Communication Disorders: An Introduction for Community-Based Rehabilitation Workers

2. Principles of Counselling

2 Principles of Counselling Introduction The term 'counselling' encompasses the relationships, skills and processes used when one person helps another with a problem or series of problems. Often this help takes place during a discussion or within an interview. For the rehabilitation of communication disorders we require both counselling and interviewing skills. These will also be useful in all our human relationships whether with family members, friends or colleagues. Counselling skills develop over many years and are dependent on our personalities, interpersonal skills and knowledge. How we apply these will vary a little according to the culture to which we belong; however, the application will make the difference between being an average or excellent clinician. Counselling or helping can include processes which deal with the feelings, thoughts and behaviours of a person. Counselling usually involves two people: the person with a problem and the helper or counsellor. Counselling can also be done in a group format when these roles are less clearly delineated, and people with similar problems may help one another. For example, a group of laryngectomee patients and their spouses may all help one another by sharing their practical problems and feelings and the manner in which they cope with them. By reading this book you will have some appreciation of both the 'art' (pertaining to feelings) and 'science' (pertaining to knowledge) of counselling, and some knowledge of the personalities, processes and interactions required. The needs of the patient will be addressed along with possible outcomes. Counselling is critical in the management of 12 Communication Disorders communication disorders because communication is the way we express our thoughts and feelings. Historically, help was offered by family, friends, and communities, and was built on relationships of care and trust. With the coming of psychoanalysis help became not only scientific but somewhat exclusive. Yet in many ways more and more help was required as the pressures of twentiethcentury changes were felt and the influence of the extended family diminished, particularly in Western cultures. Helping skills and education have now been extended across many professions including all those involved with rehabilitation. Without counselling, one cannot make the best use of other specific knowledge and skills. In times of crisis, such as earthquake, famine, war and air disasters, the role of the counsellor has now become clearly identified as one of maximum importance if the longterm effect of such disaster on an individual is to be reduced. The effects of acute or chronic illness and disability need to be managed in a similarly caring manner in order to maximize the effects of rehabilitation. Every professional dealing with handicap requires counselling, caring or appropriate helping skills. Components of the counselling relationship 1. The counsellor, helper or therapist brings to the task a specific personality as well as a theory base and practical skills. 2. The person with a problem has a specific personality, needs and coping/ non-coping capabilities. 3. The outcome of the procedure these two go through together will depend on the interactions of the following components: • the personalities of both people • the theories used • the relationship established • the type of problem and prognosis • associated difficulties and needs • the actions taken • the achievements 4. The goal is to help the patient function as well as possible independently. The relationship The relationship between the counsellor/therapist/helper and the patient includes the following attributes: Principles of Counselling 13 Counsellor Patient Knowledge Problems Skills Coping/Non coping A personality A personality relationship Value system Value system Needs Needs Experience Experience Hopes Hopes Counselling components in rehabilitation Each helper needs the skills to be able to: 1. deal with intervention and refer on if necessary (onward referral might be to a specialist doctor, support group or social welfare organizations) 2. cope with the diagnostic period and accompanying feelings of (a) shock (b) denial (in which the patient may 'pretend' to be coping or refuse to accept a specific diagnosis) (c) grief or feeling of hopelessness (d) anger (maybe against even the helper whose presence verifies the need and the condition) (e) eventual acceptance of the problem (These reactions are often delayed or may re-occur in cycles.) 3. identify the problems and all associated feelings, thoughts and behaviours 4. supply information and continuing support 5. shape new behaviours 6. evaluate 7. allow the patient to develop responsiblity and initiative in handling the problem 8. plan with the patient The counsellor Brammer (1988) has...