to understand that the purpose of self-reflection is not to identify all the ‘mistakes’ you have made and where you have gone wrong. All counsellors are individuals and bring with them into the counselling session different strengths and weaknesses, values and biases. It is impossible to be completely value and bias-free. What is important is that you make an effort through self-reflection to become aware of any values and biases that may be impacting the communication process and make a plan to do things differently next time. This means that in order for self-reflection to be useful and effective, you need to be completely honest and open when thinking about, recording, and analysing the outcomes of your counselling communication and with a client. Remember, the aim of self-reflection is to help you become a more effective counsellor!

Check your understanding of the content so far!

Now that you have an understanding of what self-reflection involves, let’s have a look at how this might work in a counselling situation.

Case Study

Andy works at a youth organisation that offers counselling and support to young people. He has a just finished a session (their second) with Rebecca, a 16 year old girl who has been referred to the centre for school refusal. Andy feels that he and Rebecca are not communicating very well and consequently not making much progress in helping her back into school. Andy decides to take some time out to self-reflect on the session and see if he can identify what might be affecting the counselling process in order to improve things.

Step 1: Select

Andy decides to focus on his communication with Rebecca, including reviewing what microskills he has been using.

Step 2: Describe

Rebecca was non-communicative and defensive during their session. She sat slouched in her seat with her arms crossed and avoided eye contact. She does not want to talk about school and only appears interested in talking about her pet dog, Cody.

Step 3: Analyse

Andy starts to think about the counselling strategy that he has been using. As the referral had stated that the purpose of counselling was for school refusal, Andy had been very focused on school attendance. Rebecca had expressed an interest in nursing, so she would need to stay in school. Andy also personally believes school is very important and had been using challenging (highlighting the discrepancy between Rebecca’s interest in nursing and not attending school) and reframing strategies to try and help Rebecca overcome her reluctance to attend school.

Step 4: Appraise

When Andy thought about their conversation, he realised that Rebecca had been trying to convey something to him about her pet dog through both her verbal and non-verbal behaviour. In fact, he remembered her saying that her pet dog kept escaping from their yard as her brother always left the gate open. Looking back, Andy realised that Rebecca had seemed quite upset at that point. Although he had empathised with her using the appropriate responding skills, he had not really used noting and reflecting techniques to gain a deeper understanding of her feelings around this and explore why it was so important to her. As Andy was not an animal lover himself, he had not perhaps understood how attached Rebecca was to her dog and underestimated the stress and worry her dog’s escapes were causing her. Perhaps this was contributing to her reluctance to attend school. He also realised that although school was very important to him, he had not really explored Rebecca’s values around school and what her priorities were.

Step 5: Transform

Andy decides that he will slow the counselling process down and focus on Rebecca’s concern about her dog and what he might represent before focusing on what Rebecca wants to do going forward. He will focus on building up their relationship by using attending behaviour and responding as well as reflection of feelings to get a better understanding of what is going on for Rebecca. He will also avoid challenging and reframing techniques for now. Andy decides that he will ask to see a picture of Cody in their next session and go from there.

You can see from this scenario that a structured process of self-reflection can highlight various areas and opportunities for improvement. In the example, Andy became aware of several biases or expectations, such as his own values about education and the place of pets in people’s lives. This is an example of developing self-awareness as a result of self-reflection. Andy evaluated the effectiveness of his counselling communication and identified that he needed to utilise different counselling skills to develop a more effective client-counsellor relationship with Rebecca. He also recognised that he needs to shift the focus of his practice from what he thinks is important (i.e., getting Rebecca back to school as soon as possible) to Rebecca’s immediate needs, which may be around her home life. This would also mean his practice would be more person-centred.

Person-Centred Practice

Modern counselling practice is person-centred. This means that the client is put at the centre of the counselling process, and the counsellor focuses on the client’s needs as opposed to his or her own agenda. The techniques employed in the person-centred approach are aimed at creating an environment that facilitates the process of self-awareness and understanding, and which then empowers the client to make changes. It is important to recognise that what your client considers important (based on their values and beliefs) may differ considerably from what you might think is key (based on your own values and beliefs).

Person-centred communication involves the counsellor using counselling skills in an appropriate way at an appropriate time. The principles of person-centred counselling promote the following:

• Demonstrating honesty and genuineness in communication
• Demonstrating empathy (i.e., an understanding of the client’s position)
• Demonstrating acceptance, respect and care for clients
• Facilitating autonomy
• Being non-directive.

You should recall these principles of person-centred practice from CHCCSL001 Establish and confirm the counselling relationship.

It is important to note that when counselling practice is client-led, counsellors are less likely to engage in unhelpful communication or actions based on their own values and/or biases. Counsellors adhering to a person-centred approach are also more likely to respect their client’s autonomy and implement appropriate client/counsellor boundaries. The ACA points out that “in counselling the balance of power is unequal and counsellors must take care not to abuse their power” (ACA, 2013, p. 5). By ensuring the focus is always on the client and ensuring they are non-directive, there is less chance of counsellors overstepping the boundaries of their role.

The self-reflection process can be more effective if you can refer to client case notes during the process. This is true for supervision as well. For example, if a supervisor makes a suggestion, you can check and see if you have already tried this (McMahon, Palmer & Wilding, 2009). However, taking notes is also important for several other reasons, including:

• Acting as a memory aide. As you see more clients, you may find it more difficult to recall particular client issues and their counselling stage, particularly if you have many clients presenting with similar issues (McMahon, Palmer & Wilding, 2009). It is important for your client-counsellor relationship that you can remember key aspects of their lives.
• Enhancing the effectiveness of the counselling process. If you read the client’s record before meeting with them again, you can ‘tune in’ with the client right from the start of the session and not waste time on unnecessary repetition (Geldard and Geldard, 2009).
• Providing continuity for the client’s counselling process. If you cannot carry on counselling a client, having a record allows another counsellor to continue working with a client without starting from scratch.

What Do Counsellors Need to Record?

Client session notes are not intended to act as a transcript or detailed report of exactly what happened in the session (i.e., exactly what the client said and how you responded). In fact, it is important to keep them brief and factual for reasons we will discuss shortly. Different organisations and agencies may have specific templates or guidelines for client session notes. If you work for an organisation that does, you must follow these. In general, session notes typically include the following elements:

1. Date of the session and session number. It may also be useful to note how many sessions have been contracted for so you know how many sessions you have left. For example, Session 2/5.
2. Factual information given by the client. This will likely include information from the ‘gathering data’ stage of the counselling interview process. Useful information may include details about family, relationships, education, financial status, employment etc.
3. Details of the client’s problems, issues or dilemmas. This should be brief and factual. For example, client A is experiencing conflict with her mother-in-law (MIL). She feels MIL interferes with how she is raising her children and that her husband takes her MIL’s side. This results in tension between the client/husband.
4. Notes on the outcome of the counselling session. This is the session's result or how things were left. For example, client A decided to discuss her feelings with her husband as a first step.
5. Notes on any intervention used by the counsellor. You should note any specific techniques or skills you have done with your client. For example, explored appropriate conflict resolution and communication skills with client A.
6. Notes on any goals identified. These outline the client’s overall desired outcome. For example, Client A and their husband to agree on mutual parenting strategies and to make these rules clear to MIL.
7. Notes on any contract between client and counsellor. These include agreements you have explicitly made with the client. For example, client A will be attending fortnightly instead of weekly.
8. Notes on matters to be considered at subsequent sessions. Occasionally a client will introduce an important issue just as the session finishes. You should note these. You may also note down what is planned for future sessions. For example, client A would like to explore parenting strategies such as 'Positive Parenting'.
9. Counsellor’s initials or signature. By signing session notes, you take responsibility for what you write in them.

^{Adapted from Geldard and Geldard, 2009, p. 323}

When deciding what content to include in your counselling notes, you should ask yourself:

• Would another counsellor be able to pick up where we have left off from my notes?
• Do my notes have enough detail? Are they legible?
• Have I included details the client wouldn’t want anyone else to see?
• How would I feel if these were my notes and they were read by someone else?

Following is an example of how client session notes might look. However, it is important to remember that organisation and agency session record templates may differ significantly from the example provided. It is your responsibility as an employee to follow the format of the organisation templates.

How Do Counsellors Take Client Notes?

It is important to obtain permission to take notes in the ‘initiating the session’ stage when working with a new client. You could say, "I like to take a few notes while we talk. Is that ok?” You should also explain to them exactly how these might be used, how they will be kept confidential and under what circumstances others may access them.

Although note-taking provides many benefits for both client and counsellor (as described), one of the risks of taking notes during sessions is the distraction and potential interruption to the communication process that can occur. Although you will likely take extensive notes in the ‘gathering data’ stage of the counselling interview process to ensure you have recorded accurate client information, you should take minimal notes during ongoing client sessions (Ivey et al., 2014). The bulk of content should be completed as soon as possible after the session has ended.

During the session, you should focus on jotting down brief keywords or phrases that encapsulate what the client is describing while maintaining attending behaviour. While there is always the potential for distraction, note-taking during the session can be used as a way of communicating understanding. For example, if a client has revealed something important to them, showing them that you are noting this down conveys to them that you have understood the significance of this.

Sometimes it is not appropriate to take notes. This applies in situations where the client might be experiencing a strong emotional reaction (as described earlier in this module) – for example, while listening to a client relate a deeply personal and traumatic experience. In this case, you should give your full attention to the client and use an appropriate communication technique based on the situation.

Notes are clearly helpful. However, there are a number of ethical and legal implications involved in creating a record of client sessions, which we will now discuss.

Note Taking in Counselling

The presenters in this video discuss the importance of taking notes and what needs to be recorded in counselling notes.

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There are ethical and legal considerations related to client records you need to consider when recording client session details. These are set out in the Australian Counselling Association’s Code of Ethics and Practice and the Guidelines for Client Records developed by the Psychotherapy & Counselling Federation of Australia (PACFA).

In general, counsellor responsibilities related to client records include:

• Duty of care (i.e. the responsibility to protect the well-being of your client and others).
• Confidentiality and privacy.
• Organisational responsibilities.

Although client records are kept for various reasons, some of which we have discussed, the most important is to support the client's needs. PACFA (2014) suggests that “conscious recording of current client needs, support and interventions is part of the practitioner’s duty of care of the client”. Records should provide enough detail to ensure continuity of care in case of an interruption in the counselling process. You should comply with these guidelines suggested by PACFA to ensure your client's well-being.

One of the key client rights is that they are entitled to a private and confidential service, which extends to any records or notes you may take during client sessions. Client records should only be used for the purpose of the provision of counselling, and the client’s written permission should be explicitly sought if they are used for another purpose (e.g., research). You should also make clients aware that you may be using the session notes in supervision sessions.

Confidentiality is discussed with the client in the contracting stage of the counselling process, and during this process, you should make clients aware that their case notes will have to be made available to a court of law if subpoenaed. This is why your notes should be factual and brief. It is worth considering the possibility of court subpoenas while writing client session notes. Clients may also have the right to see their notes (depending on the jurisdiction), although there may be certain circumstances where this is denied (see PACFA for details). You should also bear this in mind when considering appropriate session note content.

Clients should also be advised of the security arrangements for record storage. Client records need to be stored securely to ensure confidentiality and privacy. Counsellors must retain client records for a minimum of 7 years after the last contact with the client (if the client is a minor, the record retention period is extended until the minor reaches the age of 25). This is for both client continuity purposes and also for counsellors to protect themselves from professional liability.

Organisations may have procedures and templates related to client notes, and you are responsible as an employee to follow these. Your ethical and legal responsibilities are explained in more detail in the codes of practice and guidelines mentioned above. You should ensure you are familiar with these before taking client session notes.

Check your understanding of the content so far!

In this section, you have learned about the process of self-reflection and how you can use the Reflective Practice Cycle to develop self-awareness, evaluate your performance as a counsellor, and identify opportunities for improvement and development. You also learned more about taking a person-centred approach to counselling practice and how the principles of the person-centred approach reduce the likelihood of a counsellor’s values and biases influencing the communication process. Finally, you learned about client records, including the appropriate and necessary content of notes, ways of taking notes without disrupting the counselling communication process, and legal and ethical requirements for record keeping.

• Australian Counselling Association (2013). Code of ethics and practice of the association for counsellors of Australia. http://www.theaca.net.au/documents/ACA%20Code%20of%20Ethics%20and%20Practice%20Ver%2010.pdf
• Geldard, D. and Geldard, K. (2009). Basic Personal Counselling: A training manual for counsellors. (6th ed.). Frenchs Forest, Australia: Pearson Prentice Hall.
• Ivey, A. E., Ivey, M. B., & Zalaquett, C. P. (2014). Intentional interviewing and counseling: Facilitating client development in a multicultural society (8th ed.). Belmont, CA: Brooks/Cole.
• McMahon, G., Palmer, S. and Wilding, C. (2009). The essential skills for setting up a counselling Practice. Routledge.
• PACFA (2014). Guidelines for client records. http://www.pacfa.org.au/wp-content/uploads/2014/12/Guidelines-for-Client-Records.pdf