Reading D

Counsellors and counselling trainees make choices both concerning specific interventions and about interventions used in combination. An important distinction exists between interventions and plans.

Interventions

In lifeskills counselling, interventions are intentional behaviours designed to help clients attain problem management and problematic skills goals. In the context of this and subsequent chapters, interventions mean ‘change strategies’ (Cormier et al., 2013) or techniques.

Interventions or change strategies can be either counsellor-centred or client-centred. With counsellor-centred interventions, you do something to or for clients – for instance, you may give clients advice on how to behave. With client-centred interventions, you develop clients’ capacities to intervene in their own problem and problematic skills areas: for instance, you may assist clients in how to monitor their thinking. The object of all your interventions should be to strengthen clients’ self-helping interventions: ‘I as a counselling trainee am of most use to you as a client if I help you to intervene – at first with my assistance but, later, on your own – to develop and maintain your skills to manage your problems now and in future.’ You require a repertoire of interventions or intervention skills to cover a variety of clients’ lifeskills deficiencies. Because of the enormous range of problems and insufficiently strong skills, sooner or later you may need to specialize in the most useful interventions for the client populations with which you deal.

Plans

Plans are overall statements of how to combine and sequence interventions for managing problems and attaining goals. They are the outlines, maps or diagrams that enable counselling trainees and clients to get from where they are to where they want to be. The term ‘treatment plan’ is sometimes used. A possible risk in employing this term is that it may connote counsellor-centredness rather than your developing clients’ skills to help themselves. The term ‘working plan’ may be more appropriate, since plans provide frameworks within which both you and clients work. Plans outline interventions beforehand. However, as the Roman writer Publilius Syrus observed in the first century BC, ‘it is a bad plan that admits of no modification.’

Choosing Interventions

Many counselling trainees, after agreeing on a shared definition of a client’s problems, experience a sense of emptiness about their ability to do anything useful to help clients attain them. The requirement to choose and plan interventions creates pressure to ‘deliver the goods’. You need time and experience to build a repertoire of interventions that you can apply confidently and competently. Furthermore, even experienced counsellors often find that decisions about interventions are not clear-cut and involve trade-offs between conflicting considerations. Your anxieties about choosing interventions are not in themselves detrimental – how you handle these anxieties is what matters.

Whatever interventions counselling trainees choose in conjunction with clients, you should always offer them within the context of a supportive relationship. A risk for some trainees when breaking down problems, stating goals and specifying interventions is that you become too technique oriented. For some vulnerable clients, until they gain more confidence and insight, the emphasis on them as persons derived from a supportive counselling relationship may be the major intervention. For all clients supportive relationships will contribute to the working alliance and facilitate motivation. Supportive relationships can assist more task-oriented interventions: for instance, by providing better emotional climates for role-plays and coached performance of skills.

Emphasis of Interventions on Managing Problems or Altering Problematic Skills

Counselling trainees and clients may choose to focus more on managing an immediate problem than on altering problematic skills. How you intervene will be heavily influenced by such a decision. For example, there may be more emphasis on problem management when clients are in crisis. They may feel overwhelmed by the intensity of their emotions and be in shock, disoriented, highly anxious, extremely depressed, very angry, contemplating suicide and fearing insanity or nervous breakdown. The objectives of intervention in crises include protecting clients, calming them down and assisting them in here-and-now problem-solving and planning so that they regain a sense of control over their lives. A clear focus on problematic skills is deferred until later, if at all.

Similarly, clients may be faced with coping with immediate problems: for instance, upcoming tests, public speaking engagements or confrontations with difficult people. Together you and the client can develop ‘game plans’ for dealing with the immediate situation rather than emphasize self-helping skills which may warrant consideration later. Or clients may have limited goals: dealing with an immediate problem may be all that they have time or inclination for. Furthermore, your own schedule as a trainee may be so busy that all you have time to offer is emergency problem management assistance.

Counsellor Competence

If your only tool is a hammer, you will probably treat everything as if it were a nail. Wise counsellors know their limitations and strengths. You need to acknowledge the range of interventions within which you can work effectively. Initially focus on building a repertoire of central interventions. For example, helping clients build the thinking skill of identifying, disputing and restating unrealistic personal rules is pertinent to numerous client problem areas (Ellis, 2011). Similarly, helping clients learn skills of delivering verbal, voice and bodily assertive messages has widespread relevance (Alberti and Emmons, 2008). Another criterion for developing a repertoire of interventions is to focus on those of most use to the client populations with which you either work or are likely to work. As time goes by, most counsellors acquire a fund of practical knowledge concerning what goals and interventions to use for which kinds of insufficiently strong problems and skills.

You cannot expect to perform interventions competently without adequate training, practice and supervision. You put much less pressure on yourself if you aim to achieve limited agendas well rather than attempt too much. Though some trainees are over-ambitious, many underestimate their potential to help. This may lead you either not to suggest interventions or not to implement them confidently. Self-consciousness and a degree of discomfort are inevitable when learning new interventions. If under-confident, you require good training and supervision coupled with realistic self-appraisal. In addition, be open to client feedback about how well you implement interventions. Experienced counsellors too may doubt themselves as they take risks to develop their repertoire of interventions. Nevertheless, it is important that they continue to build their skills.

Client Considerations

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 focused 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 resistance. 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.

Development of Self-Helping Skills

Some interventions may directly address issues of clients maintaining skills: for instance, helping clients develop realistic expectations and explanations of the reasons they experience difficulty in acquiring and maintaining skills. You can also choose to implement interventions in ways that emphasize self-helping: for instance, by ensuring that clients understand and can verbalize the sequence of choices involved in specific skills – an example is that of self-administered relaxation as contrasted with counsellor-administered relaxation.

Appropriateness of Group Interventions

Some clients might best attain some or all of their working goals by attending one or more lifeskills training groups. Others might benefit from joining longer-term interactional groups, if possible also incorporating a skills focus (Corey, Corey, and Corey, 2013; Yalom and Leszez, 2005). Considerations relevant to selecting group interventions include the nature of the clients’ problems; availability of appropriate groups; and clients’ willingness to participate in group work instead of, concurrently with, or after individual work.

Appropriateness of Third-Party Involvement

Sometimes counselling trainees may choose to work with people who are part of clients’ environments. Those working in schools with depressed or acting-out pupils may, with permission, choose to work with parents or families as well. You can also involve third parties as counsellor’s aides. For example, you can enlist parents, teachers, or peers to help shy clients to develop confidence and communication skills. In work settings, you can enlist the help of supervisors and managers, for instance in developing employees’ public speaking skills. On other occasions your interventions with third parties may even involve advocacy on clients’ behalf.

Appropriateness of Referral

When making referrals, you generally assess that other counsellors or helping professionals can deal with clients’ problems and problematic skills better than you can. You may start making referral hypotheses in stage 1 of the lifeskills counselling model. Whether or not you implement them then or in subsequent stages depends on whether and when you become sufficiently certain that referral is in your clients’ best interests.