In this section, you will learn to:
- Begin the counselling process and enable the client to express themselves freely.
- Explore the client’s presenting issues/concerns and their nature and depth.
- Support the client to prioritise concerns and determine the focus of counselling.
- Consider issues of referral and take appropriate steps.
- Support clients to fully explore their concerns and links in their experiences.
- Assist clients in becoming aware of underlying issues where appropriate and begin to identify ways of dealing with them.
- Identify and implement appropriate interventions for the client.
- Support clients to identify and use known and previously unknown strengths.
- Support clients throughout the counselling process.
Supplementary materials relevant to this section:
- Reading A: Starting Initial Sessions
- Reading B: Prioritising and Focusing
- Reading C: Stages and Tasks of Helping
- Reading D: Interventions and Plans
So far in your Diploma, you have learned about various counselling skills and approaches. This module aims to bring this information together and expand upon it so that you can better understand how counsellors facilitate the counselling relationship and process from inception to conclusion. We will begin with an in-depth exploration of the skills required to facilitate the beginning phase of counselling, which typically involves the counsellor helping the client to identify concerns before exploring how counsellors can assist clients in working through their concerns.
Counselling has evolved significantly as a helping relationship over time. Following are some key ways in which counselling has transformed and developed.
The shift from expert to collaborative approach: In the past, counselling often followed a more hierarchical model, with the counsellor seen as an expert providing advice and solutions. However, counselling has shifted towards a collaborative approach, recognising the client as an active participant in their growth and healing process. The counsellor now emphasises empathy, active listening, and partnership with the client.
Person-centred and client-focused approach: Counselling has increasingly embraced a person-centred approach, emphasising the uniqueness and autonomy of each individual. The focus is on the client's subjective experience, needs, goals, and values. The counsellor provides a supportive environment encouraging self-exploration, self-awareness, and client-led decision-making and recognising the client as the expert in their life.
Integration of diverse theoretical orientations: Counselling has become more inclusive and flexible by integrating various theoretical orientations and approaches. Therapists draw from multiple perspectives, such as cognitive-behavioural, psychodynamic, humanistic, solution-focused, and cultural models. This integration allows for a more tailored and holistic approach to meet clients' diverse needs.
Increased awareness of cultural and social factors: Counselling has recognised the importance of cultural, social, and systemic influences on an individual's well-being. Therapists are more sensitive to the impact of cultural backgrounds, gender, sexuality, ethnicity, and other social factors on clients' experiences. This awareness informs therapeutic interventions and promotes cultural competency in working with diverse populations.
Emphasis on evidence-based practices: Counselling has become more evidence-based, incorporating research findings and best practices into the therapeutic process. There is a focus on interventions demonstrated to be effective through empirical studies. This helps ensure counselling approaches are grounded in scientific evidence and can produce positive outcomes.
Integration of technology: With technological advancements, counselling has expanded beyond traditional face-to-face sessions. Online counselling, video conferencing, and mobile applications have emerged as additional means of accessing therapeutic support. These digital platforms provide increased accessibility and convenience for clients.
Focus on prevention and mental health promotion: Counselling has extended its reach to encompass prevention and mental health promotion. Therapists work not only with individuals experiencing distress but also provide psychoeducation, develop resilience-building programs, and offer support in maintaining mental well-being. The focus has shifted towards early intervention and empowering individuals to take proactive steps to maintain their mental health.
Ethical guidelines and professional standards: Counselling has developed comprehensive ethical and professional standards to ensure client welfare and professional integrity. Therapists adhere to ethical principles, confidentiality standards, and ongoing professional development to provide high-quality services and maintain clients' trust.
Overall, counselling has evolved into a more collaborative, person-centred, and evidence-based practice that recognises the complex interplay of individual, cultural, and social factors in clients' lives. It continues to adapt and grow, embracing new technologies, research findings, and approaches to serve better the diverse needs of individuals seeking support.
Preparing for the Counselling Relationship
The counselling relationship often begins before the counsellor and client even meet. Counsellors must ensure that any promotional material or initial telephone contact is appropriate and helps set the scene for effective, professional counselling. Additionally, counsellors must be particularly mindful of the initial face-to-face contact with a client.
For counselling to be effective, the counsellor needs to build a relationship of equals. This is easier said than done, especially in the early stages when the client may be feeling vulnerable and insecure, and bearing in mind that it is usual for the client to meet the counsellor on unfamiliar territory, i.e. the counsellor’s consulting room. Striving to keep the room neutral, in other words, free from personal belongings such as books, ornaments and family photographs, is a positive step that counsellors can take to reduce the equality gap. Barriers such as desks should also be avoided, and chairs should be uniform and placed approximately three to four feet apart and slightly at an angle. Being in direct eye contact with the counsellor can leave some clients feeling very uncomfortable or embarrassed. A small clock needs to be positioned where the counsellor can glance at it, and attention should be paid to the lighting and room temperature. A box of tissues strategically placed where the client can easily reach them is a must, and a vase of fresh flowers or a potted plant can add a touch of warmth and colour to the setting and reflect something of your personality. The following figure shows how a counsellor room might look.”
(Adapted from Sutton & Stewart, 2002, pp. 25-27)
During the initial contact, it is vital to greet the client and engage in appropriate contracting activities before beginning the therapeutic process of exploring the client’s story. The fundamental aspects of this process were covered in detail in CHCCSL001 Establish and confirm the counselling relationship, so we will only provide a brief overview here.
Essentially, counsellors must ensure that clients are aware of the counselling service on offer, all relevant organisational processes (e.g., payment schedules, cancellation policies, termination procedures, etc.), confidentiality and record-keeping processes, and the boundaries of the counselling relationship and process before engaging in in-depth counselling work. After this initial contracting, counsellors work with their clients to explore their needs and concerns and engage in the helping process. This helping process begins with the counsellor encouraging clients to share their concerns and tell their stories. However, this process is often easier said than done. Let’s look closer at how counsellors can help clients explore their concerns and begin to tell their stories.
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Reading A - Starting Initial Sessions
Reading A explores some essential practical skills a counsellor may employ to commence the counselling process and initial sessions.
The Purpose of Counselling
Counselling aims to facilitate personal growth, improve mental health, and help individuals lead more fulfilling and satisfying lives. It is a collaborative process between the client and the counsellor, tailored to meet the unique needs and goals of each individual seeking support.
At its core, counselling involves helping clients to share their stories and work towards change. Of course, each client’s story and their way of telling it will be different.
Some of the stories you will help clients tell will be long and detailed; others, short and stark. Some will be filled with emotion; others will be told coldly, even though they are stories of terror. Some stories will be, at least at first blush, single issue stories – “I want to get rid of these headaches” – whereas others will be multiple-issue stories. Some stories will deal with the inner world of the client almost exclusively – “I hate myself,” “I’m depressed,” “I feel lonely” 1– whereas others will deal with the outer world – for instance, problems with finances, work, or relationships. Still, others will deal with a combination of inner and outer concerns.
Some clients will tell the core story immediately, whereas others will tell a secondary story first to test your reactions. Some clients will make it clear that they trust you just because you are a helper, but you will read mistrust in the eyes of others, sometimes just because you are a helper. In all these cases, your job is to establish a working relationship with your clients and help them tell their stories as a prelude to helping them manage the problems and take advantage of the opportunities buried in those stories. A story that is brought out into the open is the starting point for possible constructive change. Often the very airing of the story is a solid first step toward a better life.
(Egan, 2010, p. 99)
Counsellors must help clients tell their stories by first listening to the client’s story and staying with the client’s perspective. Effective listening skills are a central technique that counsellors use to do this. It is important that clients feel as though the counsellor is genuinely interested in what they are saying.
Geldard and Geldard (2012) remind us that the counsellor is primarily a listener:
The first skill for the new counsellor to learn is to put deliberate effort into listening with interest. This needs to be done in such a way that the client recognises that you are totally focusing your attention on what is being said, and are comprehending and understanding it. Listening with interest involves the use of the following:
- Minimal responses
- Brief invitations to continue
- Non-verbal behaviour
- Silence
(Geldard & Geldard, 2012, p. 44)
Of course, counsellors also use a fuller range of the counselling communication skills you have been learning about throughout your Diploma (e.g., active listening, effective questioning, paraphrasing, reflection, and focusing) to continue to help clients to feel comfortable and explore their stories and concerns throughout the counselling relationship and process. Additionally, most counsellors use some variation of the person-centred counselling techniques of unconditional positive regard, empathic understanding, and genuineness/congruence to provide an effective counselling environment to encourage clients to share their stories. The goal is for the client to feel comfortable enough to open up and discuss their concerns. Counsellors often find that staying with the client’s perspective is also an effective technique to facilitate client openness.
‘Taking the client’s perspective’ is another way of stating the ability to understand the internal frame of reference. There is an American Indian proverb that states: ‘Don’t judge any person until you have walked two moons in their moccasins.’ If as a trainee you are to be perceived by clients as receiving them loud and clear, you need to develop the ability to ‘walk in their moccasins’, ‘get inside their skins’, and ‘see the world through their eyes’. At the heart of active listening is a basic distinction between ‘you’ and ‘me’, between ‘your view of you’ and ‘my view of you’, and between ‘your view of me’ and ‘my view of me’. ‘Your view of you’ and ‘my view of me’ are inside or internal perspectives, whereas ‘your view of me’ and ‘my view of you’ are outside or external perspectives.
The skill of listening to and understanding clients is based on choosing to acknowledge the separateness of ‘me’ and ‘you’ by getting inside the frame of reference of the other rather than remaining in your own frame of reference. If you show accurate understanding of the client’s perspective, you respond as if inside the client’s internal frame of reference. However, if you choose not to show understanding of your clients’ perspectives, or lack the skills to understand them, you respond from the external frame of reference. Box 6.1 provides examples of counsellor responses from the external and internal frames of reference.
Box 6.1 Counsellor Responses from the Internal and External Frames of Reference
External Frame of Reference Responses
‘Well, there were other ways you could have responded to your boss.’
‘Let me tell you about a similar experience I had to yours.’
‘Everyone economizes the truth sometimes.’
‘You should show you’re in control more.’
‘You’re a very angry person.’
Internal Frame of Reference Responses
‘You’re frightened by the news that you have breast cancer.’
‘You have very mixed feelings about staying in the relationship.’
‘You’re fed up with your mates.’
‘You really love having him staying with you.’
‘You’re feeling scared about getting your exam results.’
Often you can show that you are working from within your client’s internal frame of reference by starting your response with ‘You’. However, as the statement ‘You should show you’re in control more’ indicates, you can make responses starting with the word ‘You’ which are clearly coming from the external frame of reference and are manifestly directive.
Always consciously choose whether or not to respond as if inside your clients’ internal frame of reference. Think of a three-link chain: client statement/counsellor response/client statement. Trainees who respond from clients’ internal frames of reference allow them to choose either to continue on the same path or to change direction. However, if you respond from your external frame of reference, you can influence clients in such a way as to divert or block trains of thoughts, feelings and experiences that they might otherwise have chosen.
(Nelson-Jones, 2014, pp. 87-88)
Using empathic listening skills and staying with the client’s perspective/frame of reference helps counsellors to join with the client and demonstrate to the client that the counsellor is there to help without judgement. This generally facilitates the client’s readiness to discuss their concerns/issues.
10 Therapy Questions to Get to the Root of the Problem
In this video, Mike Tyrell discusses how ten sample therapy questions you can use in conversations with your clients to help assess their lifestyle, and where changes could be made.
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Check your understanding of the content so far!
Reflect
Consider the impact it might have on a client if a counsellor continued using an external frame of reference during the initial session. Do you think the client would feel understood? Would the client feel safe and confident enough to explore their deepest concerns?
Once the client has begun to tell their story and revealed their presenting issues/concerns, the counsellor will need to work with the client to explore these in more detail. Helping clients gain clarity on the nature and depth of their presenting issues is an important part of understanding the client’s issues/concerns. According to Egan (2010), clarity means assisting clients to move “from the general to the specific.” This includes specific experiences, thoughts, behaviours, intentions, points of view, and decisions. For example, it is more helpful to know that a client was feeling lethargic, had not gotten out of bed in three days, had a fight with their partner, and had decided to quit their job, than to simply accept that the client had been “feeling a little down lately”.
Exploring the background or context of concerns can also help clarify the client’s story and primary concern. The following table provides some examples of the types of questions that counsellors may ask clients to explore different aspects of the client’s presenting issues.
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|---|---|
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(Adapted from the Department of Health and Human Services, 2015)
It is important to note that many counsellors avoid the use of ‘Why’ questions in the initial stages of counselling. Using ‘why’ questions can evoke the client's externalised rather than internalised response. Additionally, some clients may feel they need to justify or defend their position when answering a question beginning with ‘why’. Open questions beginning with ‘What’, ‘How’ and ‘When’ are generally more useful for exploring the client’s concerns.
Asking appropriate questions and fully exploring the nature and depth of the client’s presenting concerns helps both the client and the counsellor better understand the client’s situation. In some cases, this exploration helps clients with multiple concerns understand which is most important for them to address first. However, in other cases, the counsellor will need to guide the client through the process of prioritising concerns.
Human Nature & Counselling - Why your belief in Human Nature is so important in Counselling
In this video, the narrator explores why your belief in human nature is so important in counselling and also the approach that you use as a therapist. He asks you to consider the following questions for reflection about your belief in human nature:
- Do you believe that people are born good, bad or as a blank slate?
- Do you believe that people can ultimately be trusted or need guidance and advice?
- How do we explain the bad things that people do?
- Are people ultimately self-centred and just look after themselves or are ultimately caring and selfless?
- Do we have free will or does a higher power or fate determine our choices and decisions?
- Are people naturally social or self-centred?
- What has the biggest influence - nature or nurture?
- Is Mental Health determined by social factors or genetics?
- Can people change or are many behaviours set after a certain period?
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In many cases, clients will present with a range of issues/concerns they wish to work on in the counselling relationship. Of course, it is not possible to work on every issue/concern at the same time and these issues/concerns will need to be prioritised. A difficulty that many beginner counsellors have when working with a client who presents with multiple issues is knowing how to handle the prioritisation process.
Imagine conducting an initial counselling session with a client who immediately outlines twelve different issues that they want to discuss. It would be easy for a counsellor to feel a little overwhelmed! However, in such cases, an effective counsellor would typically acknowledge all of the issues that the client mentioned by engaging in effective reflection and summarisation, tell the client that they will be able to address them all at some stage of the counselling process and ask the client to start by selecting the issue/concern that is most pressing.
But what if the client indicates that all of their issues/concerns hold equal weight or they feel unclear about which is most urgent? In such cases, the counsellor must work with the client to help them determine which to address first. Some factors to consider when helping a client to prioritise issues/concerns include:
- The impact that the issue/concern is having on the client’s life and functioning.
- The impact of the issues/concerns on significant others in the client’s life.
- The client’s motivation to change a particular behaviour, thought, or emotion.
- The client’s values.
Read
Reading B - Prioritising and Focusing
Reading B elaborates on collaborating with clients to prioritise their presenting issues.
The following extract outlines some additional guidelines and guiding questions that counsellors can use to help clients select and prioritise the issues they wish to work on.
| Guidelines | Guiding questions |
|---|---|
| Start with the presenting issue, the one that best represents why the client sought help. Fensterheim (1983, p.63) observes that relief of the presenting concern often improves the client’s level of functioning and may then make other related issues more accessible to counselling. |
“Which issue best represents the reason you are here?” “Which is the most pressing issue which brought you to counselling today?” “Out of all these concerns you’ve mentioned, identify the one that best reflects your need for assistance.” |
| Start with the primary or most important issue for the client to resolve. Often this is the one that causes the client the most pain or discomfort, or annoyance or is most interfering to the client. |
“How much happiness or relief would you experience if this issue were resolved?” “Can you rank the order of these concerns?” “Let’s start with the one that is most important for you to resolve – to the one that is least important.” |
| Start with the concern or behaviour with the best chance of being resolved successfully and with the least effort. Some issues/behaviours are more resistant to change than others and require more time and energy to modify. |
“How likely do you think we are to succeed in resolving this issue over that one?” “Tell me which of these situations you believe you could learn to manage most easily with the greatest success.” |
| Start with the issue that needs resolution before other issues can be resolved or mastered. Sometimes the presence of one issue sets off a chain of other ones. |
“Tell me which of these situations needs to be resolved before others can?” “Out of the concerns you have mentioned, identify the one impacting you the most.” |
(Adapted from Cormier, Nurius & Osborn, 2013, p.234)
By using guiding questions, such as those outlined in the table, counsellors can ensure that issues are being prioritised based on what the client believes is most important. Giving clients the responsibility for prioritising their concerns is particularly important as it allows them to set the agenda for counselling and helps to foster greater cooperation in the counselling relationship. Prioritising concerns must be a client-led or collaborative process. It is important that the counsellor does not seek to force his/her own values, beliefs, or biases onto the client. Remember, the client is the expert in their own life and success in the counselling relationship depends on the client ‘owning’ their goals.
Experiential Techniques for Deepening Inner Exploration
This video describes powerful techniques to help clients go deeper into their immediate internal experience so they can discover new facets of themselves.
After watching the video answer the question that follows.
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A Note on Issues/Concerns Requiring Immediate Action
While most issues that clients present with can be explored over the counselling process, there are some instances where a client’s issue/concern calls for prompt action. These usually involve time-pressing issues that may have been the impetus for bringing the client to counselling in the first instance. If the client reports an issue/concern that is pressing or time-sensitive, the counsellor should ensure that this issue is prioritised in the counselling conversation. Focusing on issues/concerns relevant to the client’s immediate situation first can assist the client to feel more empowered and in control.
Reflect
Take a few moments to reflect upon how you would help a client with multiple issues/concerns and prioritise these for their counselling plan.
Counsellors may also identify other issues/concerns that require immediate attention, such as when there is a current threat to the client’s safety and well-being. Such client circumstances are known as risk situations and should always be prioritised. Situations of risk that require immediate action include:
- When the client is self-harming or has suicidal ideations.
- When the client threatens to harm another person.
- When a client appears to be experiencing symptoms of mental illness or psychosis.
- When a client is in a state of crisis.
Although these situations may be rare in general counselling contexts, it is important to be aware of a counsellor’s ‘duty of care’ and follow the necessary procedures for assessing risk and crisis intervention. Your supervisor must always be consulted in such circumstances, and your organisation’s policies and procedures must be followed. You will learn more about working with clients in crisis in CHCCCS019 Recognise and respond to crisis situations.
A Note on Referrals
Sometimes, counsellors may need to refer clients to other helping professionals, such as doctors, social workers, psychologists, psychiatrists, or specialist counsellors. Clients may come to counselling with various concerns, including emotional, physical, and mental health issues and matters relating to their living situations or conditions. A counsellor should be able to discern which client needs/issues/concerns can be met through counselling and which would require the expertise of other helping professionals (and hence require referral).
It is also important for counsellors to be aware of their competence, strengths, and limitations. When a client’s needs require specialist counselling skills beyond your level of competence or area of training, it is appropriate to refer the client to another counsellor or helping professional who is equipped to meet that client’s needs. Consultation with your supervisor can assist you in identifying situations that are beyond your limits and require referral.
You must consult with your client, discuss the referral process, and obtain their consent before making a referral. It is also recommended first to contact the professional to whom the referral is being made to ensure the referral is acceptable and appropriate. Most counselling organisations will have a referral directory of relevant referral organisations. However, it is also useful for counsellors to maintain their knowledge of available professionals, services, and supports. When referring, counsellors must follow their organisation’s policies and procedures. Referrals are generally rather detailed documents that provide the referred service/specialist with an overview of the client’s situation. When completing referrals, it is also important to be mindful of the information you include in the referral forms to other services. Sometimes counsellors use industry-specific terminology or shortened comments, which can be a quick way of communicating with others within their organisation, but which can be meaningless or not allow for the full context of a client’s situation to be communicated to external service providers. Care must always be taken when making referrals to ensure they are accurate and well-written.
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A Note on Counselling Plans
Once the client’s needs are prioritised, the counsellor should work with the client to develop specific counselling goals and then develop a counselling plan so that the counselling relationship and process has structure and direction. This helps ensure that both the client and counsellor know the focus and direction of counselling. The development of a counselling plan was covered in detail in CHCCSL001 Establish and confirm the counselling relationship, so we will not go into further detail here. Instead, the remainder of this section of the module will explore some of the key counselling processes and techniques that counsellors use to support clients in working through their concerns throughout the counselling process.
Therapy Interventions Cheat Sheet for Case Notes
This video describes how to make your notes much easier and faster to write, while still keeping your progress notes ethical and maintaining a high clinical quality.
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Clients often come to counselling because they feel ‘stuck’ or unsure about what to do in key areas of their life. The counsellor’s role is to help the client process and move beyond these difficulties. In some cases, the client will have high levels of self-awareness and can clearly verbalise their issues, concerns, emotions, and thoughts. However, in other cases, clients can struggle to identify and verbalise these. As such, counsellors need to be able to use a range of skills and techniques to help clients to better experience and process their difficulties. We will explore some of the most important of these now.
Recognising Emotions
Recognising and responding appropriately to key feelings, emotions, and moods is important for the counselling process and for helping clients experience and process difficulties. A counsellor must be able to observe and identify verbal and non-verbal cues in the client to understand what the client may be feeling. Clients may verbally express various emotions, stating they are feeling sad, happy, surprised, frustrated, disgusted, or fearful. However, for some clients, expressing themselves or identifying their own emotions is difficult. By paying attention to the client’s non-verbal indicators, such as facial expressions, body language, body position, rate of breathing, flushing of the skin, and moistness in the eyes, a counsellor can identify the emotion a client may be experiencing. The following table describes some non-verbal indicators/expressions that could indicate particular emotions. These expressions are generally common across all cultures.
| Emotion | Expression |
|---|---|
| Joy | Relaxed body, open stance, direct eye contact, corners of the mouth turned up |
| Surprise | Eyes wide open, mouth held open, still body position |
| Anger | Rigidity, frowning, clenched fists, the tenseness of jaw |
| Sadness | Slumped posture, corners of the mouth turned down, lowered gaze |
| Fear | Mouth open, lips stretched and drawn back, wrinkles between the brows, visible upper white of the eye |
Of course, counsellors need to confirm the accuracy of their observations. This is typically done using reflecting skills, in which the counsellor tentatively reflects the emotion they have observed and either directly or indirectly asks for the client’s confirmation. For example:
- “It seems as though that makes you sad. Is that right?”
- “David, I sense that you’re feeling discouraged…”
- “It looks like you’re happy with that outcome. Are you?”
- “Lynn, it sounds to me like you’re disappointed with how things went – am I hearing you correctly?”
Appropriately empathising, understanding, and acknowledging the client’s feelings is a fundamental counselling skill. It helps clients feel heard and understood and can also help them to clarify their experiences.
Assisting Clients to Explore and Elaborate on Their Stories and Concerns
As you help your clients to explore their stories and emotions in depth, it is important to support them appropriately. Counselling can be a draining process for many clients, so it is appropriate for counsellors to acknowledge this and ensure the client is comfortable and ready to continue. Doing so can help facilitate the counselling relationship and build the client’s trust in the counsellor. Some common techniques counsellors use to do this include:
- Checking in – The counsellor asks the client how they feel after a period of deeper exploration (e.g., “What’s this like for you?” or “How are you doing with this?”)
- Crediting client’s strengths – Pausing the conversation to give the client deserved appreciation for their strengths (e.g., “It takes courage to do what you’re doing.”)
- Slowdowns – Putting on the brakes, so to speak, to reduce the speed of the session when the client appears to be rushing (e.g., “Take your time, there’s no need to rush” and “Give yourself the time you need.”)
- Validating the difficulty of disclosure – Acknowledging the difficulty of sharing painful stories and emotions (e.g., “This is hard for you, and I respect your willingness to share this with me.”)
These types of acknowledgements help the client feel as though the counsellor is really listening to their story and caring about their experience. Another highly important factor for supporting clients to experience and process difficulties involves moving at a pace that the client is comfortable with. The counsellor should always be mindful of the client’s current experience and not push them to explore issues too quickly. Additionally, if a client is experiencing heightened emotions, it can be useful for the counsellor to allow the client to have a few moments to process this before continuing to explore potentially more emotional issues (Murphy & Dillon, 2015).
Murphy and Dillon (2015) recommend that counsellors take a gradual approach to explore client issues in depth. Having the client tell painful or overwhelming stories in detail can be traumatic for both the client and the counsellor, so it is important that you take this slowly, always monitoring how the client is reacting. Sometimes, a new topic or line of exploration may bring up sudden intense feelings of apprehension or shame in the client. The counsellor, too, may feel uncomfortable with confronting information that the client may bring up. This can create an awkward moment for both counsellor and client. However, by acknowledging the rough spot or moment, you can deepen the counsellor-client relationship: “Something’s just happened. Let’s stop a minute and talk about it. I think it’s important not to just let it go by” (Murphy & Dillon, 2015, p. 201).
Of course, it is equally important for the counsellor to help the client focus on things they can change through the counselling process. When a client focuses too much on past experiences, it can be useful to re-orient or re-focus them to the ‘here and now’ or present moment and discuss changes that can be made. One method to help clients to re-focus on the present is to ‘reflect back’ what you notice in their non-verbal behaviour. For example, if you notice the client’s jaw tensing and eyebrows frowning as they recall something in the past, you might say, “Tell me what you are experiencing emotionally right now”, “Where are you feeling that emotion in your body?” This helps the client to focus on ‘here and now’ physical sensations and become more in touch with their internal experiences.
Clients can get stuck in their past experiences, which blocks and impedes progress. For example, imagine a situation where a client is upset about the emotional abuse she suffered from her stepmother when she was a child. Rather than allowing the client to continuously talk about and ‘re-live’ her experiences in detail, it would be more beneficial for the counsellor to help bring her focus to what is happening within her ‘now’ as she speaks about these experiences. The benefit for the client is to recognise how this is impacting her now and to experience how to respond to those feelings appropriately, helping her move toward her current goals and desired outcomes.
Check your understanding of the content so far!
Reflect
How would you manage a demanding counselling situation, such as a display of intense anger from your client?
Take a moment to reflect and consider how it would make you feel and what skills you currently have that would help you appropriately address the situation.
Let’s look at an example of how a counsellor can use some of the techniques we have discussed to support clients in exploring their concerns.
Case Study
Leona is a counsellor working with her client, Inara, for two sessions now regarding self-esteem issues. During the current session, Inara tells the counsellor that her mother has come to live with her. Leona notices that Inara’s body is rigid, her fists are clenched, and her jaw is tense as she speaks about her mother’s arrival.
| Leona: | Inara, I sense you are feeling angry about this development. Is that right? (Reflection of feeling and check-in) |
| Inara: | Absolutely! Anger is an understatement. I can’t believe my partner dared to call her to come to stay at our home without my permission. It is my house, too, and I am a responsible adult. |
| Leona: | So I understand that you are not happy that your mother has come to live with you. (Paraphrasing) |
| Inara: | I know I shouldn’t talk like this…. It’s just…. (looking down and avoiding eye contact) I don’t get along with my mother. (pause) She’s a very… controlling woman. It has taken me so long to get out of her grip and now… now Neil has spoilt everything by calling her. |
| Leona: | It must be hard to talk about this. I appreciate your willingness to share your hurt. (Validating difficulty of disclosure) |
| Inara: | (Starts taking deep breaths to regulate her emotions) |
| Leona: | I can see you are dealing with a lot. Take your time. There is no need to rush. (Slowdown) |
| Inara: | (Thoughtfully) I didn’t want to go back... |
| Leona: | What do you mean, ‘go back’? (Probing) |
| Inara: | Well, the truth is I have been in bed a lot lately and have been struggling to take care of the kids. I know I didn’t tell you before, but… I have had some issues with depression in the past. I guess Neil was worried about me and called my mum to come to care for me and the kids. But it is so embarrassing for me. |
| Leona: | You feel embarrassed that your mother has been called in to take care of you? (Paraphrasing) |
| Inara: | (softly) Yes. |
This case study provides an example of the importance of fully exploring the client’s concerns and story. In some cases, clients may not reveal the full extent of their issues/concerns. Some issues are difficult for clients to discuss because they are too painful or have never spoken about them. Clients might also decide to “test the water” with you if they are unsure how you will react to them – they might reveal a little bit at a time and carefully watch your response. Taking the time to explore the client’s difficulties fully can reveal these additional issues that can then be incorporated into the counselling plan. Additionally, in some cases, a client’s stated issues and concerns are often a symptom of something else happening in the client’s life. As such, it is always important for counsellors to be mindful of the possibility of underlying issues, parallels, and links in the client’s concerns.
In some cases, a client’s presenting issues and stated concerns may not be the central problem. The following extract provides an example of this.
Susan was a woman in her late 20s. Her presenting problems were: she felt generally depressed, she had no interest in sexual relations with her husband, she felt that their relationship was on a downward spiral, she had no energy or enthusiasm for anything, suffered from severe headaches and had heavy, painful menses. During the first few sessions of counselling Susan was composed and appeared somewhat distant both from what she was saying and the counselling experience. Although she talked openly about her deteriorating relationship with her husband and her lack of sexual drive, she spoke without feeling, completing most statements by rubbing her eyes. I sensed an underlying sadness that was incongruent with her matter-of-fact outward manner. When I related this to her, she told me that two years previously her four-month-old son had died in a ‘cot death’ (also termed Sudden Infant Death Syndrome). When I asked her how she had felt at the time of the death she used the word ‘numb’. She related that she cried at the time but there had always been an air of unreality about it, especially when her husband and relatives kept telling her to ‘try for another baby as soon as possible’ as if the infant was replaceable. She began to cry when I asked her the baby’s name, saying that neither her family nor her friends ever referred to him anymore. For everyone else’s sake she had tried to behave as if she had fully recovered but she never had. Instead, to protect herself, she had cut off from her feelings and this had inadvertently caused close relationships to suffer.
In the sessions we had together, Susan experienced the grief that she had clearly repressed. She talked about the initial shock, the pain, guilt, sadness, anger and helplessness she had felt and continued to feel. She felt immense guilt – blaming herself for the infant’s death. Visits from various sympathetic personnel, including a police interview, only confirmed her fears. She was angry with herself and others ‘for letting it happen’ and angry towards the child for going, as if he had changed his mind about accepting her as a mother. She recalled the way those around her had adopted a ‘hush hush’ approach to the tragedy, which left her feeling rejected and ‘lost’; she yearned to hold and touch her baby.
By acknowledging and re-experiencing the grief she had originally been unable to express fully, she began to understand why she had distanced herself sexually from her husband. She acknowledged that she was terrified of the possibility of having another child; she also felt that she had no right to experience love or pleasure, judging herself to be a bad, neglectful mother who deserved punishment.
(Milne, 2010, pp. 245-246)
Another underlying symptom often overlooked is ‘life stage’ changes that might also be happening in the clients’ life. Many clients do not realise or acknowledge that the changes in their life are causing them added distress. Some common life changes include developing relationships, ending relationships, moving house, moving cities, having children, negotiating adolescence, children leaving home, and retiring. Counsellors need to acknowledge and recognise when a client is experiencing difficulties with life changes and work with them to help them understand the impact that these changes are having on them and, in turn, learn how to adjust to them. Asking appropriate questions to explore the client’s story fully can help reveal the presence of underlying issues.
Reflect
Reflect upon each of the common life changes mentioned in the previous paragraph. What impacts do you think these could have on a client’s life? What ‘symptoms’ might they produce?
As counsellors more fully explore the client’s story, they may also observe parallels and links in the client’s life and issues. For example, clients might talk about different events without identifying a relationship between them; however, the counsellor might suspect a relationship. For example, imagine a client who reports being under a lot of pressure at work and also discussing losing their temper with their partner. Links and parallels often come in themes and patterns, as outlined in the following extract.
People’s lives develop rich meaning and complexity, which at times can be organized into themes and patterns. Because the themes and patterns often reflect some of the client’s central organizing schemas, clinicians must attend to them as they emerge both in the client’s story and in the clinical relationship. Repeating themes and patterns often signal topics important to explore further.
Themes
Themes are repeated sets of ideas and beliefs. They may be expressed directly and with awareness (“There I go again, blaming myself”). However, they often emerge indirectly and without conscious recognition, as when a client describes a persecuting sibling in one session, a persecuting lover in another, a persecuting employer in another, and annoyance at the clinician for “running the show” in yet another. Clinicians commonly encounter client themes of loss, betrayal, oppression, injustice, hopelessness, and despair, as well as companion themes of courage, persistence, survival, and resistance to oppression.
For almost six months, I had been working with Johann on problems with self-control at work. It took me that long to realize that in almost every session, he would mention alcohol. For example, he would say: “Last night a couple of us went out for drinks”; “The other day we put away a couple of martinis at lunch”; or in describing a picnic at work, he said, “We polished off a keg of beer.”
Patterns
Patterns are repeated behavioral or affective sequences. Like themes, patterns may have a great impact on clients’ daily lives, and clients may be aware or unaware of them. Some common patterns observed in client stories include the avoidance of intimacy, frequent angry outbursts, crying when anxious, addiction to substances or people, and picking inappropriate partners. Other patterns include choosing loyal friends, asserting oneself in adversity, protecting vulnerable others, and using spiritual resources.
(Murphy & Dillon, 2015, p. 134)
Another example of a recurring theme can be seen in the following counselling scenario extract:
| Rene: | I do seem to get on the wrong side of people…the rent people, the Social Services. Why me? Would you believe it…but I was even singled out at my last job, and I’m sure that it was because of my personality…the fact that I say what I mean. |
| Counsellor: | I know you’ve mentioned this several times…that you say what you mean. Maybe we should look at that to see how much it might be contributing to the problems you describe. |
In this example, the counsellor focused attention on the client’s insistence that she only said what she felt. This identification of a pattern, or theme, enabled the client to look more honestly at the way she communicated with other people, and the problems this seemed to generate. If at all possible, it is always best to encourage clients to confront themselves, and, in this case, this is exactly what happened. Since the client has already identified her problem in relation to others, the counsellor’s task was simplified as a result.
(Hough, 2014, p. 68)
As the client’s issues and emotions are explored, their recurring themes and underlying issues may start to become visible to the counsellor but not to the client. Therefore, exploring these themes and parallel patterns must be done carefully. Although such exploration can be useful, the counsellor should assess whether the exploration is likely to assist the client in achieving the goals that have been agreed on. It is also important to develop trust and rapport with your client before identifying and highlighting these patterns. We will now look at how counsellors can share ‘hunches’ about the client’s behaviour patterns or other inferences they may make during counselling.
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Sharing Hunches
One of the many ways counsellors can help clients to explore and deal with underlying issues is to offer a gentle challenge, or as is described in the following extract, by sharing hunches:
As you listen to clients, thoughtfully process what they say, and put it all into context, you will naturally begin to form hunches about the message behind the message or the story behind the story. You can share the hunches that you feel might add value. The more mature and socially competent you become and the more experience you have helping others, the more educated your hunches become. Here are some examples:
- Hunches can help clients to see the bigger picture.
- Hunches can help clients see more clearly what they are expressing indirectly or merely implying.
- Hunches can help clients draw logical conclusions from what they are saying.
- Hunches can help clients open up areas they are only hinting at.
- Hunches can help clients see things they may be overlooking.
- Hunches can help clients take fuller ownership of partially owned experiences, behaviors, feelings, points of view, and decisions.
(Egan, 2010, pp. 231-232)
It is important to remember that some clients may reject the counsellor’s hunch. It may offend the client if attempted too early in the counselling relationship. This may be because the counsellor has in fact misinterpreted the client or the client is not yet ready to make the connection that the counsellor has made. A sensitive and well-timed hunch can help clients develop new perspectives and model the process of looking for alternative meanings or possibilities in their thoughts, feelings, or actions. Hunches are not wild guesses but are rather a form of advanced empathy arising from a well-developed understanding of the client. However, they must still be shared tentatively – as a possibility rather than as a conclusion (Murphey & Dillon, 2015). When sharing a hunch it is useful to use phrasing such as “Perhaps…”, “I wonder if….”, and “Is there a chance that…”.
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Reading C - Stages and Tasks of Helping
We have discussed a number of the techniques involved in helping the client share their concerns and be open within the counselling process. A wider range of techniques are outlined in Reading C. Take the time to read through this to more fully understand how counsellors help clients to identify and work through their concerns.
Once the counsellor fully understands the client’s story, concerns, and underlying issues, it will be time to implement specific counselling interventions.
Client discomfort in counselling
This video discusses aspects of client discomfort in the counselling process.
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Implementing Interventions
Counsellors do not just use counselling techniques and interventions at random. Instead, they carefully select the interventions that most relate to the client’s current issues, goals, and circumstances and are most likely to facilitate the client’s understanding and ability to change.
You have learned about various interventions so far in your Diploma (e.g., interventions related to cognitive behavioural therapy, solution-focused therapy, and acceptance and commitment therapy). Depending upon the counsellor’s theoretical orientation, they may use one counselling style or an eclectic mix of useful interventions from several different therapeutic approaches. However, before using a particular intervention, counsellors will reflect upon the purpose and likely outcomes of the intervention and whether or not it is suitable for the client. When selecting interventions, counsellors consider the client’s individual factors.
Numerous client considerations influence both choosing and implementing interventions, including the following:
- Anxiety level and sense of worth. Always take into account how psychologically vulnerable clients are and how badly their anxieties interfere with how they feel, think and act. For example, interventions based on improving marital communication assume that clients can accept some responsibility for contributing to marital distress. Interventions to assist highly anxious clients to initiate friendships may need to wait until they have sufficient confidence to start implementing them. Specific interventions for building career decision-making skills may be premature for clients badly out of touch with their valuing process.
- Motivation and resistance. With its emphasis on developing clients' self-helping skills, motivation is a critical issue in lifeskills counselling. As with goals, clients can say 'yes' to interventions when they mean 'no' or 'maybe'. Assess clients' motivation for implementing interventions and explore potential difficulties and resistances. Clients need to own interventions both intellectually and emotionally in order to exhibit commitment to attaining them. Interventions that bring early rewards, including relief of psychological distress, can enhance motivation.
- Expectations and priorities. Related to motivation is the degree to which interventions are geared to outcomes that clients want and expect from counselling. Always take client expectations and priorities into account. For instance, those who enter counselling wanting to manage an immediate problem may not want interventions focused on longer-term skills building. Clients who see career issues as the main focus for counselling may resist interventions focused on their personal lives.
- Age and maturity. You may need to adjust interventions to the age of clients. Although friendship skills for adults and pre-teen children have similarities, children and adults require somewhat different skills for relating to peer and friendship groups. Take into account how much both children and adults know about relationships. Ways in which you can deliver interventions according to the age and maturity of clients include varying how you use language.
- Intelligence level and ability to comprehend interventions. Depending on their intelligence level, some clients may experience difficulty comprehending certain interventions: for instance, the mind skill of identifying possible misperceptions, generating alternatives and choosing best-fit perceptions. You must work with interventions that clients can comprehend. Ultimately clients have to understand the choices involved so that they can implement lifeskills on their own.
- Culture. Take into account clients' cultures when choosing and implementing interventions. For instance, since the rules for work and personal relationships differ greatly across cultures, relationship skills interventions need to be sensitive to such cultural rules.
- Sex and gender. Depending on their biological sex, clients may have learned different skills strengths and deficiencies. Be careful to avoid fitting clients into masculine and feminine stereotypes. Nevertheless, you can assess where inappropriate sex-role conditioning interferes with the development of clients' lifeskills, and choose interventions accordingly.
- Support factors. Families, peer groups, friendship groups and work colleagues can support or interfere with skills acquisition. Sometimes clients can be trained to identify and use environmental supports better. As part of this process, they may also learn how to be more supportive to others. On other occasions, interventions may focus on helping clients develop skills to protect themselves from environmental pressures.
- Practical considerations. Practical considerations that may influence choice of interventions include pressing current difficulties, threatening upcoming tasks, unexpected challenges and stresses, time available for counselling, whether or not the client lives locally, financial circumstances and so on.
(Nelson-Jones, 2014, pp. 229-230)
Check your understanding of the content so far!
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Reading D - Interventions and Plans
Reading D outlines some key considerations in selecting and implementing interventions with counselling clients.
Ultimately, the choice of intervention must always be in the client's best interests. Two different clients presenting with the same general issue may require different interventions due to their individual differences. The goal is for the counsellor to select interventions most likely to facilitate meaningful change in the client. Of course, this is easier said than done. Counsellors are not future-tellers, and they are not infallible. Counsellors may not always be able to identify the “best” technique or intervention. However, as long as they have taken the time to consider the usefulness and likely effectiveness of each intervention and selected an intervention that they believe will benefit the client, they are likely to support meaningful change.
We try to determine which strategy is best for this individual at this time, given our understanding of the client, his or her problem, our theoretical orientation, and the treatment context. The client’s participation in this decision making increases the possibilities for successful outcomes. We carefully explain to the helpee the approaches we are considering, their rationale, possible consequences, time and activities involved, and any other pertinent information.
(Okun & Kantrowitz. 2015, p. 226)
Principles of Crisis Intervention
Learn about the Principles of Crisis Intervention with this video.
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Let’s look at an example of how a counsellor considers interventions for use with a client.
Case Study
Marjorie is a counsellor working in her own private practice. She has just started working with a new client, Betty, who has sought counselling to help develop her ability to assert herself in her relationships. While exploring Betty’s story, Marjorie begins to suspect that Betty suffers from low self-esteem – Betty regularly indicates a belief that her ideas and opinions are not very valuable. She discloses that she was neglected as a child, which she believes has impacted her ability to assert herself appropriately.
Marjorie considers Betty’s concerns, goals, and individual circumstances and thinks it would be most appropriate to use a combination of person-centred and cognitive behavioural techniques with Betty. Marjorie thinks the person-centred approach would be appropriate because she believes that its focus on emphasising the client’s inner strengths and potential will assist Betty in seeing herself from a new perspective and developing the self-esteem needed to assert herself. Additionally, Marjorie thinks cognitive restructuring techniques would help Betty to help her to restructure her self-defeating thoughts and beliefs and replace them with more adaptive ones that will allow her to become more assertive. Marjorie discusses her conceptualisation of Betty’s concerns with Betty and outlines the approach that she would like to use, obtaining Betty’s agreement before proceeding.
What is a strengths-based approach?
This video summarises the processes and the key elements to consider in relation to using a strengths-based approach.
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When people spend considerable hours focusing on what is wrong with their lives, it can have the effect of causing them to feel anxious and hopeless. In the beginning stages of a counselling relationship, the conversation usually focuses on “what’s wrong” in the client’s life. Clients often arrive at an initial counselling session feeling troubled emotionally and unable to move forward on a particular issue or concern. This is often accompanied by a feeling of helplessness and an assumption or belief that they lack the ability to generate solutions or new options. However, it is the client’s strengths that lead to change. Therefore, it is very useful for counsellors to acknowledge and highlight the skills and strengths that they observe in their clients.
Identifying a client’s strengths and the resources that will help them succeed toward their desired outcomes can be an important part of the counselling process.
Taking a Strength Based Approach
Watch the following example of taking a strength based approach and answer the questions that follow.
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Awareness of their strengths helps clients feel empowered to make the necessary changes and commit to counselling interventions. Some common strengths you may observe in clients include knowledge, experience, skills, capabilities, coping skills, beliefs, attitudes, character traits (such as empathy and resilience), and social supports and relationships. Geldard and Geldard (2012) propose several simple techniques counsellors can use to help clients identify and embrace their strengths. These include:
- Externalise the problem – that is, help the client to recognise that they are not their problems, ‘the problem is the problem’. By separating themselves from the problem, clients are able to gain a clearer perspective of their strengths.
- Look for exceptions – This is particularly helpful in situations where clients use generalised statements such as “I always do the wrong thing.” Point out the times when they did the right thing (i.e., exceptions).
- Identify positive responses to negative experiences.
- Give positive feedback about change that has occurred.
- Be optimistic about the future.
The following extract outlines some counsellor responses that emphasise the client’s strengths:
“It’s amazing how much you got done with almost no support.”
“You said you ‘ran out on every relationship you ever had,’ but you’ve come to see me for 3 months straight now, and this is a relationship. This relationship counts; it’s a very important exception to your stated pattern, and it suggests to me that you do not in fact ‘run out’ on every relationship. Maybe we could take a look at when relationships work for you and when they don’t.”
“I notice you whizzed right over the statement that for the first time, when you felt like drinking this week, you increased your AA attendance. That was such an important step. I’d like to hear more about how you made that change happen.”
“You say you’re embarrassed to talk to me over and over again about job achievements, but I like to hear about them. I think it’s wonderful that things are working out for you now, and frankly, I think you deserve a little more support for your successes than is out there for you right now.”
(Murphy & Dillon, 2015, p. 155)
Identifying and emphasising a client’s strengths assists the process of facilitating meaningful change in the client’s life.
Reflect
Can you think of any other benefits that emphasising client strengths might have? What might happen if a counsellor focused only on the client's ‘problems’?
Praising Client/Emphasising Clients' Strengths
Watch the following video providing an example of a Counsellor emphasising a client's strengths, and answer the question that follows.
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Ultimately, counsellors are responsible for supporting the client throughout the counselling process. This not only involves facilitating an initial exploration of client issues and development of a counselling plan with appropriate interventions, but it also involves incorporating any changes that occur in the client’s life (e.g., if the client’s circumstances and needs change), monitoring the counselling process, making adaptations as needed (e.g., if interventions do not have the expected effect), and working towards the ending of the counselling process.
The counselling process and the counselling relationship go through common stages. A simple but elegant way of structuring the process and the relationship is to think in terms of a Beginning, Middle and Ending.
Stage 1: Beginning – Establishing the relationship and agreeing how to work together
The most important part of this stage is building the relationship. From the start, it is important that the counsellor provides a safe place for the client. The client needs to feel heard in their own terms and feel that they can trust the counsellor to hear and understand what they are saying. In a sense, the counsellor is helping the client to make contact with what is happening for them right now and clarifying what the client wants from counselling and how they are going to work together.
During this stage, the counsellor will be carefully checking their understanding of the client's story through empathic reflections and questions to seek clarification. The counsellor may also start to hear what is unsaid or unacknowledged by the client, perhaps feeding back the 'blind spots' or implied meanings that the client is not engaging with or aware of. Throughout this process, the client is supported in seeking a fuller picture for what is going on for them. With this clarity, the counsellor can then support the client to identify their objectives and choose the focus for their work together.
Stage 2: Middle – Working with the client on their issues towards change
Once the client has clarified and understood their issues and is clear what the focus of the work needs to be, the counsellor uses their knowledge, understanding and skills to actively facilitate the client's progress towards their objectives using skills and interventions consistent with their way of working. Client objectives may vary from specific concrete changes in the external world to more intrinsic internal changes such as self-acceptance or healing. This will depend on the client, the therapist and the nature of the therapy. The middle stage is often turbulent and more ambivalent than the other two stages, as the client struggles with the process of change and responds to the increased depth and challenge of the work. This response is only possible if trust is established and the working alliance solid.
Stage 3: End – Working towards an ending
During this final stage, the counsellor supports and encourages the client in making and living with the changes or finding strategies to achieve their objectives. The counsellor is also preparing the client for the ending so that the client is able to sustain change and manage without the support of counselling. The client is the centre of this process model which can also be applied to each individual counselling session in microcosm. However, it is important to remember that the client will not necessarily work through these stages in a linear way. If there are any breaks or ruptures in the counselling relationship (planned or unplanned), or there is a loss of trust, or an unexpected introduction of new issues into the work, then it might be important to revisit Stage 1, but it is always important to pay attention to the end stage.
(Ballantine Dykes, Kopp & Postings, 2014, pp. 143-144)
Managing Expectations, Creating Space for Gratitude
In this video a counsellor shares his approach about juggling responsibilities and demands.
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So far in your Diploma, you have learned a lot about the beginning stage of the counselling process, some of the key processes of the middle stage (i.e., selecting and implementing interventions), and very little about the ending stage. The remainder of this module aims to fill in some of these gaps. Section 2 of this module will explore some important aspects of the middle stage of counselling, including how counsellors monitor client progress, while Section 3 will explore the key aspects involved in the ending stage of counselling.
Check your understanding of the content so far!
In this section of the module, you have learned about several key skills, techniques, and processes that counsellors use to initiate the counselling process and assist clients to identify and work through their concerns.
- Ballantine Dykes, F., Kopp, B., & Postings, T. (2014). Counselling skills and studies. London, UK: Sage Publication.
- Cormier, S., Nurius, P. S., & Osborn, C. J. (2013). Interviewing and change strategies for helpers. (7th ed.). Belmont, CA: Brooks/Cole, Cengage Learning.
- Department of Health and Human Services. (2015). Prioritising and exploring client's needs. Retrieved from Services Connect Practice Manual http://manual.servicesconnect.vic.gov.au
- Egan, G. (2010). The skilled helper: A problem management approach to helping (9th ed.). Belmont, CA: Brooks/Cole.
- Geldard, D., & Geldard, K. (2012). Basic personal counselling (7th ed.). Frenchs Forest, NSW: Pearson Australia.
- Hough, M. (2014). Counselling skills and theory (4th ed.). Abington, UK: Hodder Education.
- Milne, A. (2010). Understanding Counselling. London, UK: McGraw Hill Companies
- Murphy, B.C. & Dillon, C. (2015) Interviewing in action. (5th ed.). Stamford, CT: Cengage Learning.
- Nelson-Jones, R. (2014). Practical counselling and helping skills (6th ed.). London, UK: Sage Publications.
- Okun, B. F., & Kantrowitz, R. E. (2015). Effective helping: Interviewing and counseling techniques (8th ed.). Stamford, CT: Cengage Learning.
- Sutton, J., & Steward, E. (2002). Learning to counsel (2nd ed.). Oxford, UK: How to Books.
