What is Counseling?

The dictionary describes counseling as provision of advice or guidance in decision-making, in

particularly in emotionally significant situations. Counselors help their clients by counseling
them. Counselors also help clients explore and understand their worlds and so discover better
ways of thinking and living.

Some definitions include:

...help clients understand and clarify their views of their lifespace, and to learn to
reach their self-determined goals through meaning ful, well-informed choices and
through resolution or problems of an emotional or interpersonal nature. (Burks and
Steffire, 1979)

...work with individuals and with relationships which may be developmental, crisis
support, psychotherapeutic, guiding or problem-solving... (BAC 1984)

The task of counseling is to give the client an opportunity to explore, discover and
clarify ways of giving more satisfyingly and resourcefully. (BAC 1984)

A principled relationship characterized by the application of one or more

psychological theories and a recognized set of communication skills, modified by
experience, intuition and other interpersonal factors, to clients' intimate concerns,
problems or aspirations. (Feltham and Dryden, 1993)

A common factor in most counseling situations is that the client is demoralized, distressed or
otherwise in a negative state of mind about something.

Counseling can be for one person or a group (typically couples and families) and may be
delivered through a number of methods, from face-face dialogue, group work, telephone,
email and written materials.

Counseling is largely a voluntary activity whereby clients must wish to change and collaborate
willingly with the counselor. Early counseling activity in some cases involves bringing referred
clients to this point of readiness.

Results of counseling can include:

 Insight and understanding of oneself, with greater self-awareness.

 Changing of one's beliefs and mental models.
 Increased acceptance and appreciation of oneself.
 Increased emotional intelligence.
  Increased ability to control oneself and one's urges.
 Development of skills and abilities that require self-management.
 Improved motivation towards actions that are good for one's self.
 Understanding of others and why they act as they do.
 Increased appreciation and care for others.
 Improvement in relationships with others.
 Changing of relationship with family, friends and others.
 Making amends for past negative actions.

In summary, counseling typically leads to resolution of a living problem, learning of some kind
and/or improvements in social inclusion.

Counseling is also a profession, with national associations and control bodies, who, along
with academics, have explored its detail further.
Discussion

Contact between counselors and clients may be through a third party who refers the client.
The client may also seek out the counselor for help with their troubles.

Counselors often subscribe to particular schools of thought as to the most effective and useful
way of helping. A critical variable in this is the extent to which the solution to problems are
provided by the counselor or by the client. This leads to two very different roles for the
counselor: problem-solving or facilitator. A facilitative approach may also be used when a
more open exploration approach is used.

There are hence a number of theories in counseling, including those held by the client and
those held by the counselor. Theories provide simplified models for understanding and ways
of acting. They help the counselor how to percieve the client and decide what to do. They
may also provide the client ideas for what to think and do differently.

Counseling is particularly common at transition points in a person's life, where they are
moving from the familiar to the strange, going from child to adult, single to married and so on.
These changes can be difficult and the counselor can help their client successfully make the
change, both emotionally and cognitively.

There has been ongoing debate about the difference between counseling, coaching and
therapy and the boundaries are not at all clear. Therapy can be more clinical but counseling
still addresses serious issues, whilst 'coaching' can effectively be a euphemism for lighter
forms of counseling. Generally, counseling tends to have a more social focus, whilst therapy
and coaching are more individually focused.

Historically counseling in personal issues was done by close relatives, friends or the local
priest. Although counsel has always been given within families, parents and siblings are not
 always the best people to do this when they are effectively a part of the problem. Likewise
with friends, the penetrating need of counseling means a fun-based friendship is not the best
place to go.

With the rise of the industrial revolution and the mobility of populations, this stable support
network was often lost. At this time caring professions started to develop and the asylum as a
place of entertainment faded as mental illness and simpler personal issues were taken more
seriously.

In the 20th century, counseling emerged as a profession, splitting from therapeutic

approaches and developing its own ways, although still retaining much in common with
therapy. There are still competing approaches within counseling that parallel therapeutic
though.

Religion has continued to be an influence in the development of counseling and several

counseling agencies grew out of religious organizations which sought to help people in need.
This has influence the general thinking withing counseling, which is suffused with Judeo-
Christian thought.

Counseling has also been influence by the arts and has had some focus here, for example in
using methods such as dance, painting and drama for therapeutic benefit in providing a
channel that enables people to express their emotions.

CFN9885 - SECTION 8: COUNSELING AND TREATMENT GOALS

Helping Clients Develop Goals

The research shows that clinician empathy is positively related to client progress - when
progress is measured by clients’ estimates of progress. However, when progress is measured
by more objective measures, for example by a standardized text or direct observation of client
change, clinician empathy is less significant.
Just showing empathy for clients is not enough. (Lieberman & Lester, 2004) Empathy is only
one component of successful counseling. Clinicians and clients also need goals. One of the
primarily responsibilities of the clinician is to help clients develop goals that are realistic and
obtainable.
Goals serve four primary functions:
1) Motivational: Client involvement in the goal setting process can motivate clients to
accomplish their goals.
2) Educative: Setting goals helps clients to clarify and target problem behaviors or issues they
want to work on in counseling and develop realistic, attainable solutions.
3) Evaluative: Setting goals enables both the client and the clinician to evaluate or gauge the
progress toward their goals.
4) Treatment Assessment: Setting goals enables the clinician to evaluate what types of goals
and intervention work best with what types of clients. (Hackney & Cormier, 2005)

It is important to realize that gaining insight into one’s problems does not always produce
change. Even dysfunctional behavior can have rewards, and trying new behaviors can have
risks. When the problems are more recent and less complex - and the client has adequate
coping skills and a good support system - gaining insight into the problem may be enough to
motivate the client to make meaningful changes.

However, for many types of problems, gaining insight is only the first step toward meaningful
change. For these situations, clinicians and clients need to develop specific outcome goals for
counseling and use these goals to design an action plan to achieve them. The goals for the
action plan should include: 1) strategies for restructuring client self-perceptions, 2) strategies for
reducing physiological and emotional distress, and 3) strategies for behavior change. (Brammer,
Abrego, & Shostrum, 1993)

Setting realistic, obtainable goals involves identifying what goals the client would like to
accomplish; what specific thoughts, behaviors, and situations would have to change or be
evident if these goals are to be realized; and the specific tasks the client would have to
undertake for these goals to be accomplished.

When thinking about goals it is best to conceptualize them in terms of immediate, intermediate,
and ultimate goals. While it is important to identify the counseling goals, these goals are never
fixed, rather they can be altered as new information and insights into the problems are
identified.

It is important for clinicians to find out what their clients want to work on in therapy and not make
assumptions about the goals of counseling. When clients do not want to work on a problem area
that we as clinicians feel they should work on, we need to respect their decision because they
may be telling us very important things about them, about us, and the counseling process.
While developing meaningful counseling goals is important, sometimes clinicians can be so
predisposed to finding a solution to the client’s problems that they forget that it is ultimately the
client’s responsibility to solve the problems. By offering premature suggestions to resolve
clients’ concerns prior to giving them adequate time and attention so that they feel comfortable
that you truly understand them and their concerns, can give clients the impression that it is the
clinicians’- and not ultimately the clients’ - responsibility to solve their problems.

Coming up with treatment goals is important because it allows both the client and the clinician to
monitor the progress of their work together. Goals represent the results the client wants to
achieve in counseling. Goals give direction to the counseling process and help both the clinician
and the client to move in a focused direction. Goal setting is an extension of the diagnosis or
assessment process.

During the assessment process, the goal is to determine what problems or concerns the client
wants to work on in counseling. In goal setting, the clinician and client identify specific areas
they want to work on in the counseling process. While setting specific goals is very important to
the success of counseling, some clients and some clinicians can be hesitant about
implementing this step. Setting specific goals involves making a commitment to a course of
action and an outcome.

Counseling Lessons

We need to be careful not to conclude that we are necessarily more insightful or clever than our
clients. I learned this lesson with two of my earliest clients.
A woman in her mid-30s came to therapy wanting help in a difficult marriage. In the course of
therapy, she revealed that she was molested by a cousin when she was five, raped by a former
boyfriend when she was 17, and got pregnant and had an abortion. All of the red flags from my
training went up and I immediately wanted to address these areas. However, she assured me
that with the help of some friends and over time she had worked through these issues earlier in
her life and they were no longer significant issues.
With more experience, I later realized that she was not in denial. I needed to trust her when she
said they were no longer significant issues in her life and she was in therapy to get help for her
marriage. We focused counseling on her marriage and after about 8 sessions we were satisfied
that she was making good progress in the areas she came to counseling to work on, and we
both decided to terminate therapy at that time.
In another case, a couple in their mid-30s came to therapy for help with their marriage. During
the course of therapy, they identified a number of problem areas including their sexual
relationship. During our six months of therapy they made significant progress in a number of
areas, but despite my prodding, they refused to discuss or work on their sexual problems.
Later, I came to see that they were telling me they were not ready to look at this very personal
and difficult issue in their marriage and I needed to respect their decision and to acknowledge
the improvements they did make in many other areas of their marriage.

Goal Setting and the Clinician/Client Relationship

The type of relationship clinicians have with their clients will influence the types of goals that can
be developed and worked on. If clients are in a visitor relationship there is no joint definition of
the problems, so it is difficult to agree upon the goals or how to accomplish them.

At that moment, there appears to be nothing that the client wants to work on with the clinician.
These clients might be seeing a clinician because they are being pressured by family or friends
or forced by a person or agency with the authority to do so (courts, schools, social welfare
agencies, employer. etc.). If clients are being pressured to come to counseling, then the
challenge might simply be to get them to come back for another session. For clients who are
forced, the challenge is to understand why they are reluctant or resistant and find ways to
address their concerns.

One way to do this would be to thank clients for coming to the first session and sharing their
thoughts. The clinician might say that the two of you have discussed a number of interesting
things during the session. You then ask if the client would be willing to come back for another
session to continue the discussion. If clients are unwilling to schedule another appointment, you
should thank them for coming and offer your services at any time in the future if the need arises
or offer the client some referrals.

If clients are in a complainant relationship, the problems have been jointly identified, but clients
do not see anything they might do to solve meaningfully address the problems. Often these
clients have little sense of what they might want to be different, except they want others to
somehow be different. The challenge with these clients is to help them develop goals for their
own thoughts and behavior that are not dependent upon other people’s thoughts and behaviors.

With clients in a customer relationship, there is a jointly developed definition of the problem,
clients accept their role in addressing the problems, they appear to be motivated to work on the
problems, and they are willing to begin to try some different things.
Goal Setting Tools
One of the most difficult challenges a clinician can face in working with some clients is helping
them to change their most dysfunctional, deeply held beliefs about themselves. These core
beliefs often originated in childhood and are part of the cognitive make-up of clients. Beliefs
such as “I am unlovable,” “I am not good enough,” or “I am helpless” are difficult to modify
because in many cases they have become part of the client’s identity.
The Core Belief Worksheet helps clients to monitor their progress in changing their negative
core beliefs. (Beck, 1998) The worksheet can be used during a counseling session or it can be
used by the client during the week when they become aware that one of their negative core
beliefs has been activated, that is, when they start to feel bad, unlovable, helpless, inadequate,
etc.
Core Belief Worksheet

Name: ____________________________ Date: ___________________

Old Core Belief: I feel like a failure.

How much do you believe the old core belief right now? (1 to 10) 7

New Belief: I’m ok. I have strengths and I have weaknesses.

Evidence that Contradicts the Old Core Belief and Supports the New Beliefs: I am a good
mother and my children are doing well in school. I have some good friends who like me. My
supervisor recently wrote me a positive evaluation of my work.

Solution talk is very useful to counter the sense of powerlessness that many clients are
experiencing when they first come for counseling. Most clients when they first come to see a
clinician focus on their problems and how these problems are making their life difficult.

The challenge is to gradually shift the conversation to invite clients to talk in detail about what
they want to be different in their lives and how this might happen. When this happens, most
clients feel empowered in that they become more hopeful and even confident that they can
make meaningful changes in the life. The goal is to help clients become experts about their own
world.

When I say that you want your clients to become experts about their own world this does not
mean that you as the clinician do not have responsibilities. You lead best when you follow the
client's lead.

Using the Solution-Focused Approach to Develop Treatment Goals

The solution-focused approach can be very useful in setting counseling goals. The solution-
focus approach can be conceptualized in terms of the following stages:

Stage I: Describing the Problem: Clients are asked to describe the problems that have brought
them to counseling with the goal of thinking about ways to turn the conversation toward the next
step which initiates solution talk.
Stage II: Developing Well-Formed Goals: Clinicians work with clients to elicit descriptions of
what will be different in their lives when their problems are solved.
Stage III: Exploring for Exceptions: Clients are asked about those times in their lives when their
problems are not happening or are less severe and who did what to make the exceptions
happen.
Stage IV: End of Session Feedback: The client is complemented for what they are already doing
that is useful in solving their problems and the client is given feedback based upon information
that clients have revealed in the conversations about well-formed goals and exceptions.
Stage V: Evaluating Client Progress: Clients are regularly evaluated on how they are doing in
reaching solutions satisfactory to them and what needs to be done before they feel their
problems have been adequately solved and they are ready to terminate services. (DeJong &
Berg, 2002)

The solution-focus approach assumes that clients, sometimes with the help of clinicians and
other people, are competent to figure out what they want and need and how to go about getting
it. The clinician's responsibility is to assist clients in uncovering these competencies and help
them to create more satisfying life situations. (de Shazer, 1985)

When clients begin to talk about what they might want to be different they often state their goals
in abstract, vague ways such as: “I want to be happy. I want to feel loved and appreciated. I
want to stop feeling depressed”.

Clinicians can then help clients to begin to form concrete, well-defined, achievable goals and
solutions to accomplish their specific hopes and dreams. Additionally, these concrete goals
enable both the clinician and the client to evaluate if they are making progress toward
satisfactory solutions.

Using supportive nonverbal responses, paraphrases, and affirmation of clients’ perceptions can
all convey a sense of empathy without amplifying the situation. Clinicians should pay particular
attention to anything that clients say that might suggest they want something different in their
life, they have had past success in an area of their life, or they have already tried to improve
their situation.

You want to shift the focus from problems to past successes and future possibilities. For
example, you could say: “I can see that your marriage is not what you would like it to be.” You
can then explore what the client might want different in the relationship or what the client is
doing to use her strengths to get through this difficult time. This can change the client’s focus
from problem talk to solution talk. (de Shazer, 1994)

Solution-focused therapy tries to help clients remember times in their lives when they were able
to successfully deal with their presenting or other related problems. These are called
exceptions, and they are those past experiences in a client’s life when the problem might
reasonably expected to occur, but somehow did not.

You can do this by asking such questions as: “Have there been times in your life when the
problem has not happened or it has been less serious? Have there been times when your life
was a little like the miracle picture you described? How did this happen?

For example, a mother may come for counseling and she describes how she feels she has no
control over her daughter both at home and what she does outside the home. By questioning
her in a solution-focused manner and listening to, and seeking clarification of her answers, the
same mother is able to figure out that her daughter is not out of control all the time, that most of
the time the mother has some degree of control and her daughter does obey her rules and
expectations.
Understanding the when and how of those times when the daughter is cooperative and
complaint, helps the mother and the clinician to see the mother in a different light, and to work
on finding ways to improve the problem situations.
Using scaling questions can help clients to express their observations about their past
experiences and estimates of their future possibilities. For example, the clinician might say to
the client: “Let’s say that 0 equals how bad your marriage was at the time you made the
appointment to see me and 10 is the miracle you described to me earlier. Where are you on that
scale today?”
You then ask a series of follow-up questions to expand their response. You should pay
particular attention to the ways in which these exceptions time were different from the problem
times. You should inquire about who did what to make the exception happen.
Clinicians often assume that clients begin to change when the clinician starts working with them.
To the contrary, change is regularly happening in most clients’ lives. Two-thirds of clients report
positive change between the time they made the appointment and their first meeting with
clinicians. (Weiner-Davis, de Shazer, & Gingerick, 1987)
You can also ask a scaling question that asks how confident or motivated the client is to work
on building solutions. For example, you could ask the client: “Let’s say that 10 means you are
willing to do anything to find a solution, and 0 means that you are willing to do nothing. How
hard, from 0 to 10, are you willing to work?” You then ask a series of follow-up questions based
upon the client’s response.
With each client you need to develop a treatment plan with specific goals that are consistently
being examined, evaluated, and modified if necessary. What goals you develop with your client
will depend upon your assessment of types of relation you have with your client and the degree
to which the client has developed well-formed goals. (de Shazer, 1988)

Scope of Services
The Counseling Center provides clinical and campus-based services to help students maintain
and develop their emotional well-being and achieve their educational and personal goals. We
promote a healthy and inclusive community through relationship-building, education, crisis
intervention and support.

Our individual services are based on a brief therapy model and are designed to help students
manage immediate problems and provide short-term therapy. These services are ideal for
issues that have arisen recently or that are expected to resolve relatively quickly. If you are
facing ongoing difficulties (6 months or longer) or if you have engaged in ongoing therapy in the
past, it is likely that the Counseling Center will recommend that you establish a relationship with
a provider in the community to ensure you have access to mental health treatment that is not
limited. Decisions regarding treatment recommendations are made by counselors in
consultation with the clinical team of the Counseling Center. Services to fit your needs:
assessment, workshops, group counseling, short term individual counseling, comprehensive
referral support

In addition to short-term individual therapy, the Counseling Center offers a strong group
counseling program with many helpful options. Our group program has been very popular, and
counselors often recommend group as the preferred mode of treatment. Whereas our individual
counseling is brief, students may participate in one or various groups throughout their time at
Loyola. We run multiple groups each year, some specifically themed and some aimed at more
general concerns. Themed groups include those for grief and loss, stress management,
unhealthy eating or body image, and sexual/gender or racial/ethnic identity concerns. The
typical group involves about 8 students, meets weekly for 60-90 minutes, and is facilitated by
one or two counselors. Please see our group page for more information.
When off-campus therapy is recommended or preferred by students, a counselor will support
the student through the process of getting connected. We will help to identify several referral
options selected specifically for their personal situation. We can help with accessing health
insurance benefits and navigating transportation options. Local counseling options include some
providers within walking distance to campus and some that provide low or sliding scale fee
services.

Access to the Counseling Center for an emergency meeting, and assistance with navigating on
or off-campus resources remains available to all students throughout their college career,
regardless of whether they have been referred to an off-campus provider for on-going treatment.

Common concerns that may be addressed in short-term therapy may include:

• Mild to moderate anxiety and depression
• Adjustment and developmental concerns
• Interpersonal concerns (friends, family, roommates, romantic partnerships)
• Self-esteem concerns
• Concerns related to the transition to college
• Identity development related to various dimensions of identity (sexual, racial/ethnic, religious,
gender, etc.)
• Academic performance and motivation

Concerns that are commonly addressed through a referral to an off-campus provider may
include:
• Students whose needs warrant treatment over multiple semesters
• Students needing more than once a week intervention on an ongoing basis
• Long-standing and/or significant depression, mood disorder, or anxiety concerns
• Active, significant eating disorders -- please view treatment options for Eating Disorders for
more information
• Students with alcohol or drug problems as the primary issue (may be referred for on-campus
support through the Office of Student Support and Wellness Promotion or to an off-campus
provider)
• Forensic evaluations
• Medication evaluations and/or management for students who are not being seen for short-term
counseling at the Counseling Center
• Medication evaluation and/or management for attention deficit disorder
• History of inpatient treatment for mental health purposes
• Mandated mental health evaluation or counseling
• Court appearances/testimony/evaluations or court-ordered assessment and treatment
• Students requiring specialized or more intensive treatment
• Students who require counseling to meet an academic requirement and/or are interested in
counseling solely to gain clinical experience
• Students whose needs are determined to be beyond the scope of the Counseling Center
services through assessment with a counselor and for whom short-term counseling would not
be an effective form of treatment
• Learning disability assessments: The Counseling Center does not conduct psychological
evaluations for the purpose of determining disability status and also does not make
accommodations recommendations for persons who have been diagnosed with a disability. For
this reason, we cannot provide documentation for students seeking authorization for an
emotional support animal, even if the student is a current or former Counseling Center client.
The Counseling Center can provide students with a referral to a community provider for a
disability evaluation. An off-campus psychologist or psychiatrist can evaluate a student's
disability status and determine if based on the student's condition, an emotional support animal
is medically necessary. Alternatively, students may choose to consult with their primary
physician.

For more information or to schedule an appointment to discuss what treatment options are best
for you, please call 410-617-CARE (2273).

Please note that the clinical services of the Counseling Center are intended for students and are
not available to Loyola University employees. Employees may contact Human Resources or the
Employee Assistance Program for resources and assistance.

Counseling Center Core Principles

We believe these principles are at the heart of every effective clinical interaction. Individually
and collectively, we strive to make sure that we adhere to these principles. They shape our
interventions as clinicians, our interactions as colleagues and our liaison, consultation and
outreach to the larger Skidmore College Community.
COMPASSION
Students who come to the Counseling Center are typically in some kind of emotional pain,
distress or confusion. We strive to provide an empathic, nonjudgmental environment where we
listen to students carefully and without preconceptions and where students will feel heard and
validated.

COLLABORATION
Effective mental health interventions always involve good collaboration between clinicians and
clients. We strive to insure that our clients are equal participants in their therapy, that they
understand their treatment plan and that the relationships between students and Counseling
Center staff are open and respectful. We also strive to maintain effective teamwork within the
Counseling Center and to collaborate effectively across campus with other student services,
with faculty and with parents.

EXPERTISE
As clinicians, we take our responsibility to provide expert care seriously. We take responsibility
for our continued growth as professionals. We are open about our professional credentials and
training and we use consultation services as needed and appropriate.

RESPECT FOR AUTONOMY

We respect that the students coming to the Counseling Center are emerging adults, who are
taking responsibility for seeking help to solve their problems. We believe that treatment is there
to help students provide their own answers and solutions to their questions and problems. We
encourage students to work with us to meet their goals and to assume responsibility for their
current lives and future direction.

SENSITIVITY TO DIFFERENCE
We understand, appreciate and celebrate the differences that exist between individuals at
Skidmore. We are committed to insuring that the Counseling Center is a welcoming and safe
space for all.

CONFIDENTIALITY
Our staff recognizes the importance of privacy and safety as the basis of effective therapy. We
take student confidentiality very seriously. We do not share information about students seeking
help at the Counseling Center with anyone without written permission. Exceptions to
confidentiality are rare and specifically mandated by law and professional ethics. We make sure
to review confidentiality during our first contacts with all students and are available to answer
any questions about confidentiality as they may arise in the course of treatment.