COUNSELING Interpretation

Dr. Agnes Segunda Gerasmo Confrontation

Information Giving
Counseling Summarizing
To give advise or opinion on what to Goal setting
do.
Dr. Rakel Family Practice emphasizes CIA- Client Centered
knowledge in such areas as Family Counseling
psychodynamics, interpersonal Catharsis- Ventilation Stage
relationship, counseling and Insight
supportive psychotherapy. Action
Dr. Engel- Biosphychosocial Model Based on Carl Rogers
Also called Client-centered
2 Types of Counseling counseling or patient-centered
couseling.
1. CIA- (Catharsis, Insight, Action)
Individual counselling, with Carl Rogers Basic Premise
psychosocial issues based on Carl Rogers Human Beings are essentially
rational, constructive, positive,
2. CEA- (Catharsis, Education, Action) independent, realistic, cooperative,
Individual or group counseling usually trustworthy, accepting, forward-
done on clinical consult moving and full of potential.

2 things necessary in counselling When there is a discrepancy between

actual self (described above), and the
1. Characteristic of a good counselor: perceived self- creates Misperception
Empathy Tension, Internal Confusion---ill
Unconditional Positive Regard Health.
Genuineness
The 3 main conditions can promote
Characteristic of Good Counselor: growth towards actual self and
improve communication.
a) Genuineness-
transparency, absence of Active Listening Skills
pretense. Skills used by the doctor-counselor to
b) Unconditional Positive regard- understand how the patient sees the
we can care for and accept the world and how he perceives the
confusion, fear, anger, loneliness, problematic reality for which he is
resentments of our client. consulting.
c) Empathy
ability to put oneself in the Active listening skills (Opening
situation of another. skills)
Attending Skills
2. Active Listening Skills Bracketing
Opening skill Leading
Attending Skills Reflecting
Bracketing Focusing
Leading Probing
Reflecting Summarizing
Focusing
Probing 1. Attending skills- paying attention,
Summarizing maintaining eye contact, nonverbals or the
verbals like saying yes or go on indicating
Closing skill that you are listening to the patient.
 articulate into words patients emotions.
2. Bracketing -not so much a verbal or non- Giving name to feelings makes pt. more
verbal skill as it is a mental skill. aware of emotions.
Feelings not articulated and
3. Reflecting Skill- mirror reflecting back acknowledge have a way of taking
the image of the person gazing at it. A control of behavior.
patient who is emotionally burdened is also When feelings accurately reflected
unable to see himself clearly. back,
Example Reflecting skills: patient feels understood, rapport
(45/M walks in the office, sits down, improves.
stands up again and looks out the door Example:
to where his wife is sitting. He shuts Reflecting feeling: You seemed so anxious
the door and sits down again.) about your sore throat?
Patient: Doctor, a month ago, I had
this sore throat, so I went to a doctor C. Reflecting Experience
and he gave me penicillin for it. So I pointing out the non-verbals in order
took it for 7 days and it went away. for the patient to become aware of how he is
But a week later, I had sore throat behaving.
again. Example:
Reflecting Experience: I noticed that a
(patient shifts in his seats and looks while ago you looked out at the door at your
down at the floor.) wife and you shut it? Could you tell me
The doctor gave me amoxicillin this behind the action?
time and I took it and the sore throat
went away. But a few days ago
( patient takes his handkerchief and Leading
crumples it and pulls at it repeatedly)
The sore throat came back. 2 Kinds of Leading:
(Voice becomes softer; patient shakes 1. Indirect Lead- open invitation. Choice of
what to talk about depends on the patient.
his head).
Indirect leads take the form of words or
I just cant understand what is
phrases such as: Yes, Go on, And then?
happening.
2. Direct Lead- requires that the doctor-
counselor make a judgment call to where the
A. Reflecting content
patient should go.
verbal content is repackages or
rephrased to become clearer.:
Example:
a. Paraphrasing- putting to clearer
P: You see, we have been married for 5 yrs
words and
and we were okay most of the time but
summarizing what the patient is saying.
several months ago, I noticed she had been
b. Perception Check- use same words
less talkative and irritable and I got a hard
with that of the patient but putting is that it
time because she keeps on cutting me off.
at the end to confirm the counselors
D: Tell me more about how she cuts you off?
perception.
Example:
Focusing
Paraphrase: This is the 3rd time you
Asking the patient to prioritize his emotions
have had a sore throat within a month or identify which one is heavier or
and you dont understand why it keeps troublesome for him.
on coming back. Example:
Perception check: This is the 3rd D: You have financial difficulties, your wife is
time you have had a sore throat within nagging you, your daughter is rebellious, and
a month and you dont understand your son had an accident. But of this 4 which
why it keeps on coming back. Is that one gives you the most pressure.
it?
Probing
B. Reflecting Feeling
Probes are questions asked to elicit more P: I dont like selfish people.
information. D:Because?
They must be open-ended. You can P: Selfish people arent so popular
probe by beginning the questions with D: (I.Q.): So popularity is important to you;
What, Where, and when and how and if you are self-centered, people wont
Probe for the feeling rather than like you. Is that getting close to where you
content. are now?
Probe where the emotional content is
greatest, and watch out what the patient Interpretation as Fantasy or metaphor
decides to mention last or when patient Another form of interpretative
often repeats it. statements using fantasy or metaphor.
Example:
Active Listening skills (Closing Metaphor: I perceive you are like a puppet
with strings who conforms to what ever you
Skills)
are told to do.
Interpretation
Confrontation
2. Confrontation
Information Giving
This skill enables the doctor-counselor to
Summarizing challenge, discrepancies, distortions that the
Goal setting patient is using knowingly or unknowingly.
a. Challenging Discrepancies
b. Challenging Distortions.

1. Interpretation a. Challenging Discrepancies

An active process of explaining the Confrontation can be 0 in on
meaning of events that happened in discrepancies between what the patients
the patients life from the Doctor- thinks or feels and what he says and
counselor Frame of Reference. between what he says and what he does,
Interpretative Statements between his perception of himself and the
Interpretative questions perception of others regarding who he is,
Metaphor between what he is and what he dreams to
be between his expressed values and actual
A. Interpretative statements. behavior.
It involves sharing your hunches
with the patient in declarative form Example:
Jenny says she feels happy and is contented
Example: with her current job and yet expresses that it
P: I hate the way I am being treated in this would be a lot better if she gets paid more
hosp. Just because I dont have enough and her boss would cut her some slack. She
money everyone feel they can bother me occasionally complains of the long hours.
anytime and insert all these needles. (She has this tired and faraway look and a
Sometimes I just feel like yelling at them all forced smile.)
to get lost. Challenge: Jen you say you are happy and
D: You feel very angry of the way you are content with your work yet I have listened a
being treated with less respect simply lot of your complaints about it. Also when
because you cannot pay. you say your happy your eyes still have this
tired and sad look. Im not truly certain if you
B. Interpretative questions are contented and happy.
The counselor who wants to confirm his
hunch uses questions. b. Challenging Distortions
Some patients find reality as harsh and very
Example: hard to face so they distort it in various
D: When are you going to be concerned ways.
about yourself too?
P: Thats selfish attitude. 3. Information Giving
D: So whats wrong with that? A. Advice Giving
 Giving suggestions and Opinions based on Active listening skills used in clinical
experience. Useful in crisis situations when practice.
several people must cooperate to prepare Correcting of emotionally critical
patient for major readjustment. misperception, and medical misperceptions.

B. Informing 2 reasons for consult

Giving valid information based on 1. Physical illness
expertise. Biomedical aspect
Advise must be clear and relevant. 2. Impact of illness or consequence of
impact of illness or psychosocial aspect
4. Summarizing of illness.
Tying together into several statements
ideas and feelings to close the discussion. 3 Reasons why we have to deal with
Summaries are good way to close a Impact of illness:
session. 1. Biopsychosocial Approach
It is useful to the doctor to check if he has -gives importance to the unity of body,
grasped the full spectrum of the patients mind and social context.
message. Holistic Approach- addressing
Example: both the illness and impact of illness.
D: Youve been discussing about your Conventional method-
ideal jobs and what things you have liked pathophysiology and pharmacology.
and disliked about your work; Youve also 2. We cannot be cerebral when we are
talked about your plans of getting more emotional.
training. Are you ready to take a look at When our patients are anxious they find
some options in planning for a new it hard to listen to us.
career? 3. Emotions have their roots in the
D: Try to put it together briefly. Lets take a patients perception.
look at what we have accomplished so
far. How does that appear to you? Perceptions of patient incongruent
with the reality as the physician
5. Goal Setting perceives it is a misperception.
As a result of earlier processes both
doctor and patient has a clearer view of ECM- Emotionally Critical
what is happening and possible solutions Misperception- are
to the problem. This is a vital part of the misperceptions that are most-
counseling process since it enables the anxiety provoking.
patient to explore new behaviors to cope
and deal with the circumstances.
CEA
Specific and measurable Catharsis- purgation ventilation of and
Realistic emotions.
Hierarchical Education
Desired by the person and tailored to Action
him.
Frequently evaluated. CEA Principles:
George Engel Biopsychosocial
___________________________________________ model
Motivation for consult may be due to
CEA physical illness or the impact of that
Dr. Agnes Segunda Gerasmo illness.
So we must address both the physical
Catharsis and emotional impact of that illness.
Education Sir William Osler The good
Action physician cures sometimes, palliates
often, but comforts always.
 2. What feelings came out when did thoughts
1. The doctor plays as a doctor counselor. came to your mind?
2. The doctor detects or identifies 3. What consequences of your illness makes
misperception on the diagnosis, disease you feel this way most?
process, treatment or prognosis. What is the worst thing that your illness
3. The doctor gives name or reflects back to can do to you?
the patient, what the patient feels for What is the result or outcome your illness
him/her to be aware. that you dread most? ( Emotionally Critical
Misperception)
Goal of CEA 4. Summarize the ECM and the emotions
Not to make patient fear the disease associated with it.
process, but rather for them to understand
and make clear the disease process. Education
He will have articulated and ventilated
When to use it: his emotions
If you perceive the patient to be anxious He has now enough space in his mind
or with medical misperceptions. to be able to listen.
Address the ECM or medical
Characteristic of Good Counselor: misperceptions.
1. Genuineness- Explain and discuss to allay emotions.
transparency, absence of pretense. Make comparison to make things
2. Unconditional Positive regard- clearer for the patient.
we can care for and accept the
confusion, fear, anger, loneliness, Tips in Educating:
resentments of our client. 1. Speak the language of the patient.
3. Empathy 2. Use the power of analogy.
ability to put oneself in the situation of 3. Use of anecdotes and personal
another. testimonies.
4. Misperceptions hidden under emotions
Active Listening Skills should be explored and corrected.
Skills used by the doctor-counselor to 5. Allaying of anxiety.
understand how the patient sees the world
and how he perceives the problematic reality Action
for which he is consulting.
Therapeutic Plans
1. Attending skills- paying attention,
Pharmacologic and non-pharmacologic
maintaining eye contact, nonverbals
Schedule date and other plans.
Catharsis
Feedback
1. Medical Knowledge- as a doctor
Ask how the patient feels.
a. Explore the patients health
understanding.
b. Identify medical misperception if
TEAM FIEL AND CO.
present (on diagnosis,treatment or
disease process.)
c. Identify Health Framework.

2. Emotional/Psychological aspect
Ventilation- as a counselor
a. Probing the patients feelings.
b. Identify the Emotionally Critical
Misperception

Steps in Catharsis
1. What came into your mind when you
started feeling your symptoms?