MH101 Manage the process of change throughout counselling

Overview

This standard is about understanding and managing the process of change within your counselling approach and practice. It will involve you paying close attention to way in which clients perceive themselves negatively and mean you using appropriate interventions to challenge and re-evaluate their perceptions. You may also need to help the client to manage change in relationships with family and friends and co-workers as a result of their changing though counselling. You will also be required to recognise and analyse any difficulties in the counselling process. You will work with the difficulty within the therapeutic alliance and assess the situation for risk to self or others. You will be required to make ethical decisions in relation to the difficulty. In addition you will have to demonstrate how you manage out of session contact with clients and determine an appropriate policy to deal with such contact. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 1

Knowledge and Understanding

You will need to know and understand:

1. how to apply a consistent, coherent and in depth theoretical perspective of practice in line with your chosen theoretical approach(es).
2. in depth theory and practice underpinning your counselling work
3. the counselling alliance and the stance of the counsellor associated with that model
4. how changes are facilitated according to your theoretical perspective of practice.
5. interventions that facilitate change according to your theoretical perspective of practice
6. psychological mechanisms of change
7. how to manage the beginning, middle and end of a counselling relationship according to your theoretical perspective of practice
8. the origin and development of psychological conflicts and difficulties
9. all aspects of the counselling contract
10. relevant theories of attachment
11. emerging scientific evidence relating to emotional development
12. emerging scientific evidence relating to human behaviour
13. assessment of psychopathology and the evidence base for treatment of specific disorders
14. general principles of counselling interventions for clients with personality disorders
15. when and how to use silence in counselling
16. where and how to access research evidence related to risk factors for particular client groups
17. how to undertake risk assessment
18. mental health legislation
19. how to comply with all relevant legislation, codes of practice, guidelines and ethical requirements and policies
20. self–care strategies for clients in distress
21. appropriate referral and other forms of on-going support
22. causes of stress and coping strategies for healthcare professionals
23. appropriate theories of vicarious trauma and how they relate to therapists
24. the importance of strategies and procedures and appropriate referral systems when faced with difficulties
25. difficulties that are part of the therapeutic process and need to be contained by the therapist, within the therapeutic alliance wherever possible
26. when it is appropriate to contact other relevant health professionals for help, support or advice for yourself or the client
27. appropriate decision-making strategies
28. where to find and how to access mental health related resources
29. comply with all relevant legislation, codes of practice, guidelines and ethical requirements
30. the importance of boundaries in out-of-session contact
31. the therapeutic contract
32. risk Assessment
33. how to manage contact with the client in social occupational settings
34. psychopathology, particularly with respect to borderline personality disorder, manipulative, dependent and potentially dangerous clients
35. local policies and procedures for managing therapeutic contact

Performance Criteria

You must be able to do the following:

1. Practice in a way that is informed by a consistent, coherent and in depth theoretical understanding
2. Develop and sustain a relationship with the client that enables the disclosure of their concerns
3. Understand the process of change within your counselling approach and practice
4. Demonstrate competence in using the interventions prescribed by your consistent, coherent and in depth theoretical perspective
5. Be empathic and work with intellectual, emotional and behavioural expression from the client
6. Pay close attention to ways in which clients perceive themselves negatively and use appropriate interventions to challenge and re-evaluate their perceptions
7. Pay close attention to values and beliefs that create discomfort for clients and use appropriate interventions to challenge and re-evaluate them
8. Pay close attention to behaviours that create discomfort for clients and use appropriate interventions to challenge and re-evaluate them
9. Apply interventions as per your counselling theoretical framework that facilitate experiences of self-efficacy and problem-solving in clients
10. Apply appropriate interventions according to the psychopathology of the client.
11. Recognise circumstances under which it is necessary to provide a client with supportive interventions
12. Help the client manage change in relationships with family, friends and co-workers as a result of their changing through counselling
13. Recognise the attachment style of the client and consider ways in which it may impact on the process of counselling and the ending of the therapeutic relationship
14. Use language that can be understood by the client when explaining your counselling practice, its underpinning theoretical perspective, interventions and the process of change
15. Clearly communicate imminent endings for the client and work to ensure these are managed safely and appropriately
16. Respond to silence in the counselling in accordance with your consistent, coherent and in depth theoretical perspective of practice
17. Acknowledge ways in which the therapeutic frame is challenged by the client
18. Check and monitor closely the client’s response to each intervention obtaining feedback - be flexible - modify or phrase subsequent interventions that are more empowering and enabling so the client understands and finds the process more accessible
19. Acknowledge changes that have occurred for the client during the course of counselling whether they are practical, behavioural, and emotional or in relationships with the counsellor or others.
20. Review the process and progress of counselling regularly with the client to ensure that there is a mutual understanding and commitment to the task
21. Explore the limitations of your theoretical perspective of practice in working with the non dominant culture
22. When appropriate adapt and be flexible with your counselling interventions to work briefly or long-term in the best interest of your client
23. Identify and analyse the nature of a difficulty and its origins
24. Work with the difficulty within the therapeutic alliance
25. Assess the situation including risks to self and others and record the assessment
26. Contain the client when in crisis by providing information about self-care strategies, access to other support and clear arrangements for future meetings or contact
27. Decide and agree what action to take and when to take it in a way that is appropriate to the immediate needs of the client
28. Assess the ethical decisions to be made in relation to the difficulty
29. Manage interventions that might cause confusion, embarrassment or anxiety
30. Be aware of the potential for vicarious trauma when responding to difficult situations in counselling
31. Be prepared to acknowledge and apologise for your own mistakes
32. Ensure that appropriate support is in place to review and debrief following a difficult situation
33. Take the difficulty to supervision/manager and negotiate a course of action with your supervisor
34. Know what policy and procedure, actions and responses are available to you in the event of difficult situations, including risk to self and others
35. Anticipate the range of out-of-session communication that clients might use, such as email, letters, text, telephone, and visits
36. Determine an appropriate policy for contact with clients outside of sessions and ensure that the client understands it
37. Determine appropriate responses for unexpected or unplanned face-to-face contact with clients out of sessions
38. Consider how unexpected or unplanned face-to-face contact out of sessions will be integrated into an appropriate therapeutic process
39. Determine an appropriate policy for responding to clients who make contact between sessions
40. Be alert to possible danger signals in repeated or unwanted contact by clients out of sessions
41. Consider how repeated or unwanted contacts by clients out of sessions will be responded to
42. Determine an appropriate policy for communicating with clients when they miss sessions
43. Determine an appropriate policy for communicating with clients when they terminate therapy abruptly
44. Reflect on any temptation to meet a client other than in the designated therapy room and discuss this in supervision

Additional Information

This National Occupational Standard has been developed by ENTO in September 2007. It was taken over by Skills for Health in September 2008. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004) Dimension: HWB7 Interventions and treatments