Scribd
Upload
102 views

Establishing The Counsellor-Client Relationship in The First Counselling Session Session

The document discusses establishing the counselor-client relationship in the initial counselling session. It identifies key components like creating a therapeutic frame, containment, empathy and assessing the client. The importance of the first session for engagement and assessment is explored. Effective use of the initial session involves establishing a therapeutic contract, gathering information, ensuring informed consent and deciding appropriate focus. Case studies are presented to demonstrate potential issues and focuses for different clients.

Uploaded by

sagar bagul
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
102 views

Establishing The Counsellor-Client Relationship in The First Counselling Session Session

The document discusses establishing the counselor-client relationship in the initial counselling session. It identifies key components like creating a therapeutic frame, containment, empathy and assessing the client. The importance of the first session for engagement and assessment is explored. Effective use of the initial session involves establishing a therapeutic contract, gathering information, ensuring informed consent and deciding appropriate focus. Case studies are presented to demonstrate potential issues and focuses for different clients.

Uploaded by

sagar bagul
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 8

Establishing the counsellor-client

relationship in the first counselling


session

Sheila Pike
Senior Counsellor
Centre for Reproductive Medicine and Fertility
Sheffield, UK

Sheila Pike, ESHRE Amsterdam 4-12-2010

Aims of workshop

„ To identify the key components of a successful


counsellor–client relationship
„ To understand the impact of different practice
settings on the therapeutic relationship
„ To identify the essential components of an initial
session
„ To examine the potential limits of the initial
counselling session
„ To consolidate understanding through case
discussions

Sheila Pike, ESHRE Amsterdam 4-12-2010

What are the key components of the


therapeutic relationship?
„ The therapeutic frame: physical, temporal and
emotional space
„ Holding
„ C t i
Containment
t
„ A ‘way of being’ (empathy, congruence, positive
regard)
„ Psychological contact
„ Client incongruence / vulnerability

Sheila Pike, ESHRE Amsterdam 4-12-2010


What makes the first session so important?
„ Brief therapy increasingly popular
„ Many clients attend for only one session (up to 25%,
Feltham 1997)
„ CBT, stress management, crisis intervention
„ Making a connection for future client engagement
„ Assessment – therapist and client
„ Establishing a collaborative approach
„ Engendering hope

Sheila Pike, ESHRE Amsterdam 4-12-2010

Assessment
„ Formal v informal (transparent v hidden / internal)
„ Gathering information about the client
„ Establishing whether it is appropriate to offer
therapy
„ Ensuring the client is aware of the therapeutic
process
„ Gathering the facts to make a contract for therapy
„ Risk assessment
„ Providing the client with an opportunity to make an
informed choice about whether to proceed
„ Making a decision with client about referral on where
necessary and appropriate
Sheila Pike, ESHRE Amsterdam 4-12-2010

Establishing the therapeutic contract

„ Minimum and maximum number of sessions


„ Times available
„ Length of sessions
„ Details of fees,, if anyy
„ Main characteristics of therapeutic approach
„ Limits of confidentiality / record-keeping
„ Between sessions contact
„ Cancellation policy
„ Agree realistic client aims / focus of work

Sheila Pike, ESHRE Amsterdam 4-12-2010


Infertility counselling and practice settings
Specialist ART Clinic:

„ Referral route – clinic or direct


„ Number of sessions available – limited?
„ Cost
„ Confidentiality boundaries
„ Knowledge base
„ Focus of counselling

Sheila Pike, ESHRE Amsterdam 4-12-2010

Infertility counselling and practice settings


Independent practice:

„ Self referral?
„ Flexibility of sessions
„ Cost
„ Confidentiality
„ Knowledge base
„ Focus of counselling

Sheila Pike, ESHRE Amsterdam 4-12-2010

Working with difference and diversity

„ Cultural
„ Religious
„ Class
C ass
„ Sexual
„ Gender
„ Disability

Sheila Pike, ESHRE Amsterdam 4-12-2010


Focus of counselling
„ Personal
„ Couple / relationship
„ Family
„ Psychosexual
„ Infertility and loss
„ Treatment options
„ Treatment implications
„ Support
„ Making endings / new beginnings
„ Other?

Sheila Pike, ESHRE Amsterdam 4-12-2010

Starting points

„ Phone call
„ Referral letter
„ Medical notes
„ Anecdotal information
„ Client’s narrative

Sheila Pike, ESHRE Amsterdam 4-12-2010

First impressions

„ Physical environment

„ Personal presentation

„ Time management

„ Client expectations

„ Contracting

Sheila Pike, ESHRE Amsterdam 4-12-2010


Trying for a baby ~ the infertility journey

May feature four main phases

„ Phase I REALISATION
„ Phase II DIAGNOSIS
„ Phase III PROCESS OF TREATMENT
„ Phase IV RESOLUTION

Sheila Pike, ESHRE Amsterdam 4-12-2010

Kubler-Ross Phases of Grief (1969)

Sheila Pike, ESHRE Amsterdam 4-12-2010

Phases of Loss & Tasks of Grieving

Phases of Grief Tasks of Grieving


„ Denial „ Accept reality of loss
„ Pain and distress „ Experience pain of grief
„ Realisation „ Adjust to environment in
which person / child is
missing
„ ‘Acceptance’ „ Relocate emotional
energy elsewhere
[Murray-Parkes] [Worden]
BICA Workshop 08.07.09
Phase I REALISATION

„ Acknowledgement to self and others that a


problem does exist

„ Feelings of shock, anger, guilt, blame, envy,


self-pity may predominate

Sheila Pike, ESHRE Amsterdam 4-12-2010

Phase II
INVESTIGATIONS & DIAGNOSIS

„ Answers are looked / hoped for


„ Processes are time-consuming and anxiety-
producing
„ Results may provoke further feelings of guilt, blame
etc
- along with shock / denial, anger, searching
„ May also bring a sense of relief that ‘something can
be done’ to help - mixed with urgency to ‘get on and
do

Sheila Pike, ESHRE Amsterdam 4-12-2010

Phase III PROCESS OF TREATMENT

„ Focussed activity - highs and lows

„ Desire to conceive may ‘take life over’

„ Feelings of hope and dread co-exist

„ Intensity / duration of emotions is often unexpected -


and challenging of existing coping resources
/strategies

„ If unsuccessful, feelings of loss / failure are reinforced


and may have cumulative impact

Sheila Pike, ESHRE Amsterdam 4-12-2010


Phase IV RESOLUTION

„ Mourning the loss


„ reviewing past treatment and experiences
„ making decisions regarding further / no further
treatment
¾ may include taking a break from treatment,

pursuing other life goals, considering adoption


„ adjusting to ‘real’ experience of pregnancy and
making decisions regarding parenthood

Sheila Pike, ESHRE Amsterdam 4-12-2010

Case scenarios
¾ What do you think are the potential issues relating to

„ the man
„ the woman
„ their relationship
„ th i pastt / presentt / ffuture
their t iinfertility
f tilit experience
i

¾ What might be the focus for work in a first counselling


session?
¾ What might be the longer term focus?
¾ What limitations would you anticipate?
¾ With whom would you work and when?

Sheila Pike, ESHRE Amsterdam 4-12-2010

Case Scenario 1

„ Carla, 40 yrs + Edward, 39 yrs have a 3 year history of


infertility.
„ The referral letter states that in the last two months,
Edward has been diagnosed with a mild form of cystic
fibrosis and azoospermia
„ Carla’s tests suggest that her ovarian reserve is low
„ The couple have been advised by their consultant to
attend counselling to discuss treatment with donor sperm
„ They enter the counselling room and sit down at
opposite ends of the sofa. Carla looks upset and
anxious; Edward does not make eye contact.

Sheila Pike, ESHRE Amsterdam 4-12-2010


Case Scenario 2

„ Esme is a 28 yr old secretary who has been undergoing


IVF treatment for the last 18 months.
„ She has had 3 full IVF cycles and 2 frozen embryo
replacements.
„ She telephones youyou, after another negative pregnancy
test, to arrange a counselling appointment.
„ On the phone, she mentions that her partner is keen to
start another IVF cycle as soon as possible and that this
is leading to arguments
„ At the start of her first counselling session, she tells you
that she can’t face life anymore and bursts into tears.

Sheila Pike, ESHRE Amsterdam 4-12-2010

Case scenario 3

„ Ayesha is 39 yrs and has a history of bipolar disorder. She has had
several episodes of in-patient treatment in the last 6 years but
apparently has ongoing support from a strong mental health team
„ According to the consultant at the centre, Ayesha’s husband Imran,
28 yrs, appears to have little insight into or tolerance of Ayesha’s
mental health condition
„ The level of support from their extended family has been difficult to
determine
„ The couple, whose infertility is unexplained, have been asked to see
the counsellor prior to a decision whether to offer treatment or not
„ Ayesha presents with a very flat profile, bowed head and says little;
Imran, in contrast, appears to be very animated and excited at the
prospect of treatment

Sheila Pike, ESHRE Amsterdam 4-12-2010

References
„ BACP (2007) Ethical Framework for Good Practice in Counselling
and Psychotherapy. BACP (British Association for Counselling and
Psychotherapy)
„ Green, Judith (2010) Creating the Therapeutic Relationship in
Counselling and Psychotherapy. Learning Matters Ltd
„ Kubler-Ross, E and Kessler, D (2005) On Grief and Grieving. Simon
and Schuster
„ Mearns, D and Thorne, B (2007) Person-Centred Counselling in
Action. Sage
„ Milner, J. and O’Byrne, P. (2004) Assessment in Counselling:
theory, process and decision-making. Palgrave Macmillan
„ Murray-Parkes C (1998) Bereavement: Studies of Grief in Adult Life.
Penguin
„ Worden, W J (1988) Grief Counselling and Grief Therapy.
Routledge

Sheila Pike, ESHRE Amsterdam 4-12-2010

You might also like