Module V : Brief Counselling Interventions

Regardless, brief therapies are particularly important in an age when people and institutions are demanding
quick and effective mental health services. The skills employed in these approaches are vital for counselors
working in managed care settings and for counselors in public settings who are expected to do more in less time

Brief counseling approaches are characterized by both their foci and time-limited emphasis. Most brief
counseling is not systemic in nature. However, as has been previously mentioned, strategic counseling is both
systemic and time limited. Techniques used in brief counseling are concrete and goal oriented. In addition,
counselors are active in helping foster change and in bringing it about. The emphasis in brief counseling is to
identify solutions and resources rather than to focus on aetiology, pathology, or dysfunction. Therefore, the
number of sessions con- ducted is limited to increase client focus and motivation.

Solution-Focused (brief) Counseling

Solution-focused counseling does not have a comprehensive view regarding human nature, but it focuses on
client health and strength. It states that people have within themselves the resources and abilities to solve their
own problems even if they do not have a causal understanding of them. Erickson also “believed that a small
change in one’s behavior is often all that is necessary to lead to more pro- found changes in a problem context”.
Solution-focused counseling sees people as being constructivist in nature, meaning that reality is a reflection of
observation and experience. Finally, solution-focused counseling is based on the assumption that people really
want to change and that change is inevitable.

ROLE OF THE COUNSELOR. The solution-focused counselor’s first role is to determine how active and
committed a client is to the process of change. Clients usually fall into three categories:

1. visitors, who are not involved in the problem and are not a part of the solution,
2. complainants, who complain about situations but can be observant and describe problems even if they
are not invested in resolving them, EXPECT CHANGE BUT ONLY IN OTHERS –
OBSERVATIONAL TASKS and
3. customers, who are not only able to describe problems and how they are involved in them, but are
willing to work on finding solutions- ACTION TASKS

In addition to determining commitment, solution-focused counselors act as facilitators of change to help clients
“access the resources and strengths they already have but are not aware of or are not utilizing” (Cleveland &
Lindsey, 1995, p. 145). They encourage, challenge, and set up expectations for change. They do not blame or
ask “why?” They are not particularly interested in how a problem arose. Rather, they are concerned with
working together with the client to arrive at a solution to the problem. Basically, they allow the client to be the
expert on his or her life.

A solution focused therapist:

 Focuses on what is wanted rather than on what is not wanted.

 Assumes that people are already on the way to realising what they want.

 Does not try to solve problems or find solutions, but rather elicits descriptions of preferred futures and
progress being made towards them.

 Is not gather or analysing information or trying to understand the client.

  Tries to find questions to ask that connect with the client’s answers and help the client to continue to
think and talk in ways that become useful to them.

The main idea is to focus on what the client was doing that was not working. While most therapies focused on
problems, this therapy focuses on solutions. The idea is that when clients come with a problem, there is some
aspect of it that works and focusing on that can lead to a positive change.
In the general sense, the solution-focused therapist engages in three activities with the client:

1) Asking questions
2) Listening with a constructive ear
3) Responding by echoing and summarising
The solution focused therapist does not ask questions to gather information but to help the client talk
and think in ways that it becomes useful to them.

Assumptions of Solution Focused Counselling

The most basic assumption is that if someone has made the decision to talk to a person in a helping role, then
they must want something to come from this. The assumption is one of motivation. Every client must be
motivated to achieve something, otherwise they would not be talking to someone, though it might not be clear to
the client at first what they are motivated towards. It also assumes that change is inevitable and the client
functions as an agent of change. The task of the solution focused counsellor is to help highlight and amplify the
positive change that is already underway. However, it is not the therapist’s questions that are leading the change,
rather, it is the thinking and talking by the client.

• People are doing their best at any given time

• People have the ability to resolve difficulties but temporarily lost confidence

• Focus is on increasing people’s hope by creating expectancy to change

• Change is constant
• Reality is not fixed or static

GOALS. A major goal of solution-focused counseling is to help clients tap inner resources and to notice
exceptions to the times when they are distressed. The goal is then to direct them toward solutions to situations
that already exist in these exceptions. Thus, the focus of sessions and homework is on positives and possibilities
either now or in the future.

TECHNIQUES. Solution-focused counseling is a collaborative process between the counselor and client.
Besides encouraging the client to examine exceptions to times when there are problems, several other
techniques are commonly used. One is the miracle question, which basically focuses on a hypothetical situation
where a problem has disappeared. One form of it goes as follows: “Let’s suppose tonight while you were
sleeping a miracle happened that solved all the problems that brought you here. How would you know it? What
would be different?”.

Another technique is scaling, where the client is asked to use a scale from 1 (low) to 10 (high) to evaluate how
severe a problem is. Scaling helps clients understand both where they are in regard to a problem and where they
need to move in order to realistically achieve their goals.

Another intervention is to give clients compliments, which are written messages designed to praise clients for
their strengths and build a “yes set” within them (i.e., a belief that they can resolve difficulties). Compliments
are usually given right before clients are given tasks or assignments.

Two final techniques are:

1. clues, which are intended to alert clients to the idea that some behaviors they are doing now are likely
to continue and they should not worry about them; and
 2. skeleton keys, which are procedures that have worked before and that have universal applications in
regard to unlocking a variety of problems.

Treatment Plan

 Identifying a solvable complaint

 Establishing Goals

 Design an Intervention

 Strategic Tasks –

 Visitors or window shoppers – no clear complaint – counsellor should only give complaints

 Complainants – concerns and expect change but in others – observational tasks

 Customers – want to take steps to find solutions – action tasks

 Positive new behaviours and changes are identified and emphasised

 Stabilisation

 Termination of Treatment
Setting a direction towards the desired outcome- describing a preferred future- describing progress
towards and instances of the preferred future-follow up- rating

Timing
Solution focused therapy is brief and present oriented. The average length of each session is 3 to 5 sessions.

Finding Solutions

• Views clients as experts on their complaint

• Assume clients have strength
• Focus on natural consequences
• Interrupt and change non productive behaviour • Provide rationale how tasks can be helpful

• Make interventions congruent with people’s world views • Learn from past solutions
• Embed compliments in suggestions
• Encourage new behaviour

• Create expectancy for change

• Make solution practical and specific.

STRENGTHS AND CONTRIBUTIONS. Unique strengths of solution-focused family counseling include the
following:

 The approach emphasizes brevity and its empowerment of client families (Fleming & Rickord, 1997).
 The approach displays flexibility and excellent research in support of its effectiveness.
 The approach reveals a positive nature to working with a variety of clients in various set-tings,
including schoolchildren (Murphy, 2008; Paterson, 2009).
 Theapproachfocusesonchangeanditspremisethatemphasizessmallchangeinbehaviors.
 The approach can be combined with other counseling approaches, such as existentialism.

LIMITATIONS. Solution-focused counseling has its limitations. These include the following:
  The approach pays almost no attention to client history.
 The approach has a lack of focus on insight.
 The approach uses teams, at least by some practitioners, which makes the cost of this
treatment high.

Therapeutic Alliance

• Collaborative
• Counsellors talk about how clients can help counsellor and treatment process

• Counsellors maintain a positive, respectable and health-oriented focus

Techniques

 Create an environment that is conducive to change

 Identifying exceptions to people’s problematic patterns

 Solution talk

 Miracle Question

 The Use of Scaling to Measure Change

 Use of Suggested Solutions (Indirect and implied suggestions, Homework tasks and suggestions,
Solution prescription)

Solution talk examples:

 Open Questions

 Presuppositional language

 Externalise the problems

 Normalising the people’s problems

 Focus on coping behaviour

 Reinforce and notice strengths and successes

 Create hypothetical solutions

 Concentrate on describing and changing behaviours

 Use rituals, symbols, metaphors and stories

 Use of words change, different, possibility, what and how

 Use inclusive language

 Use reframing and relabelling

 Match client’s style of talking

Narrative Counseling/ A postmodern and social constructionist approach

VIEW OF HUMAN NATURE. Narrative counselors emphasize “that meaning or knowledge is constructed
through social interaction”. There is no absolute reality except as a social product. People are seen as
internalizing and judging themselves through creating stories of their lives. Many of these stories highlight
negative qualities about individuals or situations in their lives and are troublesome or depressing. Through
treatment, clients can reauthor their lives and change their outlooks in a positive way.

Assumptions

 Stories are a basic way in which people make sense of their experience. Relating a story about an event
conveys intentionality and purpose of the teller and their understanding of relationships and the social
world, expresses feelings and communicates a moral evaluation of what’s happened.

 We tell our own personal tales, but do so by drawing on a cultural stock of narrative forms. We are
born into the story of our family and community and the story of who we are. As we grow, we adopt
narratives from the cultural resources around us to give meaning and shape to our individual life
narrative.

 People are social beings and have a basic need to tell their story. Holding back on telling the story
involves a process of psychological inhibition and can have negative effects on health. Telling one’s
story promotes a sense of knowing and being known and promotes social inclusion.

 People’s perception determine their realities.

 Changing people’s perception are best way to facilitate positive development.

 Focuses on linguistic ways people construct their lives

 Humans are interpretive beings in phenomenological sense active in interpretation of everyday life

 Attribution of meaning through self-narratives

 There are no essential truths

 Realities are constructed and maintained through language

ROLE OF THE COUNSELOR. The narrative approach to change sees counselors as collaborators and
masters of asking questions. Like counselors in other traditions, those who take a narrative orientation engage
their clients and use basic relationship skills such as attending, paraphrasing, clarifying, summarizing, and
checking to make sure they hear the client’s story or problem correctly. They assume that symptoms do not
serve a function and are, in fact, oppressive. Therefore, an effort is made by counselors to address and eliminate
problems as rapidly as possible. Overall, counselors uses narrative reasoning, which is characterized by
stories, meaningfulness, and liveliness, in an effort to help clients redefine their lives and relationships through
new narratives.

GOALS. According to the narrative viewpoint, “people live their lives by stories”. (Therefore, the emphasis in
this approach is shifted to a narrative way of conceptualizing and interpreting the world that is more expansive
and filled with more possibilities. Clients who undergo narrative therapy learn to value their own life
experiences and stories if they are successful. They will also learn how to construct new stories and meaning in
their lives and, in the process, create new realities for themselves.
 TECHNIQUES. The narrative approach seeks to empower clients and play to their strengths. It emphasizes
developing unique and alternative stories of life in the hope that clients will come up with novel options and
strategies for living. In order to do so, the problem that is brought to counseling is externalized.

 In externalization, the problem is the problem. Furthermore, externalization of the problem

separates a person from a problem and objectifies difficulties so that the resources of clients can be
focused on how a situation, such as chaos, or a feeling, such as depression, can be dealt with.
Awareness and objectivity are raised through asking how the problem affects the person and how
the person affects the problem.
 Other ways narrative therapists work are raising dilemmas, so that a client examines possible aspects
of a problem before the need arises, and
 predicting setbacks, so the client will think about what to do in the face of adversity.
 Reauthoring lives is one of the main foci for the treatment, though. By refining one’s life and
relationships through a new narrative, change becomes possible. In changing their stories, clients
perceive the world differently and are freed to think and behave differently.
 Counselors send letters to families about their progress.
 They also hold formal celebrations at the termination of treatment and give certificates of
accomplishment when clients over- come an externalized problem such as apathy or depression.
 Imagining a time when they were problem free and building an alternative narrative around it.
 Recruiting new audiences to listen to the reauthored story as a way to make this narrative a part of
everyday life.
 Creation of support groups for people who are in the process of reauthoring their narrative but are
surrounded by social pressure or the dominant narrative.
 Reauthoring- possibility for thoughts, actions and demotions are expanded and new description of old
stories done. May ask alternative stories, May suggest to create a story as if they were a different
person, May suggest people to extend their stories into future, May ask about neglected aspect of
stories, May ask people to tell about stories where they felt powerful. People find it helpful to have an
opportunity to tell their story in a setting in which what they have to say is accepted and valued by
others.
 Revisioning- changing the story and changing people’s vision of their lives. The telling and retelling
of stories with a change can provide strength, courage and resourcefulness to client which can
eventually replace the more habitual, problem-saturated accounts of troubles that the client has brought
into therapy. The ritual of therapy makes it possible for the person to articulate their life narrative with
support and without interruption or competition. This gives the client a chance to reflect upon their
story and to consider if there are parts of the story they might want to articulate in different ways.

STRENGTHS AND CONTRIBUTIONS. In the narrative approach a number of unique qualities have
contributed to counseling. Among them are the following:

• Blame is alleviated and dialogue is generated as everyone works to solve a common problem

 Clients create a new story and new possibilities for action. Stories can be used even as early as the
elementary school counseling level (Eppler, Olsen, & Hidano, 2009).

 Exceptions to problems are highlighted as in solution-focused therapy.

 Clients are prepared ahead of time for setbacks or dilemmas through counselor questions.

LIMITATIONS. Narrative counseling is not without its limitations, however.

 This approach is quite cerebral and does not work well with clients who are not intellectually astute.
 There are no norms regarding who clients should become.
 The history of a difficulty is not dealt with at all.
Crisis Counselling

A crisis refers to a period of transition in the life of the individual presenting a turning point which may be seen
as a challenge or a threat. Crises outside the bounds of a person's everyday experience require expert help.
Natural disaster, sexual assault, mental illness, death, major change in relationship. Crisis can be situational
(Such as natural disasters, accidents etc), existential (Inner conflicts relating to the way we want to live our life,
our purpose, spirituality and so on) or related to the life processes one is going through. Ones response to crisis
will vary with the:

1) With the type and severity of crisis

2) Previous experience with crisis

3) Availability of emotional support

4) Ability to care for self

People can have a variety of crises. Four of the most common types of crises are:

1. Developmental, which takes place in the normal flow of human growth and development under
circumstances that are considered normal (e.g., birth of a child, retirement)
2. Situational, in which uncommon and extraordinary events occur that an individual has no way of
predicting or controlling (e.g., automobile accident, kidnapping, loss of job)
3. Existential, which includes inner conflicts and anxieties that accompany important human issues of
purpose, responsibility, independence, freedom, and commitment (James & Gilliland, 2013) (e.g.,
realizing at age 50 that one has wasted one’s life and cannot relive past years)
4. Ecosystemic, in which some natural or human-caused disaster overtakes a person or a group of people
who find themselves, through no fault or action of their own, inundated in the aftermath of an event
that may adversely affect virtually every member of the environment in which they live (James, &
Gilliland, 2013) (e.g., a hurricane such as Katrina, a superstorm such as Sandy, an act of terrorism)

The crisis response should target physical, mental, emotional and behavioural reactions of a client (mostly
aimed at reducing the dysfunctionality caused to these domains). It involves focusing on short term strategies
and takes place immediately after the traumatic events. It is then followed by long term counselling.
The primary purpose of crisis counselling is to help an individual to restore some sense of control and mastery
after a crisis event or disaster. It is not unusual that in a crisis or disaster event an individual’s normal coping
capacities are taxed. Individuals can become overwhelmed emotionally and may have difficulty with problem
solving and other coping skills. Also, the individual’s basic beliefs (western phenomenon) about themselves (I
can keep myself safe), others (humans are generally good [generally challenged in human generated disasters
such as terrorism, war, etc]) and the world (is generally a safe place) might have been violated. Crisis
counselling is discrete and has limited goals to ensure safety and promote overall stability. The goal is to
provide emotional support and concrete feedback/assistance for the individual. Crisis counselling helps
problem-solve and assists individuals in obtaining available resources.

In terms of mental health, a crisis does not necessarily refer to a traumatic situation or event. It is the person’s
reaction to an event. One person may be deeply affected by an event, whilst another does not suffer.

The purpose of crisis counselling is to deal with the person’s current status by dealing with a crisis. Chronic
exposure to stress or trauma can lead to mental illness. Therefore, it is important that counsellors have the skills
and knowledge to help clients cope with their current stressors and trauma. Crisis counselling is not intended to
provide psychotherapy or similar, but offers a short-term intervention to helps clients receive assistance,
resources, stabilisation and support. Crisis intervention differs from other counselling interventions in that it
focuses on short term strategies to prevent damage during and immediately after the experience of trauma. Crisis
counselling is often followed by counselling for long term improvement of the client’s mental health and
personal wellbeing. These will be discussed in more detail later in this lesson. Crisis intervention has several
purposes. It aims to reduce the intensity of the person’s physical, mental, emotional and behavioural reactions to
a crisis. It also helps the individual return to the level of functioning they were at before the incident. There is
also an educational component to crisis intervention. The individual will be advised of the normal reactions to
an abnormal situation. The individual will be told that their responses are temporary and that there is not a
specific time that the person can expect to recover from the crisis.

Principles of Crisis Intervention

1) Simplicity – People respond to simple not complex in a crisis

2) Brevity – Minutes up to 1 hour in most cases (3-5 contacts typical)
3) Innovation – Providers must be creative to manage new situations
4) Pragmatism – Suggestions must be practical if they are to work
5) Proximity – Most effective contacts are closer to operational zones
6) Immediacy – A state of crisis demands rapid intervention
7) Expectancy – The crisis intervener works to set up expectations of a reasonable positive outcome”

Goals of Crisis Counselling

1. Safety: Ensures the individual is safe (harm to self/others)

2. Stability: Ensures the individual is stable and has a short-term plan which includes mastery of self and
the emergency or disaster situation

3. Connection: Helps connect the individual to formal and informal resources and support. If resources
are supports are not readily available, crisis counselling helps the individual pursue potential natural
supports/resources.

4. Mitigate the impact of an event

5. Facilitate a normal recovery process, where normal people are having normal reactions to abnormal
events.

6. Restore adaptive functioning.

Role of Counsellor

 Establish rapport

 Listen to what happened

 Identify the problem

 Assess client’s safety

 Assess perceptual skills, cognitive skills, support networking skills, stress management and wellness
skills, problem solving skills, description and expression of feelings skills

 Deal with feelings

 Alternatives explored

 Action plan worked out

 Referrals (if needed)

Steps/Techniques in Crisis Counselling

 1. Establish a helping relationship- the goals of relationship building in crisis intervention is to help the
client feel understood, to reduce the client’s emotional arousal through venting and to reestablish some
level of cognitive control on part of the client. These goals can be attained through catharsis and
sharing and through the communication of. support, respect and safety on behalf of the client. Building
a relationship makes the client feel comfortable and more responsive to the clinician’s interventions.

2. Assure Safety- one of the first concerns about a client in crisis is to assess how dangerous they are to
themselves and others around them. The client might also be in danger from someone else. It is
important to ask direct and specific questions about circumstances involving suicidal ideation,
homicidal intention or any other threatened attacks on oneself or another.

3. Conduct an assessment- the crisis intervention counsellor should secure information about the event
that precipitated the crisis. They should understand what the event means to the client, the client’s
support system and their premorbid personality. This information can help the counsellor figure out the
interventions that can be put in place to help the client.

4. Give support- assessing the client’s support system means finding out who in the client’s environment
cares what happens to them. When going through a tough time, calling on such people for care and
help is essential. The counsellor too needs to make the client feel cared for. If there is a lack of support,
plans should be made for emergency contacts to be made with the counsellor in personally off hours,
this is important in case of suicidal ideation but insufficient evidence to consider hospitalisation.

5. Assist with action plan- as the client is in a state of distress, identifying an action plan and acting on it
can help the client return to a state of equilibrium. In crisis intervention, the counsellor usually takes a
more directive role when compared to other therapies because the client’s own coping mechanisms
have failed. The counsellor should help the client gain an accurate understanding of the crisis before
seeking a solution. Through the use of open-ended questioning, the counsellor tries to elicit, identify
and modify coping behaviours that have worked for the client before. The counsellor can then add to
this list with their own suggestions. Once all the coping behaviours are listed, the counsellor
encourages the client to select one or more actions that they feel capable of accomplishing. This helps
the client gain control over their life.

6. Arrange for follow-up- a follow-up meeting should be arranged to check on the client’s progress.
Based on the client’s condition, further plans might have to be made to revise the action plans.

STRENGTHS AND CONTRIBUTIONS. As a specialty, crisis counseling is unique and has con- tributed to
the profession of counseling in the following ways:

 The approach benefits from its brevity and its directness.

 The approach uses modest goals and objectives because of the sudden and/or traumatic nature of crises.

 The approach relies on its intensity, which is greater than regular forms of counseling.
 The approach utilizes a more transitional nature.

LIMITATIONS. Crisis counseling is limited in these ways:

 The approach deals with situations of an immediate nature.

 The approach does not go into the same depth in regard to resolution that most counseling approaches
do.
 The approach is more time limited and trauma oriented than most forms of therapeutic interventions.