TECHNIQUES IN

PSYCHOSOCIAL COUNSELLING FOR

SCHOOL HEALTH PERSONNEL

MARIA CORAZON A. JARDIOLIN, MD, DSBPP, FPPA

Diplomate, Specialty Board of Philippine Psychiatry
Fellow, Philippine Psychiatric Association, Inc.
 Together with open conversations
and greater understanding,
we can ensure that attitudes
for mental health change and
children receive the support they deserve
- Kate Middleton
 “PSYCHO’ refers to psychology – study of
human nature or the mind, its functions and
behavior
 “SOCIAL” refers to society – groups of
people living together with shared laws and
organizations
 Thus, Psychosocial means how humans
interact with and relate to others around
them; focuses on relationships and how
human work in society. (Maria Airth)
 COUNSELLING

Is As Old As Society Itself. In Every Day Life,

we Find, Counselling Goes On At Many
Levels In A Family Setup, In Other Words,
There Is No Limit To The Problems On Which
Counseling Can Be Offered To The Type Of
Person who Can Render This Help ( Jyoti Srivastava)
 COUNSELLING

isa method that helps the client to

use problem- solving process to
recognize and manage stress and
that facilitates interpersonal
relationships among client, family
and health care team
 COUNSELLING
 Isa series of direct contacts with the
individual which aims to offer him
assistance in changing his attitude
and behaviors. (Carl Rogers)
 Is essentially a process in which the
counselor assists the counselee to make
interpretations of facts relating to a
choice, plan or adjustment which he
needs to make (GlennF. Smith)
 Counselling is often an effective way of
dealing with psychosocial and emotional
problems of children in especially difficult
circumstances.
 -Behaviour is often an open expression of
feelings.
 Counselling requires dealing with feelings.

 -Psychological health is an important part

of child survival, protection, and general
development.
NEED OF COUNSELLING
 tosolve psychosocial problems.
 For creating self sufficiency to the client.

 For better social functioning.

 For the client to make functional

decisions.
 For the attitudinal and behavioural
change of the counselee.
 For managing anger, stress, anxiety,
depression, frustration etc.
 COUNSELLING-
can help the children and adolescence to:
 Understand why their behaviors are negative, and
how to cope better
 Recognize and change negative thoughts that may
cause or trigger their behavior
 Find better ways to solve problems
 Learn better social skills
 observe and identify problem areas (emotional,
behavioral, social, study related difficulties,
academic deterioration, etc.) properly
 provide initial support to them, initially, in school
 refer for further intervention, in time, if required
 Counselling is a process where the
client and counselor work together to
come up with different ways to
experience various situations. It’s a
therapeutic relationship. It’s both
professional and intentional.
The World Health Organization defines
MENTAL HEALTH as
“a state of well-being in which the
individual realizes his or her own
abilities, can cope with the normal
stresses of life, can work productively
and fruitfully, and is able to make a
contribution to his or her community”
 COMMON STRESS REACTIONS
 Increase or decrease in activity level
 Difficulties sleeping
 Substance use
 Disconnection and numbing
 Irritability, anger, and frustration
 Vicarious traumatization in the form of shock,
fearfulness, horror, helplessness
 Confusion, lack of attention, and difficulty making
decisions
 Physical reactions (headaches, stomachaches, easily
startled)
 Depressive or anxiety reactions
 Decreased social activities
 Diminished self-care
 CHECK THE FOLLOWING
CORRESPONDING TO DIFFICULTIES
BEHAVIORAL
 Disorientation
 Increased drug, alcohol, or prescription drug
use
 Isolation/withdrawal
 High-risk behavior
 Regressive behavior
 Separation anxiety
 Violent behavior
 Maladaptive coping
 Other ____________
EMOTIONAL
 Acute stress reactions
 Acute grief reactions

 Sadness, tearfulness

 Irritability, anger

 Anxiety, fear

 Despair, hopelessness

 Guilt or shame

 Feeling emotionally numb, disconnected

 Other ___________
PHYSICAL
 Headaches

 Stomach aches
 Sleep difficulties

 Difficulty eating

 Worsening of health conditions

 Fatigue/exhaustion

 Chronic agitation

 Other ___________
COGNITIVE
 Inability to accept/cope with death of loved
one(s)
 Distressing dreams or nightmares
 Intrusive thoughts or images
 Difficulty concentrating
 Difficulty remembering
 Difficulty making decisions
 Preoccupation with death/destruction
 Difficulties completing assignments or chores
 Other ___________
 PSYCHOSOCIAL APPROACH
 Isan intervention which looks at the
individual and the problem in relation to
one’s environment.
 “Social” environment includes society,
family, school and peers
 “Psycho(logical)” part is concerned with
mental processes such as feelings,
thoughts, behaviors and motives
PSYCHOSOCIAL APPROACH

 Looksat individuals in the context of

the combined influence that
psychological factors and the
surrounding social environment have
on their physical and mental wellness
and their ability to function.
PSYCHOSOCIAL INTERVENTION

 Aims to reduce complaints and

improve functioning related to social
problems (eg. problems with school)
by addressing the different
psychological and social factors
influencing the individuals, (en.m. Wikipedia.org,)
GENERAL PRINCIPLES OF CARE

1. Communication with people seeking care

and
their carers
 Ensure that communication is clear,
empathic, and sensitive to age, gender,
culture and language differences.
 Be friendly, respectful and non-
judgmental a
 Use simple and clear language.
GENERAL PRINCIPLES OF CARE
1. Communication with people seeking care
and their carers
 Respond to the disclosure of private and
distressing information (e.g. regarding
sexual assault or self-harm) with sensitivity.
 Provide information to the person on their
health status in terms that they can
understand.
 Ask the person for their own understanding
of the condition.
GENERAL PRINCIPLES OF CARE
2. Assessment
 Take a medical history, history of the
presenting complaint(s), past history and
family history
 Perform a general physical assessment.
 Assess, manage or refer, as appropriate, for
any concurrent medical conditions.
 Assess for psychosocial problems, noting the
past and ongoing social and relationship
issues, living and financial circumstances,
and any other ongoing stressful life events.
GENERAL PRINCIPLES OF CARE
3. Treatment and monitoring
 Determine the importance of the
treatment to the person and their
readiness to participate in their care.
 Determine the goals for treatment for the
affected person and create a
management plan that respects their
preferences for care
GENERAL PRINCIPLES OF CARE
3. Treatment and monitoring
 Address the person’s questions and
concerns about treatment, and
communicate realistic hope for better
functioning and recovery
 Facilitate referral to specialists

 Make efforts to link the person to

community support.
GENERAL PRINCIPLES OF CARE
3. Treatment and monitoring
 Encourage self-monitoring of symptoms
and explain when to seek care
immediately.
 Document key aspects of interactions with
the person and the family
 Use family and community resources to
contact people who have not returned for
regular follow-up.
GENERAL PRINCIPLES OF CARE

4. Mobilizing and providing social support

 Be sensitive to social challenges that the
person may face, and note how these may
influence the physical and mental health
and well-being.
 Where appropriate, involve the carer or
family member in the person’s care.
GENERAL PRINCIPLES OF CARE
4. Mobilizing and providing social support
 Encourage involvement in self-help and family
support groups
 Identify and mobilize possible sources of social
and community support in the local area,
including educational, housing and vocational
supports.
 For children and adolescents, coordinate with
schools to mobilize educational and social
support, where possible.
GENERAL PRINCIPLES OF CARE
5. Protection of human rights
 Promote autonomy and independent living in
the community and discourage
institutionalization.
 Provide care that respects the dignity of the
person, that is culturally sensitive and
appropriate, and that is free from
discrimination on the basis of race, color, sex,
language, religion, political or other opinion,
national, ethnic, indigenous or social origin,
property, birth, age or other status.
GENERAL PRINCIPLES OF CARE
5. Protection of human rights
 Ensure that the person understands the
proposed treatment and provides free and
informed consent to treatment.
 involve children and adolescents in
treatment decisions in a manner
consistent with their evolving capacities,
and give them the opportunity to discuss
their concerns in private.
GENERAL PRINCIPLES OF CARE
5. Protection of human rights
 Pay special attention to CONFIDENTIALITY, and the
right of the person to privacy.
 With the consent of the person, keep carers
informed about the person’s health status,
including issues related to assessment, treatment,
follow-up,
 Prevent stigma, marginalization and
discrimination, and promote the social inclusion of
people with mental, neurological and substance
use disorders by fostering strong links with the
education, social (including housing) and other
relevant sectors.
GENERAL PRINCIPLES OF CARE
6. Attention to overall well-being
 Provide advice about physical activity and
healthy body weight maintenance.
 Educate the person about harmful
alcohol use.
 Encourage cessation of tobacco and
substance use.
GENERAL PRINCIPLES OF CARE

6. Attention to overall well-being

 Provideeducation about other risky
behavior (e.g. unprotected sex).
 Conduct regular physical health checks.

 Prepare people for developmental life

changes, such as puberty and provide the
necessary support.
Techniques in Psychosocial Counseling
COUNSELLING IS DEFINITELY WORTH
CONSIDERING WHEN: SOMEONE IS

 feeling overwhelmed or depressed

 needing someone to listen and help one
work out what’s most important
 Having an issue or situation is seriously
affecting day-to-day life
 Having difficulty in making important
decisions and are not sure what to do
next
COUNSELLING IS DEFINITELY WORTH
CONSIDERING WHEN: SOMEONE IS

 being withdrawn
 lack of appetite

 taking too much food

 Sleeping very little or more than 9 hours

per night,
 loss of interest in things they once
enjoyed,
 neglecting personal hygiene
COUNSELLING IS DEFINITELY WORTH
CONSIDERING WHEN: SOMEONE IS
 crying for no reason
 Over sensitive with otherwise negligible
issues
 seeming sad for longer than two weeks

 Academic deterioration

 Disobeying significant adults

 Extreme stubbornness and difficult to

manage by any means
 DEPRESSION
 Intypical depressive episodes, person
experiences depressed mood, loss of
interest and enjoyment, and reduced
energy leading to diminished activity
for at least 2 weeks. Many people
with depression also suffer from
anxiety symptoms and medically
unexplained somatic symptoms.
 DEPRESSION –PSYCHOSOCIAL INTERVENTIONS

Psychoeducation -(
 Depression is a very common problem that can
happen to anybody.
 Depressed people tend to have unrealistic
negative opinions about themselves, their life
and their future.
 Effective treatment is possible. It tends to take
at least a few weeks before treatment reduces
the depression. Adherence to any prescribed
treatment is important.
DEPRESSION -PSYCHOSOCIAL INTERVENTIONS

The following need to be emphasized:

 importance of continuing, activities that
used to be interesting or give pleasure,
 importance of trying to maintain a
regular sleep cycle (i.e., going to be bed
at the same time every night, trying to
sleep the same amount as before,
avoiding sleeping too much);
DEPRESSION -PSYCHOSOCIAL INTERVENTIONS

 the benefit of regular physical activity,

 the benefit of regular social activity,
including participation in communal
social activities
 recognizing thoughts of self-harm or
suicide and coming back for help when
these occur;
DEPRESSION -PSYCHOSOCIAL INTERVENTIONS
Addressing current psychosocial stressors
 Offer the person an opportunity to talk, in a
private space. Ask for the person’s subjective
understanding of the causes of one’s symptoms.
 Ask about current psychosocial stressors and, to
address pertinent social issues and problem-
solve for psychosocial stressors or relationship
difficulties with the help of community services /
resources.
 Assess and manage any situation of
maltreatment, abuse (e.g. domestic violence)
and neglect (e.g. of children or older people).
Contact legal and community resources, as
appropriate.
DEPRESSION -PSYCHOSOCIAL INTERVENTION
Addressing current psychosocial stressors
 Identify supportive family members
and involve them
 In children and adolescents:

 – Assess and manage mental,

neurological and substance use
problems (particularly depression) in
parents
 DEPRESSION -PSYCHOSOCIAL INTERVENTIONS
Addressing current psychosocial stressors
 – Assess parents’ psychosocial stressors
and manage them to the extent possible
with the help of community services /
resources.
– Assess and manage maltreatment,
exclusion or bullying
 – If there are school performance problems,
discuss with teacher on how to support the
student.
DEPRESSION -PSYCHOSOCIAL INTERVENTIONS

Reactivate social networks

 Identify the person’s prior social activities that
would have the potential for providing direct
or indirect psychosocial support (e.g. family
gatherings, outings with friends, visiting
neighbors, social activities at work sites,
sports, community activities).
 Build on the person’s strengths and abilities
and actively encourage to resume prior social
activities
DEPRESSION -PSYCHOSOCIAL INTERVENTIONS
Structured physical activity program
 Organization of physical activity of
moderate duration (e.g. 45 minutes) 3
times per week.
 Explore with the person what kind of
physical activity is more appealing, and
support him or her to gradually increase
the amount of physical activity, starting for
example with 5 minutes of physical
activity.
DEPRESSION -PSYCHOSOCIAL INTERVENTIONS

Offer regular follow-up

 Follow up regularly

 Re-assess the person for

improvement (e.g. after 4 weeks).
 PSYCHOSIS
 is characterized by distortions of thinking
and perception, as well as inappropriate or
narrowed range of emotions. Incoherent or
irrelevant speech may be present.
 Hallucinations (hearing voices or seeing
things that are not there),
 delusions (fixed, false idiosyncratic beliefs)
or excessive and
 unwarranted suspicions may occur.
 PSYCHOSIS
 Severe abnormalities of behavior, such as
disorganized behavior, agitation, excitement
and inactivity or overactivity,
 Disturbance of emotions, such as marked
apathy or disconnect between reported
emotion and observed affect (such as facial
expressions and body language)
 People with psychosis are at high risk of
exposure to human rights violations.
 PSYCHOSIS

 Abnormal or disorganized behavior

(e.g. incoherent or irrelevant speech,
unusual appearance,
 self-neglect, unkempt appearance)

 Neglecting usual responsibilities

related to work, school, domestic or
social activities
 PSYCHOSIS - PSYCHOSOCIAL INTERVENTIONS
Psychoeducation -Messages to the person
with psychosis
 the person’s ability to recover;
 the importance of continuing regular social,
educational and occupational activities, as
far as possible;
 the suffering and problems can be reduced
with treatment;
 the importance of taking medication
regularly;
PSYCHOEDUCATION -MESSAGES TO THE
PERSON WITH PSYCHOSIS
 rightof the person to be involved in
every decision that concerns his or
her treatment
 importance of staying healthy (e.g.
healthy diet, staying physically active,
maintaining personal hygiene).
PSYCHOSIS - PSYCHOSOCIAL INTERVENTIONS
Additional messages to family members of
people with psychosis
 PATIENT may hear voices or may firmly
believe things that are untrue.
 patient often does not agree that he or she
is ill and may sometimes be hostile.
 importance of recognizing the
return/worsening of symptoms and of
coming back for re-assessment should be
stressed.
PSYCHOSIS - PSYCHOSOCIAL INTERVENTIONS
Additional messages to family members of people
with psychosis
 importance of including the person in family
and other social activities
 Family members should avoid expressing
constant or severe CRITICISMS or hostility
towards the psychotics.
 People with psychosis are often
discriminated against but should enjoy the
same rights as all people.
 PSYCHOSIS - PSYCHOSOCIAL INTERVENTIONS
Additional messages to family members of
people with psychosis
A person with psychosis may have
difficulties recovering or functioning in
high-stress working or living
environments.
 It is best for the person to have a job or to
be otherwise meaningfully occupied.
 PSYCHOSIS - PSYCHOSOCIAL INTERVENTIONS

Additional messages to family members of

people with psychosis
 Ingeneral, it is better for the person
to live with family or community
members in a supportive environment
outside hospital settings. Long-term
hospitalization should be avoided.
 PSYCHOSIS - PSYCHOSOCIAL INTERVENTIONS
Facilitate rehabilitation in the community
 Coordinate interventions with health staff
and with colleagues working in social
services, including organizations working
on disabilities.
 Facilitate liaison with available health and
social resources to meet the family’s
physical, social and mental health needs.
 PSYCHOSIS - PSYCHOSOCIAL INTERVENTIONS

Facilitate rehabilitation in the community

 Actively encourage the person to
resume social, educational and
occupational activities as appropriate
and advise family members about this.
 Facilitate inclusion in economic and
social activities,
 PSYCHOSIS - PSYCHOSOCIAL INTERVENTIONS
Facilitate rehabilitation in the community
 it is important to overcome internal and
external prejudices and work toward the
best quality of life possible.
 Work with local agencies to explore
educational opportunities, based on the
person’s needs and skill level.
COUNSELING IS DEFINITELY WORTH
CONSIDERING WHEN: SOMEONE IS
 Having Extreme, rapid changes in moods or
personality, or drastic changes that last more than 6
weeks
 Running away from home
 doing Illegal activities
 Having Behavior problems at school
 Using tobacco, drugs, or alcohol
 Having A sudden change in friends
 Engaging Risky sexual behavior or sexual promiscuity
 Doing Other risky or dangerous behavior
 Having Noticeable changes in school performance or
attendance
 BIPOLAR DISORDER
 is characterized by episodes in which the
person’s mood and activity levels are
significantly disturbed.
 This disturbance consists on some
occasions of an elevation of mood and
increased energy and activity (mania), and
on others of a lowering of mood and
decreased energy and activity (depression).
 recovery is complete between episodes.
People who experience only manic
episodes are also classified as having
bipolar disorder.
BIPOLAR DISORDER
- PSYCHOSOCIAL INTERVENTIONS
Psychoeducation
 Messages to people with bipolar disorder (not
currently in acute manic state) and to family
members of people with bipolar disorder
 Explanation: Bipolar disorder is a mental
health condition that tends to involve
extreme moods, which may go from feeling
very depressed and fatigued to feeling
extremely energetic, irritated and overly
excited.
BIPOLAR DISORDER
- PSYCHOSOCIAL INTERVENTIONS
 needs to be some method for monitoring
mood, such as keeping a daily mood log in
which irritability, anger or euphoria are
recorded.
 It is important to maintain a regular sleep
cycle (e.g. going to bed at the same time
every night, trying to sleep the same
amount as before illness, avoiding sleeping
much less than usual).
BIPOLAR DISORDER
- PSYCHOSOCIAL INTERVENTIONS

 Relapses need to be prevented, by

recognizing when symptoms return,
such as sleeping less, spending more
money or feeling much more
energetic than usual, and coming
back for treatment when these occur.
BIPOLAR DISORDER
- PSYCHOSOCIAL INTERVENTIONS
A person in a manic state lacks insight into
the illness and may even enjoy the euphoria
and improved energy, so carers must be part
of relapse prevention.
 alcohol and other psychoactive substances
should be avoided.
 Since lifestyle changes should be continued
as long as needed, potentially indefinitely,
they should be planned and developed for
sustainability.
 EPILEPSY
 is a chronic condition, characterized by
recurrent unprovoked seizures. It has several
causes; it may be genetic or may occur in
people who have a past history of birth
trauma, brain infections or head injury. In
some cases, no specific cause can be
identified.
 Seizures are caused by abnormal discharges
in the brain and can be of different forms;
people with epilepsy can have more than one
type of seizure.
 Convulsive movement or fits / seizures
 During the convulsion:

– loss of consciousness or impaired

consciousness
– stiffness, rigidity
– tongue bite, injury, incontinence of urine or
feces
 After the convulsion: fatigue, drowsiness,
sleepiness, confusion, abnormal behavior,
headache, muscle aches, or weakness on one
side of the body
 TWO MAJOR FORMS OF SEIZURES
1. Non-convulsive epilepsy has features such as
change in awareness, behavior, emotions or
senses (such as taste, smell, vision or hearing)
similar to mental health conditions, so may be
confused with them.
2. Convulsive epilepsy has features such as
sudden muscle contraction, causing the person
to fall and lie rigidly, followed by the muscles
alternating between relaxation and rigidity, with
or without loss of bowel or bladder control. This
type is associated with greater stigma and
higher morbidity and mortality.
EPILEPSY/ SEIZURES- PSYCHOSOCIAL
INTERVENTIONS

Provide education to people with seizures /

epilepsy and carers
Explain:
 What is a seizure / epilepsy (e.g. “A seizure or
fit is a problem related to the brain. Epilepsy is
an illness involving recurrent seizures. Epilepsy
is not a contagious disease and is not caused
by witchcraft or spirits”).
EPILEPSY/ SEIZURES- PSYCHOSOCIAL
INTERVENTIONS

 The nature of the person’s seizure and its

possible cause.
 is a chronic condition, but seizures can be
fully controlled in 75 % of individuals, after
which they may live without medication for
the rest of their lives.
 Different treatment options.

 Reasons for referral (when applicable).

EPILEPSY/ SEIZURES- PSYCHOSOCIAL
INTERVENTIONS
Explore lifestyle issues:
 People with epilepsy can lead normal lives.
They can marry and have children.
 Parents should never remove children with
epilepsy from school.
 People with epilepsy can work in most jobs.
However they should avoid certain jobs
such as working with or near heavy
machinery.
EPILEPSY/ SEIZURES- PSYCHOSOCIAL
INTERVENTIONS

Explore lifestyle issues:

 People with epilepsy should avoid cooking
on open fires and swimming alone.
 People with epilepsy should avoid excessive
alcohol and any recreational substances,
sleeping much less than usual or going to
places where there are flashing lights.
 National laws related to the issue of driving
and epilepsy need to be observed
 DEVELOPMENTAL DISORDER
 covers disorders such as intellectual disability /
mental retardation as well as pervasive
developmental disorders including autism.
 usually have a childhood onset, impairment or
delay in functions related to central nervous
system maturation, and a steady course
 tend to persist into adulthood.

 People with developmental disorders are more

vulnerable to physical illness and to develop
other priority conditions
 INTELLECTUAL DISABILITY
 ischaracterized by impairment of
skills across multiple developmental
areas (i.e., cognitive, language, motor
and social) during the developmental
period.
 Lower intelligence diminishes the
ability to adapt to the daily demands
of life.
WITH DIFFICULTIES IN CONCENTRATING AND
LEARNING
 difficulties concentrating on school tasks,
focusing on work, and learning. They may have
trouble thinking about anything other than what
happened, how life is different, and what may
be ahead.
 This may make it difficult for them to focus on
what is required in school, and add to their
distress.
 Find out if this is happening, and help the
patient to find ways to focus and get back on
track with schoolwork/teaching and other
necessary tasks.
THINGS TO ASK
 What are you worried about? How much are
you thinking about it? Have you had trouble
sleeping? Are you thinking a lot about what
happened?
 What would be a different way to give yourself
time to think about what happened and what it
means to you, so that it would be less likely to
interfere with what you have to do right now?
 What are some ways that you can stay focused
and achieve what you need to do now?
 Work with teachers and parents to
modify classroom and homework
structures for students with particular
difficulty concentrating, by reducing
distractions, breaking schoolwork into
more achievable chunks, and giving
more frequent assistance and
feedback on the student’s
performance.
 Remind the person that he will feel
better in the long run by staying on track
with what is in front of him now.
 Provide referral for additional services
for individuals who have continued
sleep difficulties, are overly preoccupied
with thinking about what happened, and
worried about the future.
WITH DIFFICULTIES IN CONCENTRATING AND
LEARNING
Other Things to Consider:
 Help the person focus on needed activities by
encouraging him to set aside times for talking
with others or for thinking about his/her
concerns. Make sure the person doesn’t plan
to think about his concerns at bedtime.
 Encourage the person to allow more time to
complete school-related tasks, including
taking more breaks and asking for help from
others.
PERVASIVE DEVELOPMENTAL DISORDERS
INCLUDING AUTISM
 The features are impaired social behavior,
communication and language, and a
narrow range of interests and activities
that are both unique to the individual and
carried out repetitively.
 originate in infancy or early childhood.
Usually, but not always, there is some
degree of intellectual disability.
 DEVELOPMENTAL DISORDERS

 Delayed development: much slower learning

than other children of same age in activities
such as: smiling, sitting, standing, walking,
talking / communicating and other areas of
development, such as reading and writing
 Abnormalities in communication; restricted,
repetitive behavior
 Difficulties in carrying out everyday
activities normal for that age
DEVELOPMENTAL DISORDERS -PSYCHOSOCIAL
INTERVENTIONS
Family psychoeducation
 Psychoeducation involves the person with
developmental disorder and the family,
depending on the severity of the condition
and availability and significance of the family
member role in daily life. Parent or
significant family member needs to be
trained to
 Accept and care for the child with
developmental disorder.
DEVELOPMENTAL DISORDERS- PSYCHOSOCIAL
INTERVENTIONS --FAMILY PSYCHOEDUCATION
 Learn what is stressful to the child and what makes
them happy; what causes their problem behaviors
and what prevents them; what are the child’s
strengths and weaknesses and how best they
learn.
 Understand that people with developmental
disorders may have difficulties when they face new
situations.
 Schedule the day in terms of regular times for
eating, playing, learning and sleeping.
 Involve them in everyday life, starting with simple
tasks one at a time.
DEVELOPMENTAL DISORDERS- PSYCHOSOCIAL
INTERVENTIONS
 Keep them in schools as far as possible;
attending mainstream schools even if it is
part time is preferable.
 Be careful about their general hygiene and
train them in self-care.
 Reward their good behaviour after the act
and give no reward when the behaviour is
problematic.
 Protect them from abuse.
DEVELOPMENTAL DISORDERS- PSYCHOSOCIAL
INTERVENTIONS

 Respect their right to have a safety

zone within a visible boundary where
they can feel safe, comfortable and
move around and play freely the way
they like.
 Communicate and share information
with other parents who have children
with similar conditions.
DEVELOPMENTAL DISORDERS-
PSYCHOSOCIAL INTERVENTIONS
Advice to teachers
 Make a plan on how to address the child’s
special educational needs. Simple tips include:
– Ask the child to sit at the front of the class.
– Give the child extra time to understand
assignments.
– Break long assignments into smaller pieces.
– Look for bullying and take appropriate action
to stop it.
DEVELOPMENTAL DISORDERS-
PSYCHOSOCIAL INTERVENTIONS
Promoting and protecting the human rights of
the child and the family
 Be vigilant about issues of human rights and
dignity.
– Do not start interventions without informed
consent; prevent maltreatment.
– Avoid institutionalization.
– Promote access to schooling and other forms
of education.
DEVELOPMENTAL DISORDERS-
PSYCHOSOCIAL INTERVENTIONS
Support for carers
 Identify psychosocial impact on carers.
 Assess the carer’s needs and promote
necessary support and resources for their
family life, employment, social activities
and health.
 Arrange for respite care, which means a
break now and then when other
trustworthy caregivers take over
temporarily.
COUNSELING IS DEFINITELY WORTH
CONSIDERING WHEN: SOMEONE IS
 Having Violent behavior
 harming or threatening to harm themselves or
others, including animals
 Using slangs

 Having Aggressive attitude

 Suddenly gaining or losing a lot of weight,

which could indicate a life-threatening eating
disorder
 Having Tendencies to violate institutional
disciplines
 “BEHAVIOURAL DISORDERS”
 isan umbrella term that includes more
specific disorders, such as hyperkinetic
disorder or attention deficit hyperactivity
disorder (ADHD) or other behavioral
disorders.
 Only children and adolescents with a
moderate to severe degree of psychological,
social, educational or occupational
impairment in multiple settings are
diagnosed as having behavioral disorders.
 HYPERKINETIC DISORDER / ATTENTION DEFICIT
HYPERACTIVITY DISORDER (ADHD)
 main features are impaired attention and
overactivity.
 Impaired attention shows itself as breaking off
from tasks and leaving activities unfinished.
 child or adolescent shifts frequently from one
activity to another.
 These deficits in persistence and attention should
be diagnosed as a disorder only if they are
excessive for the child or adolescent’s age &
intelligence,& affect their normal functioning &
learning.
HYPERKINETIC DISORDER / ATTENTION DEFICIT
HYPERACTIVITY DISORDER (ADHD)
 Overactivity implies excessive restlessness,
especially in situations requiring relative calm.
 may involve the child or adolescent running
and jumping around, getting up from a seat
when he or she was supposed to remain
seated, excessive talkativeness and
noisiness, or fidgeting and wriggling. The
characteristic behavioral problems should be
of early onset (before age 6 years) and long
duration (> 6 months), and not limited to only
one setting.
 OTHER BEHAVIOURAL DISORDERS

 Unusually frequent and severe temper

tantrums and persistent severe disobedience
may be present.
 Disorders of conduct may be characterized by
a repetitive and persistent pattern of
dissocial, aggressive or defiant conduct.
 Such behavior, when at its most extreme for
the individual, should be much more severe
than ordinary childish mischief or adolescent
rebelliousness.
 OTHER BEHAVIOURAL DISORDERS

 Examples of the behaviors may include:

excessive levels of fighting or bullying; cruelty
to animals or other people; fire-setting;
severe destructiveness to property; stealing;
repeated lying and running away from school
or home. Judgments concerning the
presence of other behavioral disorders
should take into account the child or
adolescent’s developmental level and
duration of problem behaviors (at least 6
months).
BEHAVIORAL DISORDERS
 Excessive inattention and absent-
mindedness, repeatedly stopping tasks
before completion and switching to other
activities
 Excessive over-activity: excessive running
around, extreme difficulties remaining
seated, excessive talking or fidgeting
 Excessive impulsivity: frequently doing
things without forethought
BEHAVIORAL DISORDERS

 Repeated and continued behaviour that

disturbs others (e.g. unusually frequent
and severetemper tantrums, cruel
behaviour, persistent and severe
disobedience, stealing)
 Sudden changes in behaviour or peer
relations, including withdrawal and anger
BEHAVIOURAL DISORDERS – PSYCHOSOCIAL
INTERVENTION
Family psychoeducation
 Accept and care for the child with a behavioral
disorder.
 Be consistent about what the child is allowed
and not allowed to do.
 Praise or reward the child after you observe
good behavior and respond only to most
important problem behaviors; find ways to
avoid severe confrontations or foreseeable
difficult situations.
BEHAVIOURAL DISORDERS – PSYCHOSOCIAL
INTERVENTION
 Start behavioral change by focusing on a few very
observable behaviors that you think the child can
do.
 Give clear, simple and short commands that
emphasize what the child should do rather than
not do.
 Never physically or emotionally abuse the child.
Make punishment mild and infrequent compared
to praise.
 For example, withhold rewards (e.g. treats or fun
activities) after a child does not behave properly.
BEHAVIOURAL DISORDERS – PSYCHOSOCIAL
INTERVENTION
 As a replacement for punishment, use short
and clear-cut “time out” after the child
shows problem behavior.
 “Time out” is temporary separation from a
rewarding environment, as part of a planned
and recorded program to modify behavior.
Brief the parents how to apply it when
required.
 Put off discussions with the child until you
are calm.
BEHAVIOURAL DISORDERS – PSYCHOSOCIAL
INTERVENTION
Advice to teachers
Make a plan on how to address the child’s
special educational needs. Simple tips include:
 Ask the child to sit at the front of the class.

 Give the child extra time to understand

assignments.
 Break long assignments into smaller pieces.

 Look for bullying and take appropriate action

to stop it.
BEHAVIOURAL DISORDERS – PSYCHOSOCIAL
INTERVENTION
Support for carers
 Identify psychosocial impact on carers.
 Assess the carer’s needs and promote
necessary support and resources for their
family life, employment, social activities
and health. Arrange for respite care,
which means a break now and then when
other trustable caregivers take over
temporarily.
 ALCOHOL USE DISORDERS
 Conditions resulting from different patterns of
alcohol consumption include acute alcohol
intoxication, harmful alcohol use, the alcohol
dependence syndrome, and the alcohol
withdrawal state.
 Acute intoxication is a transient condition
following intake of alcohol resulting in
disturbances of consciousness, cognition,
perception, affect or behavior.
 Harmful use of alcohol is a pattern of alcohol
consumption that is causing damage to health.
 ALCOHOL USE DISORDERS
 damage may be physical (e.g. liver disease) or mental
(e.g. episodes of depressive disorder). It is often
associated with social consequences (e.g. family
problems, or problems at work).
 Alcohol dependence is a cluster of physiological,
behavioral and cognitive phenomena in which the use
of alcohol takes on a much higher priority for a given
individual than other behaviors that once had greater
value.
 alcohol withdrawal state refers to a group of
symptoms that may occur upon cessation of alcohol
after its prolonged daily use.
 ALCOHOL USE DISORDERS
 Appearing to be under the influence of
alcohol (e.g. smell of alcohol, looks
intoxicated, hangover)
 Presenting with an injury

 Somatic symptoms associated with alcohol

use (e.g. insomnia, fatigue, anorexia,
nausea, vomiting, indigestion, diarrhoea,
headaches)
 Difficulties in carrying out usual work,
school, domestic or social activities
ALCOHOL USE DISORDERS –PSYCHOSOCIAL
INTERVENTIONS
Examples of ways that the harmful or hazardous
use of alcohol can be reduced
 not having alcohol at home;
 not going to pubs or other locations where
people use alcohol;
 asking support from family or friends;

 asking the person to come back with family

or friends and to discuss a way forward
together at the health center.
 SUBSTANCE USE DISORDERS
 Conditions resulting from different patterns
of drug use include acute sedative overdose,
acute stimulant intoxication or overdose,
harmful or hazardous drug use, cannabis
dependence, opioid dependence, stimulant
dependence, benzodiazepine dependence,
and their corresponding withdrawal states.
 Harmful use of drugs is a pattern of drug
consumption that is causing damage to
health.
 SUBSTANCE USE DISORDERS

 Thedamage may be physical (as in

cases of infections related to drug
use) or mental (e.g. episodes of
depressive disorder) and is often
associated with damage to social
functioning (e.g. family problems,
legal problems or work-related
problems).
 SUBSTANCE USE DISORDERS
 Substance dependence is a cluster of
physiological, behavioral and cognitive
phenomena in which substance use takes
on a much higher priority for a given
individual than other behaviors that once
had greater value.
 Substance withdrawal state refers to group
of symptoms occurring upon cessation of a
substance after its prolonged daily use
 SUBSTANCE USE DISORDERS
 Appearing drug-affected (e.g. low energy,
agitated, fidgeting, slurred speech)
 Signs of drug use (injection marks, skin
infection, unkempt appearance)
 Requesting prescriptions for sedative
medication (sleeping tablets, opioids)
 Financial difficulties or crime-related legal
problems
 Difficulties in carrying out usual work,
domestic or social activities
ALCOHOL AND SUBSTANCE USE DISORDERS - –
PSYCHOSOCIAL INTERVENTIONS
Ways to discuss substance use:
 Engage the person in a discussion about
their alcohol/substance use in a way that
he / she is able to talk about both the
perceived benefits of it and the actual and
/ or potential harms, taking into
consideration the things that are most
important to that person in life.
 ALCOHOL AND SUBSTANCE USE DISORDERS –
PSYCHOSOCIAL INTERVENTIONS
 Steer the discussion towards a balanced
evaluation of the positive and negative effects
of the alcohol/substance by challenging
overstated claims of benefits and bring up some
of the negative aspects which are perhaps being
understated.
 Avoid arguing with the person and try to phrase
something in a different way if it meets
resistance – seeking to find understanding of
the real impact of the alcohol/substance in the
person’s life
ALCOHOL AND SUBSTANCE USE DISORDERS –
PSYCHOSOCIAL INTERVENTIONS

 Encourage the person to decide for

themselves if they want to change their
pattern of alcohol/substance use,
particularly after a balanced discussion of
the pros and cons of the current pattern of
use.
 If the person is still not ready to stop or
reduce alcohol/substance use, then ask the
person to come back to discuss further,
perhaps with a family member or friend.
ALCOHOL AND SUBSTANCE USE DISORDERS –
PSYCHOSOCIAL INTERVENTIONS
Self-help groups
 Consider advising people with alcohol/
substance dependence to join a self -help
group, e.g.Alcoholic Anonymous and
Narcotics Anonymous. Consider
facilitating initial contact, for example by
making the appointment and
accompanying the person to the first
session.
ALCOHOL AND SUBSTANCE USE DISORDERS –
PSYCHOSOCIAL INTERVENTIONS

Supporting families and carers

 Discuss with families and carers the
impact of Alcohol and Substance use
disorders on themselves and other family
members, including children. Based on
feedback from families:
 Offer an assessment of their personal,
social and mental health needs.
ALCOHOL AND SUBSTANCE USE DISORDERS –
PSYCHOSOCIAL INTERVENTIONS
 Provide information and education about
Alcohol and Substance use disorders.
 Help to identify sources of stress related to
Alcohol and Substance use; explore
methods of coping and promote effective
coping behaviors.
 Inform them about and help them access
support groups (e.g. self-help groups or
families and carers) and other social
resources.
 SUBSTANCE USE IN ADOLESCENCE

 Clarifythe confidential nature of the

health care discussion, including in
what circumstances parents or other
adults will be given information.
 Identify the most important underlying
issues for the adolescent, keeping in
mind that adolescents are often not
able to articulate their problems well.
 SUBSTANCE USE IN ADOLESCENCE
 ask open-ended questions covering the areas
covered by the HEAD acronym (Home,
Education / Employment / Eating, Activities,
Drugs and alcohol, Sexuality / Safety /
Suicide) and allowing sufficient time for the
discussion.
 Although they usually present with less severe
substance abuse problems, young people can
present with severe dependence. It is just as
important to screen adolescents for drug and
alcohol problems as adults.
 SUBSTANCE USE IN ADOLESCENCE

 Provide parents and the adolescent

with information on the effects of
alcohol and other substances on
individual health and social
functioning.
 SUBSTANCE USE IN ADOLESCENCE
 Encourage a change in the adolescent’s
environment rather than focusing directly on
the adolescent as being the problem, such as
by encouraging participation in school or
work and activities after school / work that
occupy the adolescent’s time, and encourage
participation in group activities which
facilitate the adolescent’s skill acquisition
and contribution to their communities. It is
important that adolescents are involved in
activities which interest them.
 SUBSTANCE USE IN ADOLESCENCE
 Encourage parents and / or responsible adults to
know where the adolescent is, who they are with,
what they are doing, when they will be home, and
to expect the adolescent to be accountable for
their activities.
 Encourage parents to set clear expectations (at
the same time being prepared to negotiate these
expectations with the adolescent), and to discuss
with adolescents the consequences of the
adolescent’s behaviors and non conformity with
expectations.
 SUBSTANCE USE IN ADOLESCENCE

 Adviseparents to limit their own behaviors

which may be contributing to their
children’s substance use, including the
purchasing or providing of alcohol or the
provision of funds which are being spent
on substance use, keeping in mind the
potential influence of their own alcohol
and drug use on their children.
 SUICIDE/SELF-HARM

 Suicide is the act of deliberately killing

oneself./ is a broader term referring to
intentional self-inflicted poisoning or injury,
which may or may not have a fatal intent or
outcome.
 Any person over 10 years of age experiencing
any of the following conditions should be asked
about thoughts or plans of self-harm in the last
month and about acts of self-harm in the last
year: eg., Chronic pain & acute emotional
distress
 SUICIDE/SELF-HARM -

 Current thoughts, plan or act of self-

harm or suicide
 History of thoughts, plan or act of self-
harm or suicide
 SUICIDE/SELF-HARM -
Offer psychosocial support
 Offer support to the person.
 Explore reasons and ways to stay alive.

 Focus on the person’s positive strengths by

getting them to talk of how earlier problems
have been resolved.
 Consider problem-solving therapy for
treating people with acts of self-harm in the
last year, if sufficient human resources are
available.
 SUICIDE/SELF-HARM -
Activate psychosocial support
 Mobilize family, friends, concerned individuals
and other available resources to ensure close
monitoring of the individual as long as the risk
persists.
 Advise the person and carer(s) to restrict
access to the means of self-harm (e.g.
pesticides and other toxic substances,
medication, firearms) while the individual has
thoughts, plans or acts of self-harm.
 SUICIDE/SELF-HARM
 Optimize social support from available
community resources. These include
informal resources such as relatives,
friends, acquaintances, colleagues and
religious leaders, or formal community
resources, if available, such as crisis
centers and local mental health centers.
 SUICIDE/SELF-HARM
 Inform carers and other family members
that asking about suicide will often reduce
the anxiety surrounding the feeling; the
person may feel relieved and better
understood.
 Carers of people at risk of self-harm often
experience severe stress. Provide
emotional support to relatives / carers if
they need it.
 SUICIDE/SELF-HARM

 Inform carers that even though they

may feel frustrated with the person, it
is suggested to avoid hostility or
severe criticism towards the person at
risk of self-harm.
POINTERS
CONTACT & ENGAGEMENT

 Remain Calm: school health personnels will be

around students, parents, and other adults who
may be in distress or expressing strong
emotions. By remaining calm, this can help the
counselee to calm down.
 Take the Initiative: Initiating contact and
conversation can help to identify students or
adults who may need assistance. Conversation
starters can be as simple as “Do you need
anything?” or “Are you ok?”
CONTACT & ENGAGEMENT

 Monitor Changes in Others: Be

watchful of changes in behavior in
students or staff (e.g., not as
talkative, changes in attire, less
social, appears more angry).
SAFETY AND COMFORT
 Ensure Safety: Ask staff and students if
they have any current safety concerns at
school. Listen for rumors or threats of
subsequent incidents,
 Ensure Continued Safety: When children
are anxious, they often act out. If students
are behaving in an unsafe manner, calmly
convey the rules and what is expected of
them.
SAFETY AND COMFORT

 Watch for High-Risk Behavior: Students

may increase substance use or participate
in other high-risk behaviors (e.g., driving
recklessly, initiating fights), endangering
themselves or others. Students are the first
to know if a peer is troubled, so ask them
directly if they are concerned about
anyone’s safety. Address these concerns
immediately.
SAFETY AND COMFORT

 Support Those Overwhelmed with Grief:

Support and comfort those overwhelmed
with the death of a friend or family
member. You might work with teachers on
how to talk to their class about the death of
a student or staff member, help
administration with memorial events and
displays, and/or assess at-risk students.
STABILIZATION
 Identify Vulnerable Students and Staff:
Those with a history of prior mental health
problems. Be sure to ask about prior
experiences and coping strategies. Offer
to guide them in relaxation and grounding
techniques, and check back with them to
assess how they are doing.
STABILIZATION
 Differentiate between Physical and Emotional
Distress: Students and staff members may
present with physical reactions and may have
frequent visits to the nurse or a medical doctor.
Ask about their experience in school and how they
are coping. Find out if the physical reactions are
related to the recent problem(e.g., Did the
symptoms start around the time of the stressor?
Do they become more severe when the person is
reminded of something related to the problem?),
and consider a referral to a mental health
specialist.
STABILIZATION
 Support Those Overwhelmed: Some students
and staff may show signs of distress. See if you
can assist with any current needs.
 Stabilize the School Environment: Calmly
convey to the students that the staff and
administration are continuing to monitor the
situation and will address any concerns they
might have. Providing them with a calm,
supportive environment with clear rules and
expectations will help them regain a sense of
security and normalcy.
INFORMATION GATHERING
 IdentifyCurrent Needs: Ask simple,
respectful questions to determine how
you may help. If the person needs
assistance beyond what you can offer,
connect them to a teacher, other health-
related professional, or whoever else is
needed.
 Know the Referral System: Make sure you
know how to refer students who need
help. Learn about the warning signs
INFORMATION GATHERING
 Develop a Referral System: Educate
staff members as to how they can
refer students for evaluation.
Routinely ask teachers about how
their students are behaving in the
classroom and whether they have any
concerns.
CONNECTION WITH SOCIAL SUPPORTS
 Establish Social Connectedness Programs:
Develop venues to increase interaction among
students and staff. Facilitate group discussions
on various health- or mental health-related
topics pertinent to the problem,. Encourage
individuals to reconnect with their family
members, friends, and members of their faith
community or other social or community
organization. For students, make
recommendations specific to extramural
student group activities or facilitate a peer-to-
peer program that may provide a venue for
social support
CONNECTION WITH SOCIAL SUPPORTS

 Help to Connect with Supports: Help students

to connect with family members, teachers,
aides, coaches, or those they find as a comfort.
Also help students to gather together and
encourage them to support each other.
 Keep Watch for Withdrawn Students: Observe
students who may be isolating or limiting their
social interactions with others. Check in with
students and ask if they are okay. For new
students, introduce yourself and welcome
them.
INFORMATION ON COPING
 Meet with Parents: Attend the parents’
meetings and provide information about
common reactions, Be prepared for these
meetings to be stressful, as parents will
be anxious. Parents, like students and
staff, cope best when provided with
support. School-sponsored meetings can
provide parents with the opportunity to
build their own social support network.
INFORMATION ON COPING
 Provide a Recovery Milieu: Encourage
those that need help to seek support
during the school day as needed.
 No One Way to Recover: You could often
get questions from others about the
course of recovery. Emphasize that there
is not one way to recover .Most
importantly, emphasize that everyone
should respect individual differences.
 Health-relatedprofessionals play an
important role in monitoring the
course of recovery of the students
and staff. Health-related
professionals can help the
problematic students stabilize and
accelerate recovery.
 PSYCHOSOCIAL COUNSELLING
 is a planned intervention between the
child and counselor/helper to assist the
child to alter, improve, or resolve his/her
present behavior, difficulty, or
discomforts.
 Is a process of helping the child to
discover the coping mechanisms that
he/she found useful in the past, how they
can be used or modified for the present
situation, and how to develop new coping
mechanisms.
 PSYCHOSOCIAL COUNSELLING

 isabout strengthening the ability of the

child to solve problems and make
decisions and is different from giving
advice.
 process involves a mutual responsibility
between you and the child.
 enables the child to discuss feelings and
worries freely without cultural, gender,
and social discrimination.
 PSYCHOSOCIAL COUNSELLING

 should reduce these disturbing

conditions. By talking, the child can
express worries, release tension, and
share feelings of suffering. Talking in
detail about problems often has a
clarifying effect for the person and
through this; strategies for change can be
explored.
 PSYCHOSOCIAL COUNSELLING

 Dealswith emotional distress and

behavioral difficulties, which individuals
struggle to deal with developmental
stages and tasks, Any aspect of
development can be turned into an
adjustment problem, and it is inevitable
that everyone encounters, at some time,
exceptional difficulty in meeting an
ordinary challenge
 To effectively communicate,
we must realize that we are
All different in the way we
perceive the world and use
This undersatnding as aguide to our
communication with others.
-- Tony Robbins
24 Counselling Techniques
Florence Ng,2014
 24 COUNSELLING TECHNIQUES
1. Spheres of Influence: look at areas of
their life and see which areas may be
impacting and influencing them.
 spheres of influence to consider are:
themselves, immediate family, friends,
husband or wife, extended family, job or
school, community, culture or religion, and
any external influences.
 24 COUNSELLING TECHNIQUES
2. Clarification: will help the counselor avoid any
misconceptions or avoid them having to make
any assumptions that could hinder their
feedback.
3. Client Expectations: can help the counselor
guide and direct their counseling accordingly.
 When a person enters therapy, they should
voice their opinions about counseling and
their beliefs about treatment. In the beginning,
they should be able to communicate with their
counselor as to what they expect to get out of
counselling.
 24 COUNSELLING TECHNIQUES
4. Confrontation: does not mean the client
confronting the therapist, or vice versa.
 confrontation that should happen here is within
the client.
 client should be able to self-examine themselves
during counseling.
5. Congruence: has to do with the counselor being
genuine with their feedback and beliefs about their
client’s situation and progress.
 The more authentic and true they are with their
counselling, the more that their client and work to
grow and benefit from their help.
 24 COUNSELLING TECHNIQUES
6. Core Conditions: counselling goes over
some essential traits that the counselor
needs to integrate for effective counseling,
which are:
 positive regard,

 empathy,

 congruence or

 genuineness

 warmth.
 UNCONDITIONAL POSITIVE REGARD

 An expression of caring and nurturance as well

as acceptance.
 Includes conveying warmth through:
 Also conveying acceptance by responding to the
client’s messages (verbal and nonverbal) with
nonjudgmental or noncritical verbal & nonverbal
reactions.
 Respect - ability to communicate to the patient
the counselor's sincere belief that every person
possesses the inherent strength and capacity to
make it in life, and that each person has the right
to choose his own alternatives and make his own
decisions.
 EMPATHY
 ability to perceive another's
experience and then to communicate
that perception back to the individual
to clarify and amplify their own
experiencing and meaning. It is not
identifying with the patient or sharing
similar experiences-- not "I know how
you feel"!
Primary skills associated with the
communication of empathy include:
 a. ATTENDING – involves our behaviors
which reflect our paying full attention, in an
accepting and supportive way, to the client.
(nonverbal and verbal )
 b. PARAPHRASING- Selective focusing on the
cognitive part of the message – with the
client’s key words and ideas being
communicated back to the patient in a
rephrased, and shortened form.
PRIMARY SKILLS ASSOCIATED WITH THE
COMMUNICATION OF EMPATHY INCLUDE:
C. REFLECTING Patient’s FEELINGS- Affective
reflection in an open-ended, respectful manner of
what the client is communicating verbally and
nonverbally, both directly through words and
nonverbal behaviors as well as reasonable
inferences about what the client might be
experiencing emotionally
 It is important for the helper to think carefully
about which words he/she chooses to
communicate these feelings back to the client.
EMPATHY- C. REFLECTING PATIENT’S FEELINGS-
 The skill lies in choosing words which use
different words that convey the same or
similar.
 For example, if a poorly skilled helper
reflected to the client that he/she was “very
angry and depressed,” when the client had
only said they were irritated by a certain
event, and had felt very sad over the death of
a family pet, the result could be
counterproductive to the process of change.
 GENUINESS
 Ability
of counselor to be freely themselves.
Includes congruence between outer
words/behaviors and inner feelings;
nondefensiveness; non-role-playing; and
being unpretentious.
 For example, if the helper claims that they
are comfortable helping a client explore a
drug or sexual issue, but their behavior
(verbally and nonverbally) shows signs of
discomfort with the topic this will become an
obstacle to progress and lead to client
confusion about and mistrust of the helper.
 WARMTH
 Is the ability to communicate and
demonstrate genuine caring and concern
for the clients
 Using this ability, counselors convey his
acceptance of clients, desire for client’s
well-being and the sincere interest in
fiding workable solutions to the problems
that the clients present
 24 COUNSELLING TECHNIQUES
7. Encouraging: Being encouraging will help
facilitate confidence and respect between both
parties. Focus on the client’s strengths and
assets to help them see themselves in a positive
light.
8. Engagement: As a therapist, having a good, yet
professional relationship with your client is
essential. However, there are bound to be difficult
moments in counselling sessions, which will
require influential engagement on the
counselor’s behalf.
 24 COUNSELLING TECHNIQUES
9. Focusing: Involves demonstrating that they
understand what their client is experiencing by
using non-judgmental attention without any
words. Focusing can help determine what the
client needs to obtain next from their services.
10.Immediacy: Features the counselor speaking
openly about something that is occurring in the
present moment. This helps the client learn from
their real life experiences and apply this to their
reactions for other past situations.
 24 COUNSELLING TECHNIQUES
11. Listening Skills: are needed to show that
the counselor understands and interprets
the information that their client gives them
correctly.
 we should do this by showing
attentiveness in non-verbal ways, such as:
summarizing, capping, or matching the
body language of their clients.
12. OPEN-ENDED QUESTIONS:

A questioning process to assist the

client in clarifying or exploring thoughts
or feelings.
 counselor is not requesting specific
information and not purposively
limiting the nature of the response to
only a yes or no, or very brief answer.
12. OPEN-ENDED QUESTIONS:
a. Goal is to facilitate exploration
b. Have an intention or therapeutic purpose for
every question you ask.
c. Avoid asking too many questions, or
an interrogatory role.
d. Best approach is to follow a response to an
open-ended question with a paraphrase or
reflection which encourages the client to share
more and avoids repetitive patterns of
question/ answer/ question/answer, etc.
 24 COUNSELLING TECHNIQUES
13. Paraphrasing: will show clients that the
counselor is listening to their information
and processing what they have been telling
them.
 reiterate or clarify any misinformation that
might have occurred.
PARAPHRASING -
 Selective focusing on the cognitive part
of the message – with the client’s key
words and ideas being communicated
back to the patient in a rephrased, and
shortened form.

FOUR STEPS IN EFFECTIVE [PARAPHRASING: )

I. Listen and recall. entire client message to
ensure you recalled it in its entirety and do not
omit any significant parts.
 FOUR STEPS IN EFFECTIVE [PARAPHRASING: )
II. Identify the content part of the message by
deciding what event, situation, idea, or person
the client is talking about.
III. Rephrase, in as concise a manner as
possible, the key words and ideas the client has
used to communicate their concerns in a fresh
or different perspective.
IV. Perception check is usually in the form of a
brief question, e., “It sounds like...,” “Let me see
if I understand this,” which allows the client to
agree or disagree with the accuracy of your
paraphrasing.
 24 COUNSELLING TECHNIQUES
14. Positive Asset Search: helps clients think up
their positive strengths and attributes to get them
into a strong mindset about themselves.
15. Reflection of Feeling: Counselors use this
technique to show their clients that they are fully
aware of the feelings that their client is
experiencing.
 by using exact words and phrases that their
client is expressing to them.
 24 COUNSELLING TECHNIQUES
16. Miracle Question: will help the client see
the world in a different way or perspective.
 A miracle question could be something along
the lines of: “What would your world look like
if a miracle occurred? What would that
miracle be and how would it change things?”
17. Stages of Change: By assessing a client’s
needs, a counselor can determine the
changes that need to occur for their client,
and when they should take place. This can be
determined by what they believe to be most
important.
 24 COUNSELLING TECHNIQUES

18.Trustworthiness: counselor must

create an environment for their client as
such that their client feels that they have
the capacity to trust their counselor.
 A therapist must be: congruent, warm,
empathetic, and speak with positive
regard to their client.
 24 COUNSELLING TECHNIQUES
19.Capping: involves changing a conversation’s
direction from emotional to cognitive if the
counselor feels their client’s emotions need to be
calmed or regulated.
20. Working Alliance: client is essential for a
successful counselling environment that will work
to achieve the client’s needs.
 involves the client and therapist being active
collaborators during counselling and agreeing
upon goals of treatment that are necessary, as
well as how to achieve those goals.
 24 COUNSELLING TECHNIQUES
21.Proxemics: counselor studies the spatial
movements and conditions of communication
that their client exhibits. By studying the body
orientation, the counselor can determine mood,
feelings, and reactions.
22. Self-Disclosure: Makes note when personal
information is disclosed at certain points of
therapy. Help the counselor learn more about the
client and use this information only to benefit
them.
22. SELF-DISCLOSURE
 counselor shares personal feelings, experiences,
or reactions to the client.
 Should include relevant content intended to help
them.
 As a rule, it is better to not self-disclose unless
there is a pressing clinical need which cannot be
met in any other way.
 Remember empathy is not sharing similar
experiences but conveying in a caring and
understanding manner what the client is feeling
and thinking
 24 COUNSELLING TECHNIQUES
23. Structuring: will help the client understand
their counselor’s train of thought into
determining how this routine will work for
them.
 counselor should discuss the agenda for the
day with their client, the activities, and the
processes that they will go through.
 Soon enough, the client will get used to the
routine, and this establishes comfort and
trust in counseling.
 24 COUNSELLING TECHNIQUES
24. Hierarchy of Needs: involves the
counselor assessing their client’s level of
needs as based on the progress that they
are making.
 needs that they will factor in are:
physiological needs, safety needs, love
and belonging needs, self-esteem needs,
and self-actualization needs. All these will
determine if change needs to take place
in counselling.
Happiness can be found even
in the darkest of times,
if one only remembers
to turn on the lights
-Albus Dumble dore
The Top Ten Basic Counseling Skills
By Kevin Drab
THE TOP TEN BASIC COUNSELLING SKILLS
1. Listening
 a. Attending - orienting oneself physically to the patient
(pt) to indicate one is aware of the patient, and, in fact,
that the client has your full, undivided attention and that
you care. Methods include eye contact; nods; not
moving around, being distracted, eye contact,
encouraging verbalizations; mirroring body postures and
language; leaning forward, etc. Researchers estimate
that about 80 percent of communication takes place
non-verbally.
 b. Listening/observing - capturing and understanding
the verbal and nonverbal information communicated by
that patient.
THE TOP TEN BASIC COUNSELING SKILLS
Two primary sources of information:
 CONTENT - what is specifically said. Listen
carefully for, not only what a person says, but
also the words, expressions and patterns the
person is using, which may give you a deeper
insight. Counselors should develop their ability
to remember what was said, as well as to clarify
what was said or finding out what was not said.
 PROCESS - all nonverbal phenomena, including
how content is conveyed, themes, body
language, interactions, etc. Smiling
THE TOP TEN BASIC COUNSELLING SKILLS
2. Empathy
3. Genuiness
4. Unconditional positive regard
5. Concreteness
 Keeping communications specific --
focused on facts and feelings of relevant
concerns, while avoiding tangents,
generalizations, abstract discussions, or
talking about counselor rather then the
client.
THE TOP TEN BASIC COUNSELLING SKILLS
5. Concreteness includes the following functions:
 Assisting client to identify and work on a specific
problem from the various ones presented.
 Reminding the client of the task and redescribing
intent and structure of the session.
 Using questions and suggestions to help the client
clarify facts, terms, feelings, and goals.
 Use a here-and-now focus to emphasize process
and content occurring in current session, which
may of help to elucidate the problem being worked
on or improving the problem-solving process.
THE TOP TEN BASIC COUNSELLING SKILLS
6. Open Questions -
7. Respect – the ability to communicate
to the patient
 counselor's sincere belief that every
person has the capacity to make it
through life as well as the right to
choose whatever paths they come
across
THE TOP TEN BASIC COUNSELLING SKILLS
8. Counselor Self-Disclosure
 counselor shares personal feelings,
experiences, or reactions to the client. Should
include relevant content intended to help them.
As a rule, it is better to not self-disclose unless
there is a pressing clinical need which cannot
be met in any other way. Remember empathy is
not sharing similar experiences but conveying
in a caring and understanding manner what the
client is feeling and thinking
THE TOP TEN BASIC COUNSELLING SKILLS
9. Interpretation
 Any statement to the client which goes beyond
what they have said or are aware of. In
interpretation the counselor is providing new
meaning, reason, or explanation for behaviors,
thoughts, or feelings so that patient can see
problems in a new way. Interpretations can help
the client make connections between
seemingly isolated statements of events, can
point out themes or patterns, or can offer a
new framework for understanding.
9. INTERPRETATION
 interpretation may be used to help a patient
focus on a specific aspect of their problem, or
provide a goal.
 Keep interpretations short, concrete (see
concreteness), and deliver them tentatively and
with empathy.
 Use interpretations sparingly and do not
assume a patient’s rejection of your insight
means they are resistant or that you are right.
THE TOP TEN BASIC COUNSELLING SKILLS

10. Information Giving and Removing

Obstacles to Change
 Supplying data, opinions, facts, resources
or answers to questions. Explore with
client possible problems which may delay
or prevent their change process. In
collaboration with the client identify
possible solutions and alternatives.
Three types of Counselling
 THREE TYPES OF COUNSELLING
1. In directive counselling,-counselor identifies
the problem and tells the person being
counseled what to do about it
2. In non-directive counselling, -person being
counseled identifies the problem and
determines the solution with the help of the
counselor, the counselor has to determine
which of the 2 types or some appropriate
combination to apply to each situation
3. Participative counselling /Eclectic Counselling
Approach–BOTH PARTIES PLAN HOW THE
PROBLEM WILL BE ANALYZED & SOLVED
TYPES OF COUNSELLING –
I. DIRECTIVE COUNSELING APPROACH
 also known as prescriptive counselling or
counselor-centered approach of counseling.
 is advocated by E.G.Williamson, a professor at
University of Minnesota.
 counselor plays a leading role & uses a variety of
techniques to suggest appropriate solutions to the
counselee's problem.
 also known as authoritarian or psychoanalytic
approach.
 counselor is active & help individuals in making
decisions & finding solution to their problems.
 counselor believes in the limited capacity of the
patient.
TYPES OF COUNSELLING
I. DIRECTIVE COUNSELLING APPROACH
 patient makes the decision but the
counselor does all he can to get the
patient make decision keeping with
his diagnosis.
 counselor tries to direct the patient’s
thinking by informing, explaining,
interpreting & advising.
TYPES OF COUNSELLING
I. DIRECTIVE COUNSELLING APPROACH
 basic assumptions related to directive
counseling approach:
A need- based approach
 Problem focused rather than patient focused
approach
 Used for patients incapable of solving their
problems
 Task of a competent counselor

 Making the best possible use of counselee's

intellectual abilities & resources
TYPES OF COUNSELLING.
I. DIRECTIVE COUNSELLING APPROACH
Advantages
 save time.
 emphasizes the problem & not the individual.
 counselor can see the patient more objectively
than the patient himself.
 lays more emphasis on the intellectual rather
than the emotional aspects of an individual’s
personality.
 methods used are direct, persuasive &
explanatory.
Limitations of the directive counselling approach
 patient does not gain any liability for self analysis
or solve new problems of adjustment by
counseling.
 makes the counselee overdependent on the
counselor.
 Problems regarding emotional maladjustment may
be better solved by nondirective counseling.
 Sometimes the counselee lacks information
regarding the counselee, leads wrong counselling.
 does not guarantee that the counselee will able to
solve the same problem on his own in future.
TYPES OF COUNSELLING
NONDIRECTIVE COUNSELLING APPROACH
 Defining the problem situation Counselee given
freedom to express his feeling Termination of
counseling
 Advantages of nondirective counseling
approach
 slow but sure process to make an individual
capable of making adjustments.
 No tests are used so one avoids all that is laborious
& difficult .
 removes emotional block & helps an individual
bring repressed thoughts on a conscious level
thereby reducing tension.
 Limitations of nondirective counselling
approach
a slow & time-consuming process.
 One cannot rely upon one’s resources, judgment &
wisdom as the patient is immature in making the
decision himself.
 depends too much on the ability & initiative of the
patient.
 Sometime difficulty to control pace of the interview
discussion.
 is individual centric, it may not possible for
counselor to attend every patient equally well.
 It require high degree of motivation in the patient.
TYPES OF COUNSELLING
NONDIRECTIVE COUNSELLING APPROACH
a client-centered process.
 counselee is the pivot of the whole
counseling process.
 main function of the counselor is to create
an atmosphere in which the client can work
out his problem.
 also known as permissive counselling.-
emotional elements rather than intellectual
element are stressed.
 PARTICIPATIVE COUNSELLING/
ECLECTIC COUNSELLING APPROACH
 is based on the fact that all individuals are
different from one another.
 techniques are elective in nature because they
have been derived from all sources of counselling.
 is based on selecting the best & leaving out what
is least required.
 the basic assumption related to eclectic
counseling approach:
 There is objectivity & co-ordination between counselor
& the patient during the counseling experience.
 The patient is active & the counselor remains passive in
the beginning.
 PARTICIPATIVE COUNSELLING/ ECLECTIC
COUNSELLING APPROACH
 principle of low expenditure is adopted.

 is neither nor client centered; but a

combination of both.
 counselor makes use of all the tools & methods
in his armour.
 counselor enjoys the freedom to resort to
directive & nondirective counselling methods.
 counselling relationship is built during the
counselling interview. This helps the patient
gain reassurance & confidence.
 PARTICIPATIVE COUNSELLING/ ECLECTIC
COUNSELLING APPROACH
Steps of the eclectic counseling approach
1. Establishing rapport

2. Diagnosis the problem

3. Analyzing the case

4. Preparing a tentative plan for modifying

behavior
5. Counseling

6. Follow- up
Advantages of eclectic counselling approach
 more cost effective & practical approach.

 more flexible approach of counseling.

 more objective & coordinated approach of

counseling.
Limitations of eclectic counselling approach
 role of counselor & the counselee are not
predetermined.
 requires more skilled counselors to handle the
dynamic feature of this counselling approach.
COUNSELING PROCESS
 COUNSELLING PROCESS
 Phase I Establishing relationship
 Phase II Assessment

 Phase III Setting goals

 Phase IV intervention

 PhaseV Termination & follow-up

 COUNSELLING PROCESS
PHASE I - ESTABLISHING RELATIONSHIP
 an ice breaking session during which the counselor &
counselee introduce each other & establish a primary
rapport.
 Good rapport building provides the respect, trust & sense
of psychological comfort to the counselor- counselee
relationship for progression to the counseling process.
 Strategies to establish an effective relationship:
 Introduce yourself o Being the phase with adequate social
skills
 Always address the individual by his or her name
 Ensure physical comfort of the counselee & self.
 Do not interrupt the individual when he/she is talking.
 Listen attentively.
 Observe nonverbal communication.
COUNSELLING PROCESS -PHASE II ASSESSMENT
 is basically a data collection phase, where the counselor
motivates the counselee to provide complete
information about the problem.
 The type of information collected from counselee like
general data, physical data, psychological data,
social/environmental data, achievement data,
educational & vocational data.
 After the collection of information, diagnosis related to
the counselee’s behavior is made.
 Various tools & techniques used for data collection like
intelligence tests, achievement tests, aptitude tests,
interest tests, personality tests, questionnaires,
interview, observation, autobiography, anecdotal
records, rating scale, cumulative record & case studies.
 COUNSELLING PROCESS -PHASE III SETTING GOALS
 goals are set co-operative by both the
counselor & the counselee.
 While setting goals, the counselee’s strengths,
weakness, constraints & available resources
must be kept under consideration.
 The goal could be immediate & ultimate which
directs the counselor & the counselee to
further progress in the counseling process.
 Effective & reliable goal setting requires
following skills in counselors:  Multifaceted
knowledge related to the problem of counselee
 COUNSELLING PROCESS -PHASE III SETTING GOALS

 Ability to think critically & inference-drawing

skills.
 Judgment, planning & management skills

 Skills to segregate &differentiate the provided

information
 Ability to each individuals to think critically &
realistically
 Help the counselee set feasible, reliable &
achievable goals
COUNSELLING PROCESS -PHASE IV INTERVENTION
 is an operational phase where the counselee is
suggested the best possible options for the
management of the present problem.
 is affected by the counselor's own thoughts
about the counseling process.
 intervention will depend on the approach used
by the counselor, the problem & the individual.
 The choice of intervention is a process of
adaptation & the counselor should be prepared
to change the intervention when the selected
intervention does not work.
COUNSELLING PROCESS –
PHASE V: TERMINATION AND FOLLOW-UP
 where counselling comes to an end.
 Termination must be planned well ahead so that the
counselee may feel comfortable at the departure &
gradually able to handle the problem independently.
 Some follow-up sessions may be required to help the
counselee further to handle the problem
independently. where counseling comes to an end.
 Termination must be planned well ahead so that the
counselee may feel comfortable at the departure &
gradually able to handle the problem independently.
 Some follow-up sessions may be required to help the
counselee further to handle the problem
independently.
 School health personnel can help students
recover and succeed academically,
psychologically, and socially.
 These strategies can also help you and your
family.
 Most importantly, don’t forget to take care of
yourself.
 Always remember to take time for yourself.
 Be a good role-model, practice good self-care!
 TIPS FOR RELAXATION

 Tension and anxiety are common feelings after

crises. These feelings can make it more difficult
to cope with the many things that must be done
to recover. Using relaxation exercises to calm
yourself during the day may make it easier to
sleep, concentrate, and have energy for coping
with life. These exercises can include slow
breathing, meditation, swimming, stretching,
yoga, prayer, listening to quiet music, spending
time outdoors.
HERE ARE BREATHING EXERCISES THAT MAY HELP:
Adults and Teens
1. Inhale slowly (one-thousand one, one-thousand
two,
one-thousand three) through your nose or mouth,
and comfortably fill your lungs.
2. Silently and gently say to yourself, “I’m filling my
body with calm.”
3. Exhale slowly (one-thousand one, one-thousand
two, one-thousand three) through your mouth, and
comfortably empty your lungs.
4. Silently and gently say to yourself, “I’m letting the
tension drain away.”
5. Repeat five times slowly.
CHILDREN (PRACTICE WITH YOUR CHILD)
Let’s practice a different way of breathing that can help calm
our bodies down.
1. I want each of you to think about your favorite color. Okay, we
are going to breathe in through our noses or mouths. When we
breathe in, we are going to think about our favorite color and
the beautiful things you connect with that color.
2. Next, we will breathe out through our mouths. When we
breathe out, we are going to breathe out the gray and the
uncomfortable feelings that have been building up. Let out the
air, slowly and quietly.
3. Let’s try it together. Breathe in really slowly and inhale
thinking about your favorite color and the beautiful things
connected to this color, while I count to three. One, two, three.
Good job. Now, while I count again, slowly let the air out while
thinking about the color gray and all the unpleasant feelings.
One, two, three. Great job. Let’s try it together again.
[Remember to praise children for their efforts.]
TIPS FOR FAMILIES:
 Find a room where everyone can spread out and
have his/her own space.
 Some family members will want to lie down, others
will want to sit. Some will want to close their eyes,
and some will want to keep them open. Encourage
everyone to find a way that feels most comfortable
to them.
 Take time to practice this when everyone is calm.
That way, everyone will be better able to use the
breathing exercise when they are feeling upset.
 For young children, turn the breathing exercise into
a game. Blow soap bubbles with a wand or blow
cotton
 balls across a tabletop. Get creative and make it
fun.
IN SUMMARY .. COUNSELLING TECHNIQUES
 Identify the problem. Counselor have to make
sure that he/ she really knows what the problem
is.
 Advice and guide the counselee to the desired
solution
 Analyze the forces influencing the behavior
 Determine which of these forces you have control
over and which of the forces the counselee has
control over.
 Determine the force which has to be modified,
eliminated, or enforced
IN SUMMARY .. COUNSELLING TECHNIQUES
 Plan, coordinate and organize the session &
determine the best time to conduct the session
 Clarified Thinking(in realistic & rational to solve
the emotional problems)
 Couselor can write a plan for an action

 Allot a session at least for 30 minutes

 Remove all the distractions (phones, visitors

etc
 Set a date for follow-up
IN SUMMARY .. COUNSELING TECHNIQUES
 Communication
 Write out what the plan, what you are going to
say 0r rehearse
 Plan to take documents and develop a record a
corrective action
 During the session, determine what the
counselee believes that causes the counter
productive behavior and what will be required
to change it
IN SUMMARY .. COUNSELING TECHNIQUES
 Provide a support or resources when
appropriate
 Using all the facts, make a decision and

 /or a plan of action to correct the problem. If

more counseling is needed, set a firm date
time for the next session
 QUALITIES OF A GOOD COUNSELOR…
G – Good technical knowledge
O – Obtaining appropriate information from the patient
O – Objectively answering questions
D – Demonstrating professionalism
C – Confidentiality maintenance
O – Observant
U – Unbiased
N – Nonjudgmental
S – Sensitive to the needs of the patient
E – Empathetic
L – Listens carefully
L – Lets the patient make decisions
O – Open minded
R – Respects the rights of the patients
CONCLUSION
 Counselling is a way of working with people
who have reached a crisis in their lives. This
can take in many forms either relationship,
difficulties, lack of self-esteem, mental health
problems etc.
 Counselling is a way to help someone find his
way to lead a more satisfying and fulfilling life
Thank you
REFERENCES
 Counseling Techniques: The best Techniques for Being the Most
Effective Counselor 2014 by Florence Ng
 The Top Ten Basic Counseling Skills by Kevin J. Drab, Slide share
2015 Shaneta Burgess
 Counseling Techniques Slide share 2013 by Nair Rahul Krishnan
 Guidance and Counseling Slide share 2013 by Dr Jayesh Patidar -
Guidance & counseling
 Types of Counseling , Slide share 2013 by Tinto Johns Vazhupadickal
 ·The Psychological First Aid Field Operations Guide 2nd Edition.
(2012 )by Melissa Brymer, Anne Jacobs et al; Los Angeles: National
Child Traumatic Stress Network.
 Basic Counseling Skills, slideshare 2012 by Smaranika Tripathy
 Counseling Technique, slideshare 2012 by Jyoti Srivastava
 mhGAP Intervention Guide for mental, neurological and substance
use disorders in non specialized health settings; World Health
Organization ,2010
 Training Handbook on Psychosocial Counseling for Children in
Especially Difficult Circumstances - A trainer’s Guide Third Edition
2003 by Cueto, Khatiwada et al; UNICEF Nepal