MODULE CODE: PT05212

MODULE NAME: COUNSELLING

SKILLS
Counseling for behavior change
Related tasks
Describe counseling process
Describe counseling for behavioral
change
Identify stages of change cycle during
counseling process (pre-contemplation,
contemplation, action, maintenance and
relapse)
Identify roles of ethical counseling
Demonstrate skills for building rapport
 COUNSELLING PROCESS
Skills in counseling process
Step 1: Relationship Building
The first step involves building a relationship and
focuses on engaging clients to explore issue that
directly affect them.
The first interview is important because the client
is reading the verbal and nonverbal messages and
make inferences about the counselor and the
counseling situation ;
◦ Is the counselor able to empathize with the
client?
◦ Does the client view the counselor as genuine?
Steps for Relationship Building includes;
 Introduce yourself
 Invite client to sit down
 Ensure client is comfortable
 Address the client by name
 Invite social conversation to reduce anxiety
 Watch for nonverbal behaviour as signs of
client’s emotional state
 Invite client to describe his or her reason for
coming to talk
 Allow client time to respond
 Indicate that you are interested in the person
Step 2: Problem Assessment
o While the counselor and the client are
in the process of establishing a
relationship, a second process is taking
place, i.e. problem assessment.
o This step involves the collection and
classification of information about the
client’s life situation and reasons for
seeking counseling
Step 3: Goal Setting
o Like any other activity, counseling must have
a focus.
o Goals are the results or outcomes that client
wants to achieve at the end of counseling.
o Sometimes, you hear both counselor and
client complain that the counseling session is
going nowhere.
o This is where goals play an important role in
giving direction.
o Guidelines for setting goals selection that can
be used with students includes;
 Goals should relate to the desired end or ends
sought by the student.
 Goals should be defined in explicit and
measurable terms.
 Goals should be feasible.
 Goals should be within the range of the
counselor's knowledge and skills.
 Goals should be stated in positive terms that
emphasize growth.
Step 4: Intervention
o There are different points of view
concerning what a good counselor should do
with clients depending on the theoretical
positions that the counselor subscribes for
example, the person-centred approach
suggests that the counselor gets involved
rather than intervenes by placing emphasis
on the relationship that the behavioral
approach attempts to initiate
Step 5: Evaluation, Follow-up, Termination 0r
Referral
o For the beginning counselor, it is difficult to
think of terminating the counseling process, as
they are more concerned with beginning the
counseling process.
o However, all counseling successful termination
aims towards
o Terminating the counseling process will have to
be conducted with sensitivity with the client
knowing that it will have to end.
o Counselor always mindful of avoiding fostering
dependency and is aware of own needs
o Preparation for termination begins long before
o Open door / plan for possibility of future need
o Termination considered not just at end of
successful relationship, but also is considered
when it seems counseling is not being helpful
o Think of this as a means of empowering client
o Role to review progress, create closure in
client counselor
o Most common non-helpful Behaviors
include:
• Advice Giving
• Lecturing
• Excessive Questioning
• Storytelling
• Asking “Why?” Asking “How did that make
you feel?”
• Interrogating
• Judgmental
• Controlling rather than encouraging
• Non guarantying reassuring
• Labeling
• Jokes
Describe counseling for behavioral change

Stages of Behavior change cycle during

counseling process
Pre-contemplation
contemplation,
Action
Maintenance
Relapse
Stage 1: Pre-contemplation
o This stage is characterized by two distinct elements:

a) The person not being able to see or understand what the

problem is, and/or
b) The client wanting some other person to change (the
problem is them, not me).
o Pre-contemplators usually come to counseling because of
some form of pressure from another person (spouse,
employer, the courts, school, friends).
o Concurrently, pre-contemplators also resist change and
therefore employ denial-minimization tactics to disown any
responsibility for their contribution to the issue(s) at hand.
o Thus, one of the initial goals in counseling is to determine
how much denial or minimization the client is experiencing
that prevents change
Stage 2: Contemplation
o This stage is characterized by the client wanting
to better understand what the "bump in the road"
is, to see the causes and as well to explore what
options are available to resolve the demise.
o The key point to remember here is that even
though a person may know what is the issue and
what needs to be changed, contemplators are not
quite yet ready to make a commitment to action
(fourth stage of change).
o The second stage is a critical time for those in
counseling to better understand two (2) key
themes before action is undertaken:
 who am I (their map of orientation) and
 what strengths and resources do I have to
support my journey (map of direction)?
o Hence, in counseling the client and counselor will
know when the time for action arises when the
language and thoughts in counseling focus around
the "solution versus the problem" and a "view
more about today and the future than the past."
 Stage 3: Preparation
o This stage is characterized by the client going through
additional areas of mindfulness, learning and growth.
o Sometimes the client needs to improve their communication
skills, career goals, parenting behaviors, intimacy practices,
and further strengthening their self-esteem.
o In particular, we use this stage as an opportunity to identify
the client's values and supporting behaviors in four key
areas of life: defining the self, self-development, work and
relationships.
o The primary goal here is to actualize individual awareness
so that a sense of self-control, comfort and security are
present when the client goes from preparation to action. In
short, a mindful sense of well-being.
Stage 4: Action
o Probably the most misunderstood and misapplied stage
of all in counseling.
o The common problem here is that most clients and
counselors believe that change means action, and action
now at the onset of counseling.
o However, if the first three stages of change are not
properly addressed in counseling, failure in counseling
and/or after counseling can occur (in fact, over 45% of
all clients stop counseling before the third session as
they feel their therapist or family want action before
they are actually ready for action).
o This stage is characterized by the basic premise in positive
psychology and cognitive behavioral sciences that before
we can "change" a behavior, we must first change or
reframe our thought patterns (our mental tapes we play if
you will).
o While most of us want to "see" some form of change, often
times the more important change must occur in the way we
think where we often don't see that change until some
future point and time.
o Once the action stage in counseling has allowed us to
change our thoughts (reframing), then can we commence
with the more visible desired actions, behaviors and
feelings in and outside of counseling.
 Stage 5: Maintenance
o This stage is characterized by the counselor and client (and in
most cases his or her social support network) to identify what
possible trigger points or other conflictual issues exist in the
work and social/family setting that could cause a relapse.
o Whether a client is coming in to quit smoking or improve his
communications at work or in the marriage, the counselor
and client in this stage shall develop a strong commitment to
establishing positive reinforcement activities (validation,
cheerleading, acknowledgement, praise, rewards) to sustain
the change made in the action stage.
o In other words, change never ends in the action stage, it
merely takes a new form and presence in our life.
Stage 6: After-care
o There are some thoughts, behaviors or feelings
we wish never return (the former smoker who
doesn't take up smoking again when he gets
stressed).
o However, some healthcare professionals believe
there are certain behaviors, thoughts or feelings
we never completely remove (traditional 12 step
programs for example propose that alcoholics
will always remain "an addict in recovery").
o This stage is characterized by determining what types
of behaviors, thoughts or feelings can realistically be
terminated, and equally as well, what types require a
lifetime of support and maintenance.
o The ultimate goal though in the after-care stage is to
ensure that the client understands that by embracing
lifelong learning he or she increases the chances for a
more healthier and happier life.
o We believe that the lifelong learning process can be
experienced both in counselling and other
environments. In short, our doors are always open for
tune-ups and new learning sessions.
 Identify roles of ethical counseling
 Ethical counseling promote;
 Respect human rights and dignity
 Protect the safety of clients
 Ensure the integrity of practitioner-client relationships
 Enhance the quality of professional knowledge and its
application
 Alleviate personal distress and suffering
 Foster a sense of self that is meaningful to the person(s)
concerned
 Increase personal effectiveness
 Enhance the quality of relationships between people
 Appreciate the variety of human experience and culture
 Strive for the fair and adequate provision of counselling
and psychotherapy services
 Demonstrate skills for building
rapport
Richardson identified Six useful skills for
rapport building essential in differentiating
yourself and establishing a personal
connection.
Presence: Ability to project confidence,
conviction, and interest in body language and
voice
Relating: Ability to use acknowledgment,
rapport, and empathy to connect
Questioning: Ability to explore needs and
create dialogue
Listening: Ability to understand content
and emotional message
Positioning: Ability to leverage client
needs to be persuasive
Checking: Ability to elicit feedback
 The first two skills — Presence and Relating
o Come into play immediately upon contact.
o This is the “breaking-the-ice” stage, where
showing empathy and reducing tension is key.
 The next two — Questioning and Listening
o Are layered on top when you begin a dialogue.
o Nonverbal communication plays a key role
here, building a connection subconsciously
through body language, eye contact, facial
expressions, and tone of voice.
The last two — Positioning and Checking
o Reinforce your approach and strengthen
rapport.
o These involve asking open-ended
questions, summarizing what you’ve
heard, and building on the ideas
presented.
Key issues to note
o The point is: You’re building rapport with a
person, not an organization.
• You’re interacting with a human being who is
likely more emotional than logical.
• EQ, or emotional quotient, is more important
than IQ in establishing rapport.
• Sometimes, acting as if you already have a
good rapport is a good starting strategy.
• Talking as if the other person were a close
friend with mutual trust sends subconscious
signals to the other person to view you in the
same way.
 Key points
Stages of Behavior change cycle
during counseling process
 Pre-contemplation
 contemplation,
 Action
 Maintenance
 Relapse
Skills in building rapport include
 Presence
 Relating
 Questioning
 Listening
 Positioning
 Checking
Evaluation
What is rapport
What are the points in creating rapport
Refferences
 MoHSW. A Practical Handbook for Improving HIV
Testing and Counselling Services in Tanzania.
September, 2010.
 Ministry of Health and Social Welfare Primary Health
Services Development Programme MMAM 2007-2017,
(2007)
 MoHSW. Prevention of Mother to Child Transmission of
HIV: National Guidelines (PMTCT) in Tanzania. July,
2011.
 MoHSW. Standard Operating Procedures for HIV
Testing and Counselling (HTC) Services National
Bureau of Statistics (NBS) Tanzania and ICF Macro.
Tanzania Demographic and Health Survey 2010. Dar
es Salaam, Tanzania: NBS and ICF Macro. 2011.