Building Counselling Relationships

Introduction

The most important element in a counselling relationship, whether a single session or long-term counselling, is the quality of the relationship between the counsellor and the client. For this reason, basic counselling courses spend a large amount of time on how to effectively build relationships.

There are five factors influencing the counselling process:

  1. Seriousness of the presenting problem (the more distressed a client is, the greater improvement they will experience)
  2. Structure (helping clients understand what counselling will involve, setting time limits and expectations, etc.)
  3. Client initiative or motivation
  4. The physical setting in which counselling occurs
  5. Client and counsellor qualities

Seriousness of Presenting Problem

The more distressed a client is when they first come in for counselling, the greater the reduction in distress they will experience during counselling. (Leibert, 2004)

Edwin Schneidman once said that the more intense the crisis, the less trained an individual needs to be to respond. This is why many individuals are talked down from bridges by totally untrained individuals while the management of low-level suicidal ideation requires extensive clinical training.

Structure

The structure of counselling helps build relationships by providing expectations. This involves setting practical limits like an understanding of the length of sessions, explaining what will happen during each session, letting clients know what they can do in emergencies or high-risk crisis situations, and other elements that impact the procedure of counselling.

Most clients experience anxiety before the counselling session so the more expectations will help.

Client Initiative

Clients may be reluctant to enter counselling or even mandated to attend because of the legal system, mental health treatment or other situations. Gladding and Alderson (2012) give several suggestions for how clients can help provide initiative to clients:

  • Anticipate the feelings a client may display
  • Demonstrate understanding, acceptance and a non-judgemental attitude
  • Try to persuade clients of the benefits of proceeding through counselling
  • Use of gentle confrontation (point out how client behaviours are moving them away from their goals)

Physical Setting

Pressly and Heesacker (2001) noted that physical elements in a counselling office can contribute to the development of the counselling relationship. For instance, brighter colours were associated with more positive emotions, while softer light was associated with more positive feelings than more intense light.

As well, physical barriers between client and counsellor (like a desk) has been associated with reduced perception of empathy.

 

Empathy

Empathy is the ability to enter a client’s world and understand their perspective. (Rogers, 2007) Empathy may be separated into two categories: primary empathy and advanced empathy. Primary empathy is the ability for a counsellor to respond in a way that shows they’ve understood the situation a client is experiencing. (Singh, 2015) This is the level of empathy that crisis line workers aim for. On the Carkhuff and Truax Scale this is level 3 or Interchangeable or Reciprocal Level of Responding.

Advanced empathy is a more indepth procedure, helping to bring elements the client was holding subconsciously or below their awareness. (Veach, LeRoy & Bartels, 2003)

Building an Effective Working Alliance

While a counsellor can use empathy during their conversation during a client to begin building the relationship they need to continue establishing the 3 components required for an effective working alliance identified by Horvath (2001). Working Alliance consists of three components:

  1. Agreement about what goals to be accomplished in therapy
  2. Agreement about tasks (how will those goals be accomplished)
  3. Bond between counsellor and client

Attending Behaviour

Attending behaviour is the physical and behavioural choices a counsellor makes in order to show a client that they are paying attention. The acronym SOLER (Egan, 2007) is one acronym to remember how to show attending in person. The SOLER elements apply only to those in Western (North American or other British cultures) – it is important to modify your approach for other cultural backgrounds.

  • S – Sit Squarely
  • O – Open Posture
  • L – Learn Towards the Client
  • E – Eye Contact
  • R – Relax

References

Egan, G. (2007) The Skilled Helper: A Problem Management Approach to Helping. 8th ed. Thomson Brooks/Cole: Belmont, CA.

Gladding, S. T., & Alderson, K. G. (2012). Building counselling relationships. In B. Brandes (Ed.) (2016), Introduction to counselling (2nd Custom Edition) (pp. 113–140). Toronto, ON: Athabasca University/Pearson Education Canada.

Horvath, A.O. (2001) The Therapeutic Alliance: Concepts, Research and Training. The Australian Psychologist. 36(1). 170-176. doi: 10.1080/00050060108259650

Leibert, T.W. (2006) Making Change Visible: The Possibilities in Assessing Mental Health Counseling Outcomes. Journal of Counseling and Development. 84(1). 108-113. doi: 10.1002/j.1556-6678.2006.tb00384.x

Pressly, P.K. & Heesacker, M. (2001) The Physical Environment and Counseling: A Review of Theory and Research. Journal of Counseling and Development. 79(2). 148-160. doi: 10.1002/j.1556-6676.2001.tb01954.x

Rogers, C. (2007). The necessary and sufficient conditions of therapeutic personality change. Psychotherapy: Theory, Research, Practice, Training. 44(3), 240-248

Singh, K. (2003) Counselling Skills for Managers. Prentice-Hall: Delhi, India.

Veach, P.M., LeRoy, B.S. & Bartels, D.M. (2003) Responding to Client Cues: Advanced Empathy and Confrontation. In: Facilitating the Genetic Counseling Process. Springer, New York, NY

Cite this article as: MacDonald, D.K., (2017), "Building Counselling Relationships," retrieved on November 17, 2017 from http://dustinkmacdonald.com/building-counselling-relationships/.
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Suicide to Hope Workshop Review

Introduction

Today I had the opportunity to attend the Suicide to Hope Workshop offered by LivingWorks. This course is a complete overhaul of the suicideCare Workshop that was previously offered by LivingWorks. The seminar takes 8 hours, and includes a participant workshop (like ASIST) and also some handouts that can be used with clients. The purpose of Suicide to Hope is to provide long-term suicide prevention work after the suicide crisis is over and immediate safety is secured.

Pathway to Hope

The key to the Suicide to Hope model is the Pathway to Hope or PaTH. There are three phases (Understanding, Planning and Implementing) and six tasks. These six tasks are:

  1. Explore Stuckness
  2. Describe Issues
  3. Formulate Goals
  4. Develop Plan
  5. Monitor Work
  6. Review Process

The purpose of the workshop involves understanding how to do this, moving through each phase. In contrast to the old suicideCare workshop, Suicide To Hope is much more concrete. The goal is to identify the “stuckness” – the elements that an individual was having trouble moving through in order to reduce their suicidality going forward.

Workshop Structure

Prior to attending the workshop some pre-reading on the theoretical and empirical underpinnings of the worksheet. Once the workshop starts, registration is completed and participants are directed to a Helper Qualities worksheet. This sheet contains 20 values like “Belief in suicide recovery”, “Courage to face the pain” and “Tolerance for risk.” These qualities are looked at throughout the workshop.

Next is a review of the workshop and the five principles of hope creation. These five principles are ways in which a client can experience growth and recovery. They include:

  1. Suicide
  2. Safety First
  3. Respect
  4. Self-Growth
  5. Take Care

Essentially these principles mean that the experience of surviving suicidal thoughts or suicide attempts may represent an opportunity for growth. Ensuring a client’s safety will ensure they’re in the right frame to begin recovery and growth work. Respect for the client is key to building a strong helping relationship with them. Self-growth refers to “walking the talk”, and being able to be true to yourself. The final principle involves being careful to apply the model and not oversimplifying or forgetting client’s uniqueness.

The Three Phases are reviewed, and video illustrations are included throughout. These include some short clips demonstrating individuals who are safe but still suicidal, followed by clips of their recovery and a 25 minute single-take demo to really cement the learning.

A short roleplay experience in a triad helps individuals become more comfortable with the variety of tools that are provided (such as the questions to ask and the worksheets that are available.)

The ABCs of Safety

One of the really useful elements is a sheet titled “The ABCs of Safety”, which is an excerpt from the Suicide to Hope Planning Tool provided to workshop participants. This includes some checkboxes under the headings “I am ready to start R&G work”, “I know how to keep myself safe while doing R&G work” and “I know how we will work together.” These elements ensure that clients entering into recovery work have a safety plan and understand informed consent elements related to the treatment or service provision they will be receiving.

Conclusion

I found the Suicide to Hope workshop a vast improvement over the old version. The materials would be extremely useful for case managers, counsellors, psychologists, social workers, therapists and other professionals that are providing support to individuals struggling with suicide.

To learn more about Suicide to Hope you can read about it on LivingWorks’ website or find available training opportunities here.

Cite this article as: MacDonald, D.K., (2017), "Suicide to Hope Workshop Review," retrieved on November 17, 2017 from http://dustinkmacdonald.com/suicide-hope-workshop-review/.
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