1.3
The Counseling Stages

The School of Health Sciences, Ngee Ann Polytechnic, Singapore

Part 1 The Counseling Stages

STAGE 1: RELATIONSHIP BUILDING - INITIAL DISCLOSURE

At the beginning of a conversation the counselor evaluate each others aims and concerns, and the communication situation as a whole, and this evaluation directs the entire discussion because the participants base their actions on it (Goffman, 1982). In a hospital, it is typical that nurses initiate a discussion.

The first step involves building a relationship and focuses on engaging patients to explore issues that directly affect them. The first interview is important because the patient is reading the verbal and nonverbal messages and makes inferences about the counselor and the counseling situation.

For forming rapport and gaining the patient’s trust -

Assuring confidentiality and discussing limits of confidentiality
Allowing ventilation
Allowing expression of feelings
Exploring the problem(s), asking the patient to tell their story
Clarifying patient expectations (goals) of counseling
Describing what the counselors can offer and their method of working

STAGE 2: IN DEPTH EXPLORATION - PROBLEM ASSESSMENT

This step involves the collection and classification of information about the patient’s life situation. Assessment refers to anything counselors do to gather information and draw conclusions about the concerns of patient's.

Why Assess Patient

It should be remembered that you are assessing your patient not for the purpose of judging or evaluating him/ her. The purpose of assessment is to seek clarification; you want to know about your patient These are following reasons for assessing a patient-

Enable counselors to make an accurate diagnosis
Determine a person’s suitability for a particular treatment plan
Enable counselors to develop a treatment plan
Make goal-setting easier and achievement of goals measurable
Enable assessment of environment or context
Facilitate generation of options and alternatives

What to Assess

Here, the counselor tries to gather specific details regarding the nature and content of the problem presented by the patient. To understand in more detail the problem stated by the patient, the counselor could explore the following areas:

Feelings associated with the problem (e.g. anger, fear);
Thinking associated with the problem (i.e. the client’s beliefs, perceptions);
Behaviors associated with the problem (e.g. rude, insults, avoids being in a crowd);
Physiological complaints associated with the problem (e.g. stomach aches, unable to sleep);
Interpersonal effects (e.g. quarrels with family members, keeps to himself/herself )

STAGE 3: GOAL SETTING - COMMITMENT TO ACTION

Setting goals is very important to the success of counseling. It involves making a commitment to a set of conditions, to a course of action or an outcome. Goals are the results or outcomes that client wants to achieve at the end of counseling. Goals help the counselor and patient determine what can and what cannot be accomplished through counseling. With clear goals, patients are more likely or motivated to work toward achieving those goals.

With goals patients learn how to structure their lives towards achieving the goals.
With goals, it is easier for the counselor to select and evaluate appropriate counseling interventions.

When goals are stated clearly, both the counselor and client have a better understanding of what is to be accomplished. Clarity of purpose allows the counselor to work more directly with the patient’s problems.

STAGE 4: COUNSELING INTERVENTION

There are different points of view concerning what a good counselor should do with clients depending on the theoretical positions that the counselor subscribes to. For example, the person-centered approach suggests that the counselor gets involved rather than intervenes by placing emphasis on the relationship. The behavioral approach attempts to initiate activities that help patients alter their behavior.

After completion of the counseling intervention -
- Patient acting upon plans;
- Patient managing and coping with daily functioning;
- Existence of a support system and supports being accessed; and
- Identification of strategies for maintenance of change.

STAGE 5: EVALUATION, TERMINATION OR REFERRAL

Terminating the counseling process will have to be conducted with sensitivity with the patient knowing that it will have to end. Note that each of these Stages continues even though the counselor and the patient moves to the next step.

For example, after built a relationship, the counselor moves to Stage Two which involves assessing the problem encountered by the patient. In the meantime, the counselor continues to strengthen the relationship that has been built. In other words, Stage One or the building of a relationship does not stop but is ongoing until Stage Five which involves termination or perhaps the patient is referred to for further action.

Additional Resources

Read this article to find out more about counselling the terminally ill. Click here.

Part 3 The Counseling Stages in Motion

Here is a short video from Mometrix Academy to sum up the 5 stages of the counseling process.

This web-lecture by Mometrix Academy can be found in Youtube via this link: https://www.youtube.com/watch?v=vrfN4q3d-dg

Next Section

We will now move on to take a closer look at the Summary of Learning.

References

McKenzie, R. (2002). The importance of philosophical congruence for therapeutic use of self in practice. In D. Freshwater (Ed.), Therapeutic nursing: Improving patient care through self awareness and reflection (pp. 22-38). SAGE Publications Ltd, https://www.doi.org/10.4135/9781446220719.n2