COUNSELING IN

PSYCHIATRIC NURSING

BY- MS. PREETI SHARMA

MSC. NSG. FINAL YEAR
 OUTLINES
 Introduction  Media of counseling
Definition  Techniques
 Purpose  Benefits
 Counseling  Qualities of
interventions counselor
 Elements  Counseling Skills
 Principles  Research articles
 Types  Conclusion
 Phases
Counseling denotes “giving advice”. It is a wider
procedure concerned with emotion as well as giving
information. Peplau (1952) said that the “counseling in
nursing have to do with helping the client to remember
and to fully understood what is happening to him in the
present situations so that the experience can be integrated
with rather than disassociated from life.”
Counseling is a supportive and empathetic professional
relationship that provides a framework for the
explorations of emotions, behaviors and thinking patterns
and the facilitation of healthy changes.
Definition
of
Counseling
“Counselling is a scientific process of
assistance extended by an expert in an
individual situation to a needy person.
Counselling involves relationship between
two persons in which one of them
(counsellor) attempts to assists the other
(counselee or client) in so organising
himself as to attain a particular form of
happiness, adjusting to a life situation , or in
short ,self actualisation."
 
“Counseling is a dynamic and purposeful
relationship between two persons, who approach a
mutually defined problems with mutual
considerations of each other to the end that the
troubled one or less mature is aided to a self
determined resolution of the problem.”
 
Wren (1962)
CONT…
• First is to identify the problems of person.
• The basic purpose of counselling is to help people
use their existing problem-solving skills more
effectively or to develop new or better coping
skills.
• Their job is to provide an opportunity for the
person to describe their feelings and problems for
themselves and then to reach decisions and
actions that are based on informed choices.
• To help the student to work out a plan for solving
his difficulties.
 CONT…

• To assist the student in planning for educational and

vocational choices.
• It helps is the proper choice of course according to the
interest, aptitude and intelligence of the student.
• Good counseling helps people build skills they can use
in solving their problems. For example, if people learn
good communications skills in dealing with their
spouses, they can also use those communication skills
with children, friends, or co-workers.
 COUNSELING INTERVENTION
Counseling interventions may occur in a variety of
settings and may include the following:
Communication and interviewing techniques
 Problem solving skills
 Crisis interventions
 Stress management
 Relaxation techniques
 Assertiveness training
 Conflict resolution
 Behavior modifications
Counseling is an important intervention during one to
one interaction with the clients or during the
presentations of psycho education groups, medications
groups and discharge planning groups. Clients, family
members and significant others are given an opportunity
any concerns they may have. The counselor provides
reassurance and clarification as his need arises.

Reassurance helps the client to regain self confidence

and decreases feelings of guilt, anxiety or fear.

Clarification helps the client gain a clearer picture of

reality by understanding behavior and feelings.
 ELEMENTS
 The counselor
• a person who is professionally capable to extend
help.

 The counselee
• the person who seeks help and lets himself/herself
be subjective for counseling.

 The counseling environment

• a place to facilitate counseling.
 P NONJUDGEMEN
FLEXIBILITY
R TAL ATTITUDE

EMPATHETIC
I TRUSTWORTHI
NESS
RELATIONSHIP N
C
SIMPLICITY
RELIABILITY I
INDIVIDUALIZ
P EMOTIONAL &
PHYSICAL
ATION L SAFETY

CONFIDENTIAIL
E PRIVACY
ITY S
Types of
Counseling
Types
 Directive counseling/ counselor centered
 Non directive counseling
 Motivational counseling
 Mental health counseling
 Marriage counseling
 Problem solving counseling
 Behavioral counseling
 Individual counseling
 Group counseling
 Educational counseling
1. Directive counseling/ counselor
centered

The counselor is the central figure and plays

more active role, where he directs the
counselee to take steps in order to resolve
his conflicts.
 
2. Non Directive counseling

It rest upon the fundamental respect for the

individual’s belief in person ability to solve
problems with the aid of a sympathetic
listener.
3. Motivational counseling

It involves discussing the feelings and

incentives with the client. The counselor can
encourage establishing helping relationship
to avoid despair feelings and work through
the feelings of their motivation.
4. Mental health counseling
They rely on conversation between the client and
the therapist. This may take in the form of
questions and answers, reconstruction of past
history or discussion of current difficulties. It
consists of an emotion laden monologue by the
patient or the therapist make an initiative in
making the patient to speak out his repressed
feelings and emotions.
5. Marriage counseling

Advice and help will be provided in

selecting the spouse. To identify positive
aspects of relationships as well as those
cause conflicts. To solve the problems
related to their marital problems and marital
relationship.
6. Problem solving counseling
Suitable for patients with reaction to stress and
with minor affective problems. The patient is
helped to-
 
Identify and list problems that are causing distress
Consider what practicable courses of action might
solve or reduce each problem.
Select 1 problem and try out the courses of action
that appears most feasible and to succeed.
7. Behavioral counseling

To change specific and particular behavior

and to treat the behavioral disorder,
behavioral counseling will be effective.
8. Individual counseling

Counseling may be proceeding by an interview,

the counselor will try to establish rapport and
structuring has to be done so that client
understands what to expect at counseling. It will
be used to get information, to give information
and to change behavior.
9. Group counseling

The individual may gain an insight and

understanding into his own problems through
listening to others, who will be discussing their
difficulties, ideas, values may become more
understandable and acceptable. The counseling
group helps the individual to change and
encourage his desires, abilities through their
relationship in an accepting and meaningful social
situation.
 
10. Educational counseling

Education counseling helps you with your future

study plans, in an organized way, thus assisting
you in the decision making and final steps you
take that massively affects your future prospects.
 PHASES
 Phase 1: Establishing relationship

 Phase 2: Assessment

 Phase 3: Setting goals

 Phase 4: Interventions

 Phase 5: Termination
Phase1:Establishingrelationship
It is the core phase of counseling. It affects the
progress of the process and acts as a curative
agent in itself. It includes each factor as respect,
trust and a sense of psychological comfort.

Phase 2: Assessment
Individuals are encouraged to talk about their
problems: counselor asks questions, collect
information, seeks his/ her views, observes and
possibly help the individual to clearly state his/
her problem.
Phase 3: Setting goals

The major purpose of this phase to provide

direction to the individual and counselor.

It involves making commitments to set of

conditions, a course of action, or an outcome.

Setting goals help us to know how well

counseling is working and when counseling may
be concluded.
Phase 4: Interventions

 After setting the goal question is “how shall we

accomplish these goals”?
 The interventions used will depend upon the
approach used by the counselor, the problem and
the individual.
 Hence the choice of intervention is a process of
adaptation and the counselor should change the
intervention when selected intervention is not
working.
Phase 5: Termination

 All counseling should have an ultimate

criterion a successful termination.

 It must be done without destroying the

accomplishments gained and should be done with
sensitivity, intention and by fading.
 MEDIA OF COUNSELING
 Regional centers
 Study centers
 Face-to-face contact
 Interview
 Letters
 Radio
 Television
 Broadcast
 Teleconference
 TECHNIQUE OF COUNSELLING

1. Prescriptive technique
2. Non – directive counselling
3. Directive counseling
4. Eclectic counseling
1. Prescriptive technique

This technique is used when individual is

having health problem. There are many
different techniques that counselors can use
with their clients.
• Spheres of Influence: This assessment tool will get the
individual to look at areas of their life and see which areas
may be impacting and influencing them. The person’s job
is to figure out which systems in their life give them
strength, and which ones give them stress. Some spheres
of influence to consider are: themselves, immediate
family, friends, husband or wife, community, and any
external influences.

• Clarification: A counselor should often ask their client

to clarify what they are telling them to make sure they
understand the situation correctly. This will help the
counselor avoid any misconceptions or avoid them having
to make any assumptions that could hinder their feedback.
• Client Expectations: 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 counseling. This can help the
counselor guide and direct their counseling accordingly.

• Encouraging: Being encouraging as a counselor for

your client is an essential technique that will help facilitate
confidence and respect between both parties. This
technique asks that the counselor focus on the client’s
strengths and assets to help them see themselves in a
positive light. This will help with the client’s progression.
• Focusing: This technique involves the counselor
demonstrating that they understand what their client is
experiencing by using non-judgmental attention without
any words. Focusing can help the counselor determine
what the client needs to obtain next from their services.

•Listening Skills: With any relationship, listening skills

are needed to show that the counselor understands and
interprets the information that their client gives them
correctly. The counselor should do this by showing
attentiveness in non-verbal ways, such as: summarizing,
capping, or matching the body language of their clients.
• Trustworthiness: The 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.
2. Directive counseling

This type of counseling is mostly counselor

centered because it allows the counselor to
give the counselee information about his/her
opportunities, and his/her problems.
Five steps in performing the Directive Counseling

• Clinical analysis – collecting, summarizing, and

organizing data.
• Diagnosis – formulating hypothesis as to the cause or
causes of the problem.
• Prognosis – predicting the development of the problem.
• Counseling – the heart of the process wherein the
counselor and the counselee talk and discuss the problem,
and, by means of leading questions, enables the counselee
to develop insight.
• Follow-up – helping the pupils with recurring or new
problems
3. Non Directive counseling

This type of counseling is regarded as client-

centered because the responsibility is given
to the clients for exploring their own
problem. Emphasis is given to the
individual, not the problem. It is also known
as permissive counseling.
4. Eclectic counseling

A combination of the good features of the

directive and non-directive counseling. This
type of counseling emphasizes that the
responsibility of planning and carrying out
the counseling process is dependent on the
counselor while the development of insight
and decision making rests on the counselee.
 BENEFITS OF COUNSELING
• Helps the person being counseled to
understand himself.
• Allows the individual to help himself.
• Develops positive outlook.
• Motivates to search for alternate solutions to
problems.
• Feel better about self.
• Feel more at peace, at ease in your daily activities,
more comfortable, and more secure in the world.
• Reduce stress at home, in the workplace, or in
relationships.
• Help with your physical health by reducing emotional
worries or stressors.
• Helps in superior decision making.
• Prepares the person to cope with the situation and the
related stresses.
• Identify the goals that you have in life, as well make
new goals that you want to achieve.
• Speak with a skilled professional about your fears and
perceptions of the world, and others.
• Feel safe about expressing any personal troubles or
private concerns.
• Understand your own thoughts, feelings, and
responses
QUALITIES OF A COUNSELLOR

 Interpersonal relationship
 Friendly nature
 Gets along with others
 Sympathetic understanding
 Sincerity
 Tactfulness
 Respect clients abilities & needs
 Attentive listener
CONT…

 Personal adjustment
 Shows matured behavior
 Maintain emotional stability
 Aware about one’s limitation
 Mentally sound & healthy
 Highly cultured social interests
 Ability to work with people
CONT…

 Health & personal appearance

 Pleasing voice
 Pleasing appearance
 
Leadership
 Ability to stimulate & lead others
 Reinforce important information
CONT…

Philosophy of life
 Good character
 Positive philosophy of life
 Faith in human values & nature

Faith in the spiritual quality of the world

Had a high sense of morality

 COUNSELING SKILLS
• Listen carefully.
• Demonstrate empathy.
• Do not make judgments.
• Understand emotions/feelings behind the story of
the person being counseled.
• Use appropriate body language.
• Do not show superiority or patronage.
CONT…

• Question with care.

• Ask open ended questions.

• Reflect back, summarize and paraphrase so

that the understanding is correct and
complete.
 RESEARCH ARTICLES
Counseling and mental health nursing: a qualitative
study
T. Stickley

Abstract

• The author draws upon his experience of training,

practicing and teaching both counseling and mental
health nursing in order to examine the relevance of
counseling skills training to mental health nurses.
 CONT…
• The qualitative study reported in this paper elicits the
feelings and thoughts of five mental health nurses
about their attitude towards individual counseling
work with mental health clients.
• It is asserted that newly qualified mental health
nurses may feel inadequately prepared for this aspect
of their work and they may also feel inadequately
supported.
• Additional counseling training may help equip
mental health nurses for the skills they need to work
within the therapeutic relationship.
CONT…

• By not providing adequate counseling skills

training, mental health nurse educators may
contribute to a cycle of incompetence.
Training methods are identified that may
enhance nurse training and help promote
competence and confidence for the newly
qualified nurse.
 CONCLUSION
Counseling is the relationship between two
persons in which, one of them attempts to assist
the other in organizing himself to attain a form
of happiness, adjustment to a life situation i.e.
self-actualization. An accepted, trusting and safe
relationship will be formulated in which clients
will learn to discuss their problems, acquires the
social skills, courage, confidence to implement
desired new behavior.