Developing Counselling Skills for Health and Social Care
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Counselling is a vital part of health social care and it is important to master the counselling skills that make it possible for any health or social care worker to become an effective counsellor. In this paper, I will discuss how theoretical perspectives apply to counselling work in health and social care, how boundaries and ethical codes are applied in this field and the role of counselling interactions. I will also look at the counselling interactions that take place in health and social care, factors influencing these interactions and the individual benefits of such interactions.
1.1 There are many theorists who have made significant contribution to counselling. In fact, all the perspectives that are applied during counselling are rooted to some assumptions which make up what are known as the counselling theories. The three central theories are the person centred theory by Carl Rogers, the psychodynamic theory by Sigmund Freud and the cognitive behavioural theory by J. B Watson. There are many other theories that are used in counselling today such as the information educational, the family system counselling and many others. Perspectives on the other hand are the approaches that the therapist uses to work together with the client to resolve an issue, Davis T, (2004). The client centred or person centred therapy by Carl Rogers emphasises the need for three conditions for counselling to take place. The three conditions are empathy, congruence and unconditional positive regard (UPR), Rogers C, (2003). Carl uses what he refers to as the actualising tendency that looks at a person as a whole and motivated towards achieving their potential. The psychodynamic model of Sigmund Freud emphasises on the effects of aggression on the behaviour of a person. He cited free association and dream analysis as some of the features that can be used in this approach. The cognitive behavioural therapy focuses on how the environment influences the behaviour of an individual. Classical conditioning, discovered by Ivan Pavlov is a core part of this therapy and it focuses on studying a person’s overt behaviour rather than their mental processes. It is on the basis of these theories that a counsellor is able to choose which perspective to use in providing professional help to a client in the counselling process. To make reference to these theories, a counsellor can use psychology and counselling textbooks or use the internet which is rich with this kind of information.
1.2 There are different theoretical perspectives that are used in the counselling process. During a counseling interaction in health and social care, the counselor gets to use various counseling perspectives and skills that are suitable to that kind of environment. In health care, the counselor will be dealing with patients who are facing physical challenges while majority of the social care clients will have emotional disturbances. It is important to be equipped with a number of counseling skills that are suitable for use in these areas. The psychoanalytic perspective of counseling which is based on natural or biological instincts, the power of the unconscious motivations and early childhood experiences is one of the theoretical perspectives that can be used in health and social care. This theory was developed by Sigmund Freud who is one of the most prominent psychologists (Cox, 2000). Freud used to work with patients of mental health and it is by observing them that he developed this theory. It therefore goes without saying that it will also work well in this kind of a setting. When the patients become aware of their unconscious thought processes they will be able to take charge of their behavior. The rational emotive theoretical perspective may also be used in social care in counseling people with emotional disturbances. This is because much of the emotional disturbances they are going through are caused by frustrations brought by their inability to meet certain expectations set by others or by themselves. This theory therefore focuses on overcoming the self indoctrination that the person has developed and the need to attain an ideal state. The counselor challenges the client to replace the distorted thought patterns with rational thinking, Albert E, & Debbie J, (2011).
On the other hand, the person centered theoretical approach emphasizes that people have a good nature and they have the ability to solve their own problems without the intervention of the therapist, Neal A, & Diane M. (2004). this theory can also be used in the health and social care counselling setting.
The approach will be effective because Carl Rogers explains that the client is the one who know their problem better and they are therefore the ones who are better placed to resolve their issues. The therapist serves as a facilitator who only helps them tap in to their inner strength and use it to find a solution, Carl R. (1980). For the counsellor to use the person centered or the client centered approach, there are three conditions that Carl said must be met. The first one is unconditional positive regard, which basically means that the counselor treats all clients equally with a positive regard irrespective of their social, political, economic and cultural background. The second condition is that the counselor should express congruency which means that the counselor has to be honest with the client and avoid giving them false hope. Where the counselor feels they cannot help, they should refer the client. The third one is empathy. Empathy is very different from sympathy and it means that you as the counselor is walking in the client’s shoes and you are actually feeling the client’s pain. This helps the client to feel that they are not alone and that the counselor is listening to them. The eclectic counseling approach is perhaps the most widely used probably because of its flexibility. It is an approach that combines ideas from all the other theories. Clients are different and there is no proof that a single theory can solely be used to solve a specific problem, Mark E. (1991). This is where the eclectic counselor comes in and selects the best concept or construct to use in helping the client find a solution.
2.1 Current ethical guidelines for counselors and supervisor are a set of moral codes put in place by the association of mental professionals to achieve some goals that include, preventing clients from exploitation, professionalism and defining appropriate behavior for counselors and supervisors. It is expected that every mental health professional is familiar with the professional code of ethics and applies the same during practice. Adhering to these ethical guidelines in health and social care ensures that the counselor acts with ultimate professionalism which is vital for a result oriented relationship with the clients. It also ensures that the profession is not abused or misused, Elizabeth R. (2009). The clients, who are usually vulnerable, are protected from exploitation by these ethical guidelines. Maintaining confidentiality as a code of ethic encourages the clients to trust the therapist and this is instrumental in initiating the counseling relationship as well as maintaining it and resolving the issues that the client may be facing. The counselor may however require seeing a therapist once in a while in order to prevent burn out. Burn out occurs when the therapist has accumulated a lot of issues and keeps to themselves in an attempt to maintain confidentiality. It is important to note that there are cases when the therapist may break the confidentiality especially when the client is threatening the life of others or has suicidal tendencies.
2.2 There are legal factors that should be considered in counseling interactions in health and social care. These may not be different from the legal factors that should be considered in any other counseling setting. The first one and most common to all counseling sessions is the ability of the therapist to maintain confidentiality. If confidentiality is broken for any other reason other than what is provided in the ethical guidelines, the counselor faces some serious legal implications. On the other hand if the counselor fails to break confidentiality when it mandatory to do so, like when a client intends and threatens to commit suicide, they face serious legal implications. The counselor is also not expected to have carnal knowledge of the client. This is especially true when you consider the fact that most clients in health and social care are not self referred, they are vulnerable and unable to make proper choices in their current state. If there are minors involved, their parents or guardians should be informed on the progress of counseling. Although confidentiality should also be maintained when dealing with minors, there are instances when it can be broken especially where the law is involved Christopher C. (2001). These instances include when a therapist feels that the child may cause harm to self or others and when the child is facing abuse or neglect. If the client is an elderly or disabled person and the counselor has evidence that they are being abused, subjected to financial misuse or neglected, the therapist is required to break the confidentiality by reporting to the relevant authority. Court orders may also require certain information from the counselor and in such a case, the only way out is breaking confidentiality. The concept of confidentiality should be explained to the client appropriately at the beginning of the counseling relationship in what is professionally referred to as structuring. This enables the client to develop confidence in the counselor as well as be aware of the counselor’s abilities and limitations Mary, A., & Melanie, M., (2010). Breaking confidentiality where it is meant to be upheld will land the counselor into legal problems and they may even lose their professional license.
2.3 Supervision is one of the most important experiences in counseling. Therapists are not only supervised when they are beginners but may be supervised even after many years of working as counselors. Supervision is usually done by a more qualified therapist who is ready to help by serving as the counsellor’s therapist. This happens when the counsellor is not sure whether they are on the right track and so they consult another therapist to discuss the client’s issues and have some kind of a collaborative effort. The name and other basic details of the client that could identify them are disguised to ensure that confidentiality is upheld. Supervision helps to increase the competence of the consulting therapist. It also serves to prevent burnout from occurring by avoiding the accumulation of complex unresolved issues. Supervision is also very important in protecting the beginner counsellor from engaging in practices that could lead to legal implications such as being sued. In general supervision provides a platform for the upcoming therapist to master the counseling skills with the supervisor as the point of reference. It is a tool that is used to protect the professionalism by ensuring that counsellors are fully qualified before they set off independently. The supervisor serves as a reference point for the counselor and represents the trainee counselor in legal matters. For trainee counsellors, supervision is mandatory because it does not only help the counselor ace their work, it also helps them evaluate the progress of their client. Supervision helps counsellors to be aware of their own feelings, thoughts, possibilities and limitations as counselors. It enables put to place the theoretical knowledge they have acquired during training under the watchful eye of the supervisor. This is vital in making them autonomous and helping them to develop professional confidence.
3.1 The scope of counselling support available for individuals using health and social care services include individual counselling as well as group counseling. Individual counselling which is more widely used has a number of counselling services that are tailored to meet the specific needs of the client. Geriatric counselling which is focused at counselling the aged and retired or retiring people is a service that should be available at social care centers Gary J. (2001). The aged are faced by physical and cognitive challenges and their capacity to make informed choices is limited. The geriatric counsellor is faced with the task of choosing the best health care and social care services for their aged clients. The task involves making arrangement for delivery of items like groceries, transport housing and socialization. The geriatric counselor literally serves as the manager to the affairs of the aged client. Genetic counselling is the other type of service that one would expect to get here. In health care centers, genetic counselling targets to get a detailed family medical history in order to determine the risks of getting certain types of illnesses such as breast, colon, uterine and ovarian cancers. The counsellor works together with the doctors to carry out a blood test that will indicate whether the client is predisposed to such diseases. The major task facing the counselor is not carrying out the tests or making the arrangements for them to be carried out, but rather offering the pre-test and the post-test counseling Peter, S. (2010). It is the counsellor who identifies the need for these tests and provides the client with available alternatives. The counsellor at the health and social care units also provides referral. It is a professional and ethical requirement that the counselor refers the client to a facility that will offer the kind of help the client requires.
3.2 Most of the social workers or counsellors work in poverty ridden areas and this limits their ability to offer professional help because the people may not afford it. The other major factor that may negatively influence the use of counselling interactions in the health and social care is language barrier. The clients may not be able to speak English or the language the counselor is using and this will weigh negatively on the ability of the client to effectively express their problem and that of the counsellor to understand the client effectively. Consequently this is bound to render the interaction less fruitful than it would otherwise be. There are other factors that enhance the counselling interactions in health and social care. One of these factors is the fact that the clients are mostly willing to work together with the counselor because they have either been referred by a doctor or they are self-referred and therefore already have confidence on the counsellor. The process of initiating a counselling relationship is therefore relatively smooth and fast. The fact that there are many people facing similar challenges makes it easy to utilize group counseling which is effective because of the various advantages associated with it, Barbara E. (2008). A counsellor working at a health center may appear as a doctor and this makes it hard for the clients to differentiate the two.
3.2 There are many benefits that are associated with counselling interactions for individuals within health and social care. The most fundamental goal of counseling is to make the client feel better about themselves and feel more secure. Most clients in the health and social care centers have physical health challenges of one kind or another. Lack of mental well-being only serves to worsen their physical health. For this reason, counselling interactions provide an avenue where the clients can improve their mental health and this will consequently lead to improved physical health. By reducing the amount of stress and learning some coping skills, the clients live a happier life and feel successful which is important in boosting their self-image and esteem. Though not the main aim of counselling, it helps to uncover critical problems that the client may be subjected to by other people. This is especially so when the client is a minor or is disabled and has been neglected or is being tortured in which case confidentiality may be broken. Once the client is mentally healthy, they are able to identify their goals in life. The client then learns new behaviors that will help them in achieving their goals. Process involves being conscious of defeating behavior that the client has exhibited and actively abandoning them for more helpful ones, Albert & Debbie. (2011). The individual client is able to come up with techniques that will help them reach their goals. For the elderly, the counselling interaction offer an opportunity of being listened to by a compassionate and understanding professional. This in itself is therapeutic and it also provides a time to address those issues that are raising concern in the life of the client. It helps them understand their ‘significant others’ better as well as master their own emotions thoughts and feelings.
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