Counselling skills and mental health outcomes across local, national, and international levels

Counseling is described by Kobeisy as the professional form of guidance that is aimed at addressing concerns as well as aid individuals in improving their attitude, coping skills as well as behavior (Kobeisy 1).Counseling can help people, families as well as groups in achieving optimal growth and development for the stages of life in which they go through. Counseling as a profession has many specialties like marriage, grief, and pastoral as well as career. It is worth noting that apart from pastoral counseling, the field of counseling is meant to be a free.This is to imply that the counselor should be open minded while approaching their clients with an attitude that is non-judgmental. They are also not allowed to impose or even direct their clients. The counseling process should therefore help the clients to clearly see their choices, appropriately set their objectives while making the necessary changes in order to realize their goals. In order to practice as a professional counselor, a master degree in counseling is the bare minimum that must be attained by the practitioner (Kobeisy 1). As a consequence of increasing level of diversity in the U.S. And the rest of the world, a multicultural perspective has been added as a necessary component in all forms of counseling. This implies that there is specialization in counseling. In order to possess the necessary knowledge and competency as a counselor, it is necessary to possess three different skills. The counselor must have the skill, knowledge and awareness of self, client as well as counseling approaches.

In regard to self, the counselor should have the ability to recognize their sources of information, the possible biases as well as faulty assumptions regarding others as well as understand their strengths and limitations. In regard to the client, the counselor should be aware of the opinion of the client in a manner that is non-judgmental. The counselor must also support the legitimate goals of the clients while respecting them. The 2010-11 Bureau of Labor Statistics indicated that currently, there are 27,300 marriage and family counselors in practice with a projected increase to be 31,300 which denote a 14% increase in the number of professional marriage and family counselors in the United States (2).

Couples therapy

Couples therapy / counseling is an important modality for helping couples who are undergoing difficulties in their relationship. The feelings include repetitive arguments, emptiness, feeling of distance, anger, dissatisfaction, resentment as well as lack of affection as well as physical relationship.

The Divorce rate in America

The rate of divorce in America is alarming. According to Pew Research Centers, the last two decades has seen several divorce cases being executed in America (Taylor, Funk, Clark 43). Cohn further indicated that the national divorce rate is currently higher than it was a century ago but with a slight decline in the past two decades (2). Figures from the National Center for Health Statistics indicate that there were 3.5 divorcees per 1,000 individuals as compared with just 4 divorcees per 1,000 individuals in 2000. This could be a testimony to the effectiveness of marriage and family counseling initiatives in the last couple of decades.

Yet again, the report by the Taylor, Funk, Clark indicated that most Americans (58%) believe that divorcing is better that staying in an unhappy marriage. A higher figure (67%) believe that in a marriage that parents are equally unhappy, the children are in a better situation if their parents divorce each other. About 19% believed that children are in a better situation if the parents continue staying together while 9% believed that it depends on the nature of the situation (44).

The effectiveness of family and marriage counseling

Family and marriage counseling which is usually called couple's counseling has been indicated to be effective in saving several families from the dreadful effects of divorce.

Several studies have been dedicated to the evaluation of the effectiveness of systematic couple therapy. Carr indicated that in a review of 20 meta-analysis of family and couple therapy trials for a wide range of mental health problems, other authors such as Shadish and Baldwin (564) concluded that the average period of treated cases was immediately after therapy and a follow up of six up to twelve months and the rate was more that 71% of the families that were in the control group (Carr 46).

Distress in relationship

Carr indicated that relationship distress, conflict as well as dissatisfaction are very common in the contemporary Western Industrialized societies in which 40-50% of marriages have been noted to end up in divorce (47).It has been indicated that couple centered therapy effectively alleviates the existing relationship distress. The work of Cardwell estimated that the employment of free and effective couple therapy would have a significant effect on the cost legal as well as healthcare costs that arise from divorce as well as its related health problems (393).

Types of therapies and their effectiveness

Emotionally centered couples therapy

This therapy is based on the premise that the relationship distress as well as its related conflict are as a result of an insecure bond of attachment (Johnson 8).Partners have been indicated to be very anxious that the needs of their attachment are never met in a given relationship. The anxiety then leads to an acute conflict within the relationship. The main aim of the emotionally focused couple therapy is to assist the partners in understanding this and then effectively develop ways and means of possibly meeting the attachment needs of each partner. The best predictors of the success of this type of therapy is strength the couple's therapeutic alliance as well as the belief of the female partner that her male companion still cares a great deal about her.

Behavioral couple therapy

This type of therapy is based on the premise that the cause of distress as well as conflict within a given relationship is the unfair bargain within the relationship. When partners fail to negotiate in order to arrive at a fair exchange of responses that are pleasing, a sense of injustice is developed which subsequently leads to an acute conflict within the relationship. The main aim of this form of therapy is assist the partners to develop problem solving skills as well as communication in their behavioral exchange procedures in an effort of making their relationship a fairly negotiated one. This basis model has of late been update and modified to include cognitive components to be used in assisting the couples in challenging the destructive beliefs as well as expectations that may cause distress within the relationship and to effectively replace them with alternatives which are more benign (Epsein and Baucom 6)

The importance of Couple therapy in Public Health

It has been noted that couples resort to therapy as a result of relationship concern like emotional disengagement, jealousy, communication difficulties, power struggle, conflicts, extrarelational involvements, sexual dissatisfaction as well as violence. The need for developing appropriate interventions are based on the various negative outcomes that have been observed in adults and children alike. The affected partners are most likely to be experience depression, anxiety as well as a high rate of suicidality. Substance abuse, chronic medical conditions, high blood pressure as well as various forms of health-risk behaviors that leave them exposed to sexually transmitted diseases. Children in trouble families are also likely to experience anxiety, conduct issues, depression as well as impaired physical health.

According to Moos counseling is the chance to talk in private with someone who will really listen and try to understand you and who will not judge you or tell you what to do. It can be a great relief to talk to someone outside your situation who will not be hurt or upset by what you say. Sometimes the people closest to you may not understand, or you may feel that you don't want to burden them with your worries. Or they may be part of the problem. Counseling can also at times be a painful process as thoughts and feelings surface that may have been kept hidden for some time.

Significance of counseling

Moos continue to point out that there are a number of different theories about how counseling works. However all types of counseling have the same basic elements. These include; Privacy and confidentiality, talking to someone who will really listen, talking to someone who is not part of the problem, getting another perspective on your life and problems. There is a wide choice of different types of counseling but there is no one 'best' forms of counseling, so it is worth looking around to find what suits you. Evidence suggests that all types of counseling are effective, so the type of counseling you choose may be less important than the relationship you have with your counselor. Remember, it is always your choice whether to stay with a particular counselor - if you are not happy you can leave. A good counselor will be willing to help you to find more suitable counseling if you are not happy with him or her.

Listening is the key skill required. Counseling training is the best way to get people to appreciate the value of listening and want to listen well. Organizational performance depends on the quality of the thinking of staff at all levels.

Counseling enhances the ability of the client to think and his/her willingness to act powerfully. Advice and opinion giving, sympathizing and offering to assist are all ways of helping people, but they are not counseling. The first responsibility for any counselor wishing to use counseling skills is to create a climate of warm acceptance where the client feels safe enough to explore and understand their feelings and thoughts before considering action. We can not often solve human problems, but we can learn to manage them better; and we can help others do so by support and challenge. This three-stage model is a systematic way of learning to work with another person to help them cope more effectively with their life. The model is derived from the work of Gerard Egan, The Skilled Helper (1982), and describes the skills needed to work through the three stages. There has been a lot of discussion in counseling circles about what exactly it is that works when therapy works.

And research shows that therapy does work, regardless of the orientation of the therapist. There are a number of factors involved in counseling that stay the same across different theoretical orientations: one person seeking help from another, the boundaries of time and space, the fact of talking to a stranger, confidentiality, the chance to explore one's problems or one's life in general. It would make sense that it is one or more of these that is effective in therapy, since no one theory is shown to be the only effective one.

We need to appreciate that all the elements of therapy matter but the most important element over which the counselor has control is the relationship between the counselor and the client. The main key factors include; Empathy, that is, understanding the client's world; Unconditional Positive Regard, valuing the client regardless of how they present or what they say or do; and Congruence, genuineness on the part of the counselor, being real in the relationship. These 'core conditions' remain at the heart of client-centered therapy today. It is the client, not the therapist or technique that makes therapy work.

It is also true that while counselors facilitate it is the clients who do the work of change. In this view, the relationship is yet another resource which clients utilize to mobilize personal agency and change. Whether the relationship is the primary agent of change in therapy or not, it is the single most powerful therapeutic element over which the therapist has control.This is why it is so important for all counselors who have undertaken training and personal development work to enable us to be aware of and comfortable with whom we are.

Stages in counseling

1. Exploration

Counselors help clients to explore their issues through listening and giving full attention. The counselors' genuineness, acceptance and empathy are communicated through the use of the active listening. This can be achieved through; Paraphrasing, reflecting feelings, using open questions, focusing, helping the client to be specific through concreteness and summarizing. All these give the client the assurance that the counselor is listening to their explanations.

In some instances, the chance to explore their situation in an accepting atmosphere will be sufficient to enable them to move on by themselves. Others will need further help to enable them to fully understand the factors involved and find the resources to take effective action.

2. Finding a new perspective

The Counselors' stage 1 skill, which are fundamental to the counseling process, are used to help clients explore their world and feelings. In this stage the counselor tries to help clients to understand themselves, their situation and feelings better and in a new perspective.

.Some ways of communicating these are; Expressing what the client implies but does not state, summarizing core material, identifying themes or patterns in what the client says, connecting separate islands of thoughts or feelings; recognizing possible inconsistencies, suggesting alternative frames of reference-new ways of looking at things Other stage 2 skills include; Looking at options open to the client, including referral, the best and worst possibilities arising from the options, sharing the counselors' own experiences, where appropriate, Sharing information.

3. Action

In stages 1 and 2 of the model clients are helped to explore and understand themselves, their feelings and their world better, and in a different; light. In stage 3 clients are helped to take effective action-to achieve constructive change.For some clients, stages 1 and 2 are sufficient to enable them to mobilize their own problems-solving resources, others will need positive help with their decision making. Counselors will continue, though, to work in a client-centered way using the skills of stage 1 and 2. The most important aspect here is that of helping the client to turn a vague aim into a specific goal-another version of concreteness. Remember that any behavior-change technique should be used with clients-not on them.

The skills in this stage include: Goal and strategy setting, providing support and resources, coaching and training, using learning theory to pursue action plans, problem solving, decision-making and evaluation. Although the 3-stage model suggests counseling is a sequential process, in practice the stages are not necessarily so clearly defined. The appropriate skills may be used at any stage in response to the client's needs and on occasions the stages may be worked through several times before the client is able to mobilize all the resources required. It is however always important to ensure the real issues are understood before action is decided.

Attention

Attending or being with the client, as counselor, is important because it helps to establish a working relationship and trust between you and it improves the quality of your perceptiveness. The non-verbal behavior will signal the quality of a counselor's interest. One needs to be relaxed, face them and lean slightly forward; adopt an open posture and maintain good eye contact.

One needs to remember, that they are always communicating something, and needs to be present through what you say and do. Active listening involves not only paying attention to the verbal messages but also being aware of the non-verbal behavior: tone of voice, facial expressions, posture etc. These non-verbal messages can deny or confuse, strengthen or emphasis the spoken communication. Attention giving is hindered by; Self pre-occupation, attraction to client or opposite, the physical condition, over-eagerness to help, similarity of problems, identification with client, differences-disagreements and prejudice.

All counselors need to be in touch with their own thoughts and feelings and aware of any unfinished business of their own so that they can take these factors into account in their interaction with the client.

Listening

Listening is a difficult art. To understand another person we must resist the quick impulse to judge whether what they say makes sense. Listening means working hard to find out how what seems odd to us can make sense to someone else. Not listening means not crediting the person with any understanding of themselves or their circumstances. It implies a degree of contempt. Warning signs that we may be conveying contempt to another person include; Thinking of what we are going to say next rather than hearing the talker out and trying to understand them, dominating the discussion rather that trying to encourage participation, ignoring their remarks by changing the subject to something more interesting to us, trying to trip them up by demonstrating their views are foolish or inconsistent. All these behaviors put the other person under pressure, making it difficult for them to be open, to tell the counselor why they feel as they do and in what way they make sense to themselves. Counselors cut themselves off from learning about their real concerns.

After such a meeting both people leave convinced that the other is unreasonable, and the counselors become farther than ever from devising satisfactory remedies for our respective concerns. The basic rule of counseling is that they should have not listened unless we can state to the other person's satisfaction why their position makes sense to them. Even when counselors respect someone else by listening fully to their communication, we must demonstrate it through our behavior, both verbal and non-verbal. But caring about someone also means planning in advance. The setting in which the listening takes places obviously either facilities or hinders the process.

This therefore calls for one to; Avoid distractions such as background noise and interruptions, establish privacy by ensuring others cannot overhear and choose surroundings that suit the other person. By finding a setting that is non-threatening and conducive to conversation and by putting the other person at ease, a counselor can create an atmosphere where open communication can take place.

Once then counselor and the client meet, what the counselor say and do will largely determine how the client perceives him and his motives, and thus their willingness to talk. Other skills that a counselor needs to help him or her understand the problems of the clients include first and foremost. Establishing eye Contact; Looking at someone when they talk lets them know that we are listening and interested. Obviously if we fix our eyes on someone continuously they will become uneasy and wonder why we are staring at them. Appropriate eye contact entails looking more when you are listening and less when you are speaking and it is probably the most important way of communicating one's full and undivided attention.

It can be achieved easily as follows: Focus your eyes on the other person, and gently shift your gaze from their face to another part of the body, such as gesturing hand or a tapping foot, back to the face and to the eyes. Occasionally moving your gaze away from the person will reduce the chances of staring and causing them to feel anxiety or suspicion. Let yourself be natural.; Avoid feigning eye-contact by fixing your eyes on the other person's forehead. It is a ploy used by military personal that don't want to look superior in the eye when they are talking. This behavior conveys doubt, hostility or insincerity. One should try not to look away from the talker for long periods.

If you are distracted and turn your gaze to others or to noises in the environment, the other person may interpret this as lack of interest in them. Second is Non-verbal prompts. These demonstrate listening without disturbing their train of thought and they thus encourage the person to continue speaking: Affirmative head nodding. These nods should be used sparingly and in conjunction with eye contact; Appropriate facial expression. Generally, your facial expressions should naturally reflect the mood of what is being said rather than your own reactions. Thus when someone is sharing something that hurts or worries them you reflect that concern.

A frown is appropriate when you do not follow or understand the person's point; Silence, The use of silence by the listener can communicate respect and patience. This is more than just not interrupting. Allowing time for natural pauses, reflecting and finding the right words will change the rhythm of the exchange from the competitive ping-pong of normal conversation to a more open accepting process.

When your body shows openness and receptivity the other person is more likely to talk freely and be less defensive. You can achieve open body posture by; Sitting at a slight angle to the other person. Facing them squarely may be experienced as too confronting, initially at any rate; Uncrossing your arms and legs. Crossed arms, like a desk, can communicate superiority or defensiveness as well as serving as a barrier; Leaning slightly forward to communicate interest. Slouching or leaning back can indicate boredom, fatigue or lack of interest. Fourth are Verbal Prompts. Often, in the early stages, talkers will range over numerous topics.

Occasionally the listener's indirect responses have encouraged this wandering. When the listener thinks that the other person has explored their main areas of concern, it may be appropriate to find one topic that could be elaborate productively. A summary may be sufficient to collect the thoughts at this stage but if further action is needed. Focusing is also a skill that will help the talker home in on the main issues.

Examples of focusing are: which is the most important thing we have talked about in the last ten minutes? Or what were your feelings as we were talking? Or can you choose one word to describe the last five minutes talk? Listeners should use their own feelings of confusion or diffusion as a guide to decide when to focus. Having identified the main topic, the listener needs to encourage the other person to open up and examine their thoughts and feelings.

For example if the person says, I don't know, I guess I'm just confused, the listener repeats the word confused? This response prompts the other person to say more without using a long question, which might break the other person's train of thought.

Reflecting - back the other person's thoughts in your own words will have similar effect. Ask open questions such How do you feel about this? Can you give an example of that? And what does that mean to you? These encourage the other person to expand on the topic and clarify the experience or feeling. It is self-evident the way we feel affects our view of situations and our ability to manage them. If we are either out of touch with our feelings, or unable to express them appropriately our problem-solving and decision-making capabilities will be severely curtailed. One difficulty with the stiff upper lip approach is that our emotions do not disappear when their presence is denied. They continue to affect our behavior to the consternation of those we hide them from. They thus exercise a far greater negative influence than they would in the open.

Ultimately, we may even lose touch with our own emotions and either denies their presence completely or take on board what we think we should feel in the circumstances rather than our true feelings. These distortions and the subsequent lack of congruence between our feelings and our behavior are the source of many personal and interpersonal difficulties. One could say that counseling is creating a climate where feelings can be explored and expressed. You often have to help a client really get into feelings, sometimes very difficult feelings. It is not enough just knowing that you feel elated, depressed, sad, etc. Feelings need to be expressed, verbally and non-verbally, appropriately of course.

(Think how bad it is to feel angry and not be able to express it.)A person is a bundle of feelings, very often denied or unconscious feelings. Change and action more often happen at the level of feelings than at the level of thoughts and intentions. Very often however people are not comfortable with feelings. Some emotions can be scary for a lot of people; they need trust and confidence that it is okay to have such feelings and express them.