This week we looked at enabling the client to identify and focus on their needs and concerns. They might not know where to start, what they want to talk about or even have the capacity to put those thoughts into words. Counsellors identify any difficulties clients have, and use the relevant skills to enable the healing process.

We had a discussion exploring the difficulties that client might have of verbalising concerns and prioritising them. These difficulties were wide ranging and quite diverse. It could be that a person has no idea where to start with their problems, and a scattershot approach of trying to explain everything at once results in too much information being divulged in a short space of time, possibly overwhelming the counsellor and client. A person may not even be able to specify why they feel they need therapy – they could simply have an underlying feeling that something is not right in their life and have a compelling need to explore it with the help of a professional. A parent could be forcing a child to go to therapy, in which case, the child may not be able to put words to the behaviour that their parents feel they need to talk about, or even know that their behaviour is wrong or not pleasing their parent. A client could be in denial – they could feel that they don’t have a problem as such. It could be that a client is a repressed or controlled individual, the person that simply says “yes” to their family and friends and sees nothing wrong with that.

People who have experienced traumatic events may not be able to put their experiences into words, especially if they were young when the events occurred. They may not have formed the conscious memories of the event, or have the mental ability to process something they have so little recognition of. A person trapped in an abusive relationship could be scared to tell the truth or even simply explain their side of the story for fear of the repercussions. A client that suffers from social anxiety could have problems dealing with talking to a stranger about their problems, not to mention even turning up to therapy in the first place. A person could have very high expectations of themselves and think that they should be ok and don’t really need counselling. Or someone who needs help might simply be too embarrassed or ashamed and not feel able to express themselves openly and fully.

The skills needed to enable the client to identify and focus on their needs and concerns, as well as assist the client stay focused throughout the session are identified as follows: Establishing a relationship with a client is important. A counsellor paying attention and asking a client how his hiking weekend went shows a degree of personal care that goes a long way towards building a relationship. Building trust into that relationship is also incredibly important; it makes the client feel more inclined to open up so the discussion can go deeper. This can be achieved by being non-judgemental and showing genuine, congruent interest in what the client is saying. Showing empathic responses also builds trust; it shows that a counsellor understands how the client feels as well as understanding what the client is saying.

Devoting the entire initial session to working out what problems the client would like to tackle is sometimes a good place to start if they don’t know where to begin. If a client has a wide range of issues, it would be useful to look at what is troubling them the most right now. While it can sometimes be useful to go back and determine a person’s relationship with their parents or delve into a particular traumatic event, dealing with the here-and-now is more helpful because it is at the forefront of a person’s mind, and if they can feel a little easier about their current situation, or get it a little bit straighter in their head, then that could cascade backwards through their personal timeline, and go a long way towards them identifying, coming to terms with, and solving problems from their past. It is also possible to put very sensitive matters to one side for the time being and come back to them later if either party does not feel it is the right time to start discussing them. This could be because the counsellor doesn’t think they have enough time left in a session to do the matter justice, or the client simply doesn’t feel ready to tackle it yet – it is totally acceptable to not discuss an issue for whatever reason. A thought or memory doesn’t have to be discussed just because it has made the counsellor and client aware of its presence.

Related to this, it is important for a counsellor to recognise defence mechanisms, both conscious and unconscious, that a client uses when they are not comfortable in discussing something. This could be a change in body language on the part of the client such as a crossing of the arms or legs, turning their body partly away from the counsellor, or suddenly looking down and going quiet, re-experiencing all those heavy emotions. This could also be them abruptly changing the subject or even ignoring a direct question on the subject – immediacy is a key skill here. If you make it clear that they don’t have to necessarily talk about the subject right then, you can use immediacy to ascertain whether defence mechanisms have been activated.

It’s always wise to check in with the client frequently to see if you are going too far. And it is ok to use silence to give a client time to work out what they want to say and how to say it. As stated above, if a client is looking down then they are re-experiencing an emotional event. Let them have time. Silence is golden.

Using Ego-states from Transactional Analysis can be a useful tool in seeing things from the client’s frame of reference and understanding their perspective. It is not at all necessary to inform the client that they are currently in a Child Ego-state, chances are they wouldn’t understand unless they were into psychology and may even take it as an insult; but quietly establishing whether they are in a Child, Adult or Parent Ego-state can go a long way to explaining the things they are saying and how they are behaving. Reflecting and summarising are good ways to help keep a client focused as well. Acknowledging someone’s emotional state and letting them know you can see how they feel can be very validating, and can encourage clients to expand on them more. Summing up the main beats of the conversation so far can jog a memory or remind a client of something they would like to go back to, or act as a gateway into a new realm of discussion if the previous one is all tied up.

How a counsellor decides to structure a counselling session can also help a client focus. The first ten minutes of a session could be used to chat about the client’s week and catch up, this will help build rapport. The main emotional work is done in the middle of the session. It is very important that the counsellor leaves enough time for a cool down at the end of a session – it is irresponsible for a counsellor to work on hot emotional issues one minute then send the client out of the door the next. Leaving time for a client to cool down to reflect on the session allows them to return to feeling normality in their mind and body before they physically leave the counselling room and return to reality. A final summary at the end underlines what progress has been made, and can also be useful for a counsellor so that when the session is over and the client has left they can make notes. It is also important to take doorknob disclosures into account – often a client can mention something on their way out – to maintain strong boundaries a counsellor must not engage further with this new development, but rather let the client know that it is the first thing they discuss in their next session.

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