Counselling Skills

INTRODUCTION

The GP is ideally situated to be an effective counsellor—based on the therapeutic effect of the doctor. Counselling is not simply giving information or advice but is ‘the therapeutic process of helping a patient to explore the nature of his or her problem in such a way that he or she determines decisions about what to do, without direct advice or reassurance from the counsellor’. It therefore facilitates insight and understanding. It involves all the principles outlined in communication skills ( 139–41).

A useful model is the PLISSIT model which stands for:

• P—permission giving

• LI—limited information

• SS—specific suggestion

• IT—intensive therapy

Characteristics of the effective counsellor have been demonstrated to be genuineness, non-possessive warmth for the patient, fostering confidentiality and trust, and accurate and empathic understanding.

Some counselling strategies

• Provide guidance and facilitation to allow the patient to gain insight.

• Use appropriate ‘gentle’ confrontation to allow self-examination.

• Help patients to explore their own situation and express emotions such as anxiety, guilt, fear, anger, hostility, hurt feelings.

• Explore possible feelings of insecurity and allow free expression of such feelings.

• Ask key searching questions, e.g.:

  • – What do you think deep down is the cause of your problem?

  • – If you could change anything in your life, what would it be?

  • – How do you think your problem should be treated?

• Provide ‘okay’ specific suggestions, e.g.:

  • – I wonder if your basic problem is that you are a perfectionist.

  • – Many people in your situation feel guilty about something which may even be trivial and need to feel forgiven.

Effective counselling comes from commitment, experience and a genuine caring compassionate feeling for patients and their ethos. If one feels out of one’s depth then immediate referral to an expert is important.

COGNITIVE BEHAVIOUR THERAPY (CBT)

Cognitions are thoughts, beliefs or perceptions. CBT involves the process of knowing or identifying, understanding or having insight into these thought processes. The therapy then aims to change behaviour by teaching patients new ways of positive thinking. Patients need to be able to recognise their own negative cognitions, including their anxieties and worries.

Key rules to counselling

1. The patient must leave feeling better.

2. Provide insight into their illness and/or behaviour.

3. Address any feelings of guilt (people must feel okay or forgiven about any perceived transgression).