Online & In-Person Counselling, Therapy & Supervision

This article takes the therapist through the main processes of therapy from consultation all the way through to reflections and results.

The Consultation – Information Gathering

• What is the client’s current situation? Family, status, partner, work
• Reasons for coming to therapy
• Past experiences of therapy
• Relationships – partner, children, parents, work colleagues, friendships, social, community activities, sports, hobbies, groups, clubs
• Loss-grief – what losses, bereavement have they had in their life?
• Trauma, adverse childhood experiences
• Attachment styles with parents – secure, insecure-avoidant, insecure-ambivalent, insecure-disorganised
• Childhood, adolescence and adulthood need violations, control violations, positive attachment violations
• Lifestyle: exercise, nature, travel, hobbies, interests, diet, caffeine, drugs, spirituality/religion
• Medication
• Instincts – caring, seeking, play, lust, fear, panic-grief, rage
• Needs – orientation/control; positive attachments; self- esteem enhancement and protection; joy/pleasure maximisation and distress avoidance
• Maslow’s hierarchy of needs

Assessment

• Medication
• Medical Diagnoses
• Self-Defeating Behaviours
• Symptomology – mental, emotional, physiological, behavioural (anger, anxiety, depression, grief, PTSD, eating disorder, OCD)
• Avoidant or Approach motivational schemas
• Interpersonal
• Wellbeing
• Alcohol, drugs, smoking – quantity, units, frequency, binge drinking, triggers, severity
• Attachment style
• Approval – supervisor, tutor-mentor, placement manager
• Number of session recommended
• Goals – refer to needs, instincts, motivational schemas
• Client resources – positive

Planning

• Humanistic/PCA – core conditions, active listening skills – Key Concepts (KC) – locus of evaluation, conditions of worth, self-concept, introjections, self-actualisation
• Psychodynamic – relationships with parents, siblings, family, partner. Defence mechanisms like projection, denial, resistance, displacement, sublimation; KC like shadow, persona, unconscious, superego, ego, id, superconscious, subconscious
• CBT – beliefs, schemas, cognitive restructuring, thought records, reframing, self-perceptions, perceptions of others, perceptions of future, cognitive triad
• Self-defeating Behaviours – people-pleasing, catastrophising, ruminating, repetition compulsion
• Ethical considerations like safeguarding, boundaries, medication, drugs, harmful activities/risks
• Grief models – Kubler Ross, Worden
• Relationship models – social equity theory, equality, attachment styles, psychodynamic issues, defence mechanisms, transactional analysis, empty chair (Gestalt)
• Trauma – dissociation, abuse, control and need violations, positive attachment violations, attachment styles,
• Resources – worksheets, thought records, wheel of life, relationship reflections, diary, mood diary, journal
• Transference and counter transference
• In-between session tasks – developing motivational schemas, goals, diary or journal writing, art, sketching, painting, walking, exercise, interpersonal skills like communication, assertiveness practice, wellbeing issues, diet, moderation of activities, diet, etc
• Therapist research, reading, revision, CPD requirements, tutor-mentoring or supervision areas, ethical concerns.

Session Content Exploration and Analysis (refer to models and theories)

• Link your session exploration with the key concepts from the planning, theories and models
• Where is the client’s locus of evaluation?
• How do they relate to themselves, others, and their future?
• What do they do that shows care for themselves and others?
• How did their past relationships still affect them now?
• What emotional, physiological, mental and behavioural symptomology is currently presenting itself? How does the client manage those emotional, mental, physiological and behavioural symptoms?
• What attachment styles in early childhood were developed and how do they still affect their current relationships with people now?
• How do they relate to people at work, in their family?
• How do people in the home and at work relate to them?
• What supervision/tutor-mentoring did you have throughout the process? How did it help? What conversations, themes and learning did you move through in that process?
• Can the client identify their flaws and weaknesses, understand why they came to be and how they may mitigate their worse effects on themselves, others and their life opportunities?
• How does the therapist elicit positive rapport and relational depth with the client? Posture, speech, questions, etc
• What needs are being missed by the client?
• What are the positive resources of the client? Can they be put to work in the therapy and between the therapy?

Results

• Refer back to the assessment and consider all the goals and symptomology. Re-assess – identify movement, change and development. Identify what didn’t move forward and why and what you would do next time. Identify what did move forward and why and what you would do again.
• Gather client feedback on their goals and extra unforeseen benefits. Get as much anecdotal and objective evidence from them as possible. Also try to get from that what you could have done better.
• Consider the match between the theories and models you used and the achievement of the goals. Were you happy with the model key concepts? Did they help you and the client? Why?
• Did you have enough time?
• Do you recommend more work, sessions?
• Were there any SDBs in the client that undermined the process?

Limits and Flaws

• Consider the results section and identify the areas that need to be improved in regards to goals and symptomology?
• What skills have you really developed through your work with the client?
• What CPD, training, research and reading opportunities does the work with this client identify? What training opportunities does this experience offer you?
• What transference/counter-transference issues are there between you and your client? How were they addressed? Was supervision sought?
• How has rapport and relational depth been deepened and ensured with the client? Evidence.
• What core conditions felt good for you? How was your posture, poise, voice, tone, expression? Did you provide the active listening skills? Which ones?
• How did silence affect the process? Did you use it enough? How did you feel and what did you think of the silences? How did the client feel/think with the silences?
• What conversations have been had with the supervisor, placement manager, line manager, tutor-mentor?
• How has the supervision/tutor-mentoring helped the process? Evidence.
• How do you know the goals have been achieved? Evidence.
• Do goals need to be modified?
• What needs and instincts have been met as part of the process?
• Have attachment styles been developed, modified or changed? From what and what to? Evidence?
• Has the clients avoidance schemas been addressed? How? How have they changed to approach schemas?
• How has the clients libido been expressed and expanded? Interests, hobbies, passions, interpersonal?

© Martin Handy 2022