AMITY UNIVERSITY KOLKATA

MA APPLIED PSYCHOLOGY
PSYC624

INTERNAL ASSIGNMENT
TOPIC- COUNSELLING
Submitted By: Supervisor:

RUSHAALI SHYAMAL DR.ISTEVAN FEKETE

M.A Applied Psychology

A91316623023

1st semester
Question 1 - Define Counselling
Answer:-
(Burks and Stefflre 1979)
Counselling denotes a professional relationship between a trained counsellor
and a client.
This relationship is usually person-to-person, although it may sometimes
involve more than
two people. It is designed to help clients to understand and clarify their views of
their life
space, and to learn to reach their self-determined goals through meaningful,
well-informed
choices and through resolution of problems of an emotional or interpersonal
nature (Burks
and Stefflre 1979)
The counselling process was also viewed as a one to one process and in more
recent years the
relationship is increasingly becoming less restricted to a dyadic relationship and
the scope is
being widened to refer to more then one client Practically all the definitions
comes with the
view that counselling is a process which involves bringing about sequential
changes are a
period of counselling is concerned with bringing about a voluntary change in
the client
attractive to those seeking halthy life –stage transitions and productive lives free
from
disorders.
(Feltham and Dryden 1993) A principled relationship characterised by the
application of one or more psychological theories and a recognised set of
communication skills, modified by experience, intuition and other interpersonal
factors, to clients’ intimate concerns, problems or aspirations. Its predominant
ethos is one of facilitation rather than of advice-giving or coercion. It may be of
very brief or long duration, take place in an organisational or private practice
setting and may or may not overlap with practical, medical and other matters of
personal welfare. It is both a distinctive activity undertaken by people agreeing
to occupy the roles of counsellor and client and an emerging profession It is a
service sought by people in distress or in some degree of confusion who wish to
discuss and resolve these in a relationship which is more disciplined and
confidential than friendship, and perhaps less stigmatising than helping
relationships offered in traditional medical or psychiatric settings. Feltham and
Dryden (1993) highlight the areas of overlap between counselling and other
forms of helping, such as nursing, social work and even everyday friendship.
The existence of such contrasting interpretations and definitions arises from the
process by which counselling has emerged within modern society. Counselling
evolved and changed rapidly during the twentieth century, and contains within it
a variety of different themes, emphases, practices and schools of thought

Question 2:- If your client is too young to give the IQ test ,how can you
asses the IQ of that client.
Answer:- Intelligence is define in many different ways ,and there are three
multiple forms of intelligence ,such as musical ,athletic ,spatial ,logical-
mathematical, and so on (Gardner, 2011) .However ,when intelligence is usually
discussed ,it is done so related to Linguistic and problem –solving capabilities
(Gottfredson ,&saklofske,2009). Indeed,Aanatasi (1982) reports that most
intelligence test “are usually overloaded with certain functions, such as verbal
ability, and completely omit others “. She notes that many intelligence test are
“validated against measures of academic achievement “ and “are often
designated as test of scholastic aptitude “.such test are designed to measures an
individual ability . Most modern intelligence test are descendants of the original
scales developed in France by Alfred Binet in early 1900s. The Standard – Binet
Intelligence scale. This test is individually administered and has traditionally
been used more with children than with adults .In 2000s,it underwent a fifth
revision (SB5) and now has more modern look as well as appropriateness for
adult and those who are less verbally fluent. And then after this came a
intelligence test for the cases like if our client is too young to give normal IQ
test how can we asses the IQ of the client. Popular series of individually
administered intelligence test are these administered by David Wechsler . They
are the Wechsler Preschool and Primary Scale of Intelligence –III (WPPSI-III) ,
designed for ages of 2 years ,6 months to 7 years ,3 months ; the Wechsler
Intelligence Test provides a verbal IQ,Performance IQ, and Full-Scale IQ scores
The following are the four main indexes of the WISC-IV and what they
measure: Verbal Comprehension Index : Verbal concept formation. Tests include
Similarities, Vocabulary, and Comprehension. Optional tests are Information
and Word Reasoning. Assesses children's ability to listen to a question, draw
upon learned information from both formal and informal education, reason
through an answer, and express their thoughts aloud. It can tap preferences for
verbal information, a difficulty with novel and unexpected situations, or a desire
for more time to process information rather than decide "on the spot."
Perceptual Reasoning Index : Non-verbal and fluid reasoning. Tests include
Block Design, Picture Concepts, and Matrix Reasoning. Optional test is Picture
Completion. It assesses children's ability to examine a problem, draw upon
visual-motor and visual-spatial skills, organize their thoughts, create solutions,
and then test them. It can also tap preferences for visual information, comfort
with novel and unexpected situations, or a preference to learn by doing. Picture
Concepts - From each of two or three rows of objects, the child selects objects
that go together based on an underlying concept. This test measures fluid
reasoning, perceptual organization (i.e., the ability to organize nonverbal
concepts in a way that they can be processed most quickly and accurately), and
categorization (i.e., skill at recognizing the common features of nonverbal
concepts) Working Memory Index Tests include Digit Span and Letter-Number
Sequencing. Optional test is Arithmetic. It assesses children's ability to
memorize new information, hold it in short-term memory, concentrate, and
manipulate that information to produce some result or reasoning processes. It is
important in higher-order thinking, learning, and achievement. It can tap
concentration, planning ability, cognitive flexibility, and sequencing skill, but is
sensitive to anxiety too. It is an important component of learning and
achievement, and ability to work effectively with ideas as they are presented in
classroom situations.. Word Reasoning - measures reasoning with verbal
material; child identifies underlying concept given successive clues. This
measures a child's skills at understanding what words mean rather than simply
seeing a "collection of letters. Processing Speed Index Speed of Information
Processing. Tests include Coding and Symbol Search. Optional test is
Cancellation. It assesses children's abilities to focus attention and quickly scan,
discriminate between, and sequentially order visual information. It requires
persistence and planning ability, but is sensitive to motivation, difficulty
working under a time pressure, and motor coordination too. Cultural factors
seem to have little impact on it. It is related to reading performance and
development too. It is related to Working Memory in that increased processing
speed can decrease the amount of information a child must "hold" in working
memory.

Question 3:-Activities which may violate the boundaries of therapeutic

Relationship
Answer:- Theaurapatic relationship has been considered the foundation of
mental health care and the support for changing insight & behaviour .An
interactive & caring Relationship nurtured by Kindness ,Objectiveness , a sense
of humour and positive approach. Framework Of Therapeutic Relationship
 Background This refers to knowledge development through education
research etc .It is a knowing the client thoroughly before establishing the
relationship.
 Interpersonal Knowledge of Interpersonal relationship & development
theories includes the knowledge of theories which provides understanding the
self & low self-interact with society.  Knowledge of diversity influence &
determination Refers to the impact of Social cultural diversity & influence of
various determinacies in relationship.  Knowledge of Person This includes
understanding clients perspectives ,life history ,identifying client concern. 
Knowledge of Health & Illness This includes understanding
biological ,social ,psychological symptoms , rehabilitation, knowledge of best
practice.  Knowledge of Broad Health care policy Knowledge about health
care system available in the society understanding policies for best practice in
counselling. Boundaries of Therapeutic Relationships Professional boundaries
identify the parameters of the therapeutic relationship in which counsellor
provide care for the purpose of meeting the client’s therapeutic needs. The
counsellor is accountable and takes responsibility for setting and maintaining
the boundaries of a therapeutic relationship regardless of the client’s actions or
requests. The following activities may violate boundaries of the therapeutic
relationship:- • Accepting Gifts from Clients Counsellor must carefully consider
the implications of gifts. In most instances the nurse should decline accepting a
gift from a client. In the absence of employer policy outlining the way in which
gifts from clients are to be handled, counsellor should only accept a token gift
when the client initiates the gift-giving and giving the gift provides therapeutic
value to the client. If declining the token gift will harm the therapeutic
relationship the counsellor should consult with his/her employer. If a client
wishes to acknowledge the quality of their care by giving a large gift, a possible
solution is to direct gifts to foundations or scholarship funds. • Self-Disclosure
Self-disclosure in a therapeutic relationship can be considered useful when it is
for the purpose of providing reassurance, building rapport or for supporting a
client to meet their desired health care goals. Disclosing personal information
that is lengthy, irrelevant or is intimate in nature is not acceptable as it diverts
from a professional therapeutic relationship and outside of the zone of
helpfulness. • Commencing a Social Relationship with a Former Client When
contemplating initiating a relationship with a former client, there are a number
of factors that the impact on the well-being of the client; whether the client is
likely to require the counsellor ‘s care again , and other possible factors that
may affect the ability of the client. After a therapeutic relationship and where a
social relationship may develop between the counsellor and client, aspects of
the therapeutic relationship remain in place, such as the requirement for
confidentiality of information obtained through the therapeutic relationship. •
Entering a Therapeutic Relationship with Family, Friends or Acquaintances On
occasion, counsellors may find themselves in the position of being expected to
provide counselling care to family, friends or acquaintances. While this is
generally not appropriate, due to the inherent conflict of interest present in the
relationship, there may be circumstances where such a situation is unavoidable.
Prior to entering into a therapeutic relationship under these circumstances, the
nurse should ensure that attempts to exercise other options have been exhausted
or that other options do not exist. The counsellor must acknowledge the
presence of an inherent conflict of interest, be aware of the potential difficulties
in maintaining professional boundaries between the personal and the therapeutic
relationship and actively institute measures to manage the situation. In
communication with the client, the nurse must acknowledge that while a social
relationship exists, the client can expect to be treated professionally and that
information exchanged during the therapeutic relationship will be kept
confidential even after the therapeutic relationship ends.

Question 4:- Differentiate between Social Interaction and Therapeutic

Encounter ?
Answer:- The therapeutic relationship, also called the helping alliance, the
therapeutic alliance, and the working alliance, refers to the relationship between
a mental health professional and a patient. It is the means by which the
professional hopes to engage with, and effect change in, a patient. An
interpersonal relationship is a relatively long-term association between two or
more people. This association may be based on emotions like love and liking,
regular business interactions, or some other type of social commitment.
Interpersonal relationships take place in a great variety of contexts, such as
family, friends, marriage, acquaintances, work, clubs, neighbourhoods, and
churches. They may be regulated by law, custom, or mutual agreement, and are
the basis of social groups and society as a whole. Although humans are
fundamentally social creatures, interpersonal relationships are not always
healthy. Examples of unhealthy relationships include abusive relationships and
co-dependence. A relationship is normally viewed as a connection between two
individuals, such as a romantic or intimate relationship, or a parent-child
relationship. Individuals can also have relationships with groups of people, such
as the relation between a pastor and his congregation, an uncle and a family, or a
mayor and a town. Finally, groups or even nations may have relations with each
other, though this is a much broader domain than that covered under the topic of
interpersonal relationships. Most scholarly work on relationships focuses on
romantic partners in pairs or dyad's. These intimate relationships are, however,
only a small subset of interpersonal relationships. Social relation can refer to a
multitude of social interactions, regulated.
Question 5 & 6:- What is the difference between history taking an d
medical status examination ? What are the different Components of MSE ?
Answer:- The history taking and Mental Status Examination (MSE) both are
the most important diagnostic itools a counsellor has to obtain information to
make an accurate diagnosis. Although these important tools have been
standardized in their own right, they remain primarily subjective measures that
begin the moment the patient enters the clinic.~ HISTORY TAKING In history
taking detailed patient histoy is taken. Every component of the patient history is
crucial to the treatment and care of the patient it identifies. The patient history
begins with identifying patient data and the patient's chief complaint or reason
for coming to the clinic. The patient's chief complaint should be a quote
recorded just as it was spoken word to word , in quotation marks, in the patient's
record including psychiatric history, medical history, surgical history, and
medications and allergies are noted down it is important to make direct inquiry
to items such a family history of members being murdered—patients often do
not volunteer this information Additionally listing any family history of illness
is important. This information can be very useful later, when determining
treatment options. If a family member has a history of the same illness and had
a successful drug regimen, that regimen may prove to be a viable option for the
current patient. If possible, record the medications and dosages family members
took for their illnesses. If these medications and dosages worked for family
members, the chance is good that they may work for the current patient.Obtain a
complete social history. This addition to the patient history can be most crucial
when discharge planning begins. Inquire if the patient has a home. Also ask if
the patient has a family, and, if so, if the patient maintains contact with them.
This also is the area in which any history of drug and alcohol abuse, legal
problems, and history of abuse should be recorded. Points which are necessary
for history taking Demographic details In this we ask patients their name or
what name they prefer to be called. If the patient is a child or adolescent, asking
what grade the patient is in also may be appropriate. Also, ask patients their
marital status, occupation, religious belief, and living circumstance. Chief
complaint This is the patient's problem or reason for the visit. Most often, this is
recorded as the patient's own words, in quotation marks. This statement allows
identification of the problem by identifying symptoms that lead to a diagnosis
and, eventually, a specific treatment plan. History of present illness This is the
main part of the history taking because an exact history allows one to gather
basic information along with specific symptoms including timing in the patient's
life to allow the healthcare provider to take care of the whole patient. One more
important part of taking a history of present illness is listening. One should have
an organized format but not too rigid in administering the examination person
should go with open ended interview with client . For example, If asking about
medication allergies and the patient brings up problems with alcohol, follow the
patients lead and obtain information regarding the new data but then guide the
patient back to the interview to allow all information to be gathered. But also
Without a specific format, important information may be missed. One must
Remember to include both positives and negatives points because these could
be important aspects in determining diagnosis and treatment in complicated
cases. Record important life events to complete this part of the evaluation, and
this may help in establishing rapport with a patient. Past medical history List
medical problems, both past and present, and all medical illnesses. At least ask a
few screening questions regarding medical illnesses such as do you see a doctor
regularly. If possible, try to obtain the patient's entire medical records rather
than depending solely on the patient's self-report. Even the most minute detail
of a patient's medical history, from as far back as childhood, could play a
significant role in the presenting problem. Be certain to inquire about specific
events that may have occurred in childhood, such as falls, head trauma, seizures,
and injuries with loss of consciousness. All of these could be relevant to their
current problems. Past surgery history List all surgical procedures the patient
has undergone, including dates. Be as specific as possible when recording dates,
and obtain medical records for review when possible. Patients may not
volunteer this information unless asked specifically about operations.
Medication List the patient's current medications, including dosages, route,
regimen, and whether or not the patient has been compliant. If possible, have
the patient bring his or her medications to the visit. Also, inquire about past
medications. Additionally, with all past medications, look for signs or patterns
of noncompliance. If noncompliance issues or even drug-seeking behaviours
appear evident, ask the patient who prescribed the medications and when or
why the patient discontinued taking them. Allergies List all drug and food
allergies the patient currently has or has had in the past, and list what type of
reactions the patient had to the medications. Past psychiatric history List all of
the patient's treatment, including outpatient, inpatient, and therapy including
dates. Inquiring about past psychotropic medications and response, compliance,
and dosages. ask patients if they feel that they received any benefits from the
treatments. If so, inquire about the specific type of benefit. additionally, ask
patients which medications they feel helped them most in the past and ask
which ones helped them least. from an insightful patient, this information may
offer clues as to which class of medication the patient responds to best. Family
history List any psychiatric or medical illnesses, including method of treatment
such as hospitalization (medical and psychiatric) of family members and
response. Once again, the emphasis here is strong. Record any information
obtained because it may help in treatment planning. If a patient's family member
has been diagnosed with the same psychiatric illness and has been treated
successfully, treating the current patient with that same medication may be
appropriate. This may be a reasonable place to begin. Social history Obtain a
complete social history of the patient. Ask patients their marital status. Also,
inquire about employment status. If the patient is employed, inquire about the
frequency of absences from work. If the patient is not employed, inquire about
whether the patient currently is looking for work. Also inquire if a previously
held job was lost as a result of the illness. Obtain as much detailed information
as possible.

Now ,Let’s Consider What All Is Done In Medical Status Examination . The
Mental Status Exam (MSE) is the psychological equivalent of a physical exam
that describes the mental state and behaviors of the person being seen. It
includes both objective observations of the clinician and subjective descriptions
given by the patient. This is an essential tool that aids physicians in making
psychiatric diagnoses. Familiarity with the components of the examination can
help physicians evaluate for and differentiate psychiatric disorders. The mental
status examination includes historic report from the patient and observational
data gathered by the physician throughout the patient encounter. Major
challenges include incorporating key components of the mental status
examination into a routine office visit and determining when a more detailed
examination or referral is necessary. A mental status examination may be
beneficial when the physician senses that something is “not quite right” with a
patient. In such situations, specific questions and methods to assess the patient's
appearance and general behavior, motor activity, speech, mood and affect,
thought process, thought content, perceptual disturbances, sensorium and
cognition, insight, and judgment serve to identify features of various psychiatric
illnesses. The mental status examination can help distinguish between mood
disorders, thought disorders, and cognitive impairment, and it can guide
appropriate diagnostic testing and referral to a psychiatrist or other mental
health professional. Afer completion of the patient's history One perform the
MSE in order to test specific areas of the patient's spheres of consciousness. To
begin the MSE, once again We evaluate the patient's appearance. Document if
eye contact has been maintained throughout the interview and how the patient's
attitude has been toward the interviewer. Next, in order to describe the mood
aspect of the examination, ask patients how they feel. Normally, this is a one-
word response, such as "good" or "sad." Next, the interviewer's task is to define
the patient's affect, which will range from expansive (fully animated) to flat (no
variation). The patient's speech then is evaluated. Note if the patient is speaking
at a fast pace or is talking very quietly, almost in a whisper. Thought process and
content are evaluated next, including any hallucinations or delusions, obsessions
or compulsions, phobias, and suicidal or homicidal ideation or intent.
Components Of Mental Status Examination Appearance Record the patient's
sex, age (apparent or stated), race, and ethnic background. Document the
patient's nutritional status by observing the patient's current body weight and
appearance. Remember recording the exact time and date of this interview is
important, especially since the mental status can change over time such as in
delirium. Recall how the patient first appeared upon entering the clinic . Note
whether this posture has changed. Note whether the patient appears more
relaxed. Record the patient's posture and motor activity. Record the patient's
dress and grooming. If nervousness was evident earlier, note whether the patient
still seems nervous. Record notes on grooming and hygiene. Most of these
documentations on appearance should be a mere transfer from mind to paper
because mental notes of the actual observations were made when the patient
was first encountered. Record whether the patient has maintained eye contact
throughout the interview or if he or she has avoided eye contact as much as
possible, scanning the room or staring at the floor or the ceiling. Attitude toward
the examiner Next, record the patient's facial expressions and attitude toward
the examiner. Note whether the patient appeared interested during the interview
or, perhaps, if the patient appeared bored. Record whether the patient is hostile
and defensive or friendly and cooperative. Note whether the patient seems
guarded and whether the patient seems relaxed with the interview process or
seems uncomfortable. This part of the examination is based solely on
observations made by the health care professional. Mood The mood of the
patient is defined as "sustained emotion that the patient is experiencing." Ask
questions such as "How do you feel most days" to trigger a response. Helpful
answers include those that specifically describe the patient's mood, such as
"depressed," "anxious," "good," and "tired." Elicited responses that are less
helpful in determining a patient's mood adequately include "OK," "rough," and
"don't know." These responses require further questioning for clarification.
Establishing accurate information pertaining to the length of a particular mood,
if the mood has been reactive or not, and if the mood has been stable or unstable
also is helpful. Affect A patient's affect is defined in the following terms:
expansive (contagious), euthymic (normal), constricted (limited variation),
blunted (minimal variation), and flat (no variation). A patient whose mood could
be defined as expansive may be so cheerful and full of laughter that it is difficult
to refrain from smiling while conducting the interview. A patient's affect is
determined by the observations made by the interviewer during the course of the
interview. The patient's affect is noted to be inappropriate no connection is clear
between what the patient is saying and the emotion being expressed. Speech
Document information on all aspects of the patient's speech, including quality,
quantity, rate, and volume of speech during the interview. Paying attention to
patients' responses to determine how to rate their speech is important. Some
things to keep in mind during the interview are whether patients raise their
voice when responding, whether the replies to questions are one-word answers
or elaborative, and how fast or slow they are speaking. Record the patient's
spontaneous speed in relation to open-ended questions. Thought process Record
the patient's thought process information. The process of thoughts can be
described with the following terms: looseness of association, flight of ideas,
racing tangential, circumstantial , word salad, derailment , neologism , clanging,
punning , thought blocking, and poverty . Thought content To determine
whether or not a patient is experiencing hallucinations, ask some of the
following questions. "Do you hear voices when no one else is around?" "Can
you see things that no one else can see?" "Do you have other unexplained
sensations such as smells, sounds, or feelings?" Importantly, always ask about
command-type hallucinations and inquire what the patient will do in response to
these commanding hallucinations. For example, ask "When the voices tell you
do something, do you obey their instructions or ignore them?" Types of
hallucinations include auditory (hearing things), visual (seeing things),
gustatory (tasting things), tactile (feeling sensations), and olfactory (smelling
things). Insight Assess the patients' understanding of the illness. To assess
patients' insight to their illness, the interviewer may ask patients if they need
help or if they believe their feelings or conditions are normal. A patient's attitude
toward the clinician and the illness plays an important part to developing insight
into their condition and overall prognosis. Judgment Estimate the patient's
judgment based on the history or on an imaginary scenario. Reliability Estimate
the patient's reliability. Determine if the patient seems reliable, unreliable, or if
it is difficult to determine. This determination requires collateral information of
an accurate assessment, diagnosis, and treatment.