Counselling. Peplaus Theory Peplau has given four phases of nurse-patient relationship i.e. orientation, identification, exploitation and resolution. And during these phases nurse has to perform variety of roles and from which one of the most importan

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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 fully what is happening to him in the present situation so that the experience can be integrated with rather than disassociated from life.”


Peplau (1962) believed that nursing interventions should aid client in recognizing their dysfunctional behavior, help them to describe the behavior verbally, connect to the causes and consequences of their behavior, search for more functional behavior and transfer the improved behavior to other situation.

 Nurse therapist has developed skills through intensive supervised educational experiences to provide helpful individual, group or family therapy. Peplau suggested that it is essential for the staff nurse working in psychiatry to have a general knowledge of basic counseling techniques. A therapeutic or helping relationship is established through use of the interpersonal techniques and is based on knowledge of theories of personality development and human behavior.

Rogerian counseling involves the counselor's entry into the person's unique  world. In mirroring this world, the counselor does not disagree or point out contradictions. Neither do he / she attempt to delve into the unconscious. Rogers describes counseling as a process of freeing a person and removing obstacles so that normal growth and development can proceed and the person can become more independent and self-directed.

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).

Counseling is helping relationship that includes someone seeking help ,someone willing to give help who is capable or trained to help in a setting that permits help to be given and received .(Cormeir & Hackney 1987).

Counseling is an accepting, trusting & safe relationship in which client learns to discuss freely what respects them, to define their goals, to acquire the essential social skills & to develop the courage & self-confidence to implement desired new behavior.(Vedanayagan 1988)

The psychiatric nurse uses counseling interactions to assist the client in improving or regaining their previous coping abilities, fostering mental health and preventing the mental illness and disability (ANA, 2000).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 presentation 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 he 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 & feelings.

Concept of Counseling

  • 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 too discuss their problems, acquires the social skills, courage, confidence to implement desired new behavior.
  • The relationship between two personnel or the interaction between the counselor i.e., one professionally trained worker and the counselee i.e. the person who seeks services or who cannot cope up alone
  • Helps the individual to become aware of himself and the ways in which he is reacting to the behavioral influences of his environment.

Meaning of Counseling

Counseling is a helping relationship which includes:

  • Someone seeking help
  • Someone willing to give help
  • Capable or trained to help
  • In a setting that permits help to be given and received.
  • It is accepting trusting & safe relationship in which client learns to discuss freely what respects them, to define their goals, to acquire the essential social skills & to develop the courage & self-confidence to implement desired new behavior.

Patterson (1967) has pointed out certain behaviors that are not synonymous with the process of effective counseling:

  • Counseling is not giving the information, though information may be present.
  • Counseling is not giving an advice.
  • Counseling is not the behavior by persuading, threatening or compelling without the use off physical force.
  • Counseling is not interviewing, though interviewing is involved.

Models for counseling

Psychoanalytic: This model follows the teachings of Sigmund Freud. The emphasis is on the client's childhood experiences and relationships with the parents, and on the client's psychosexual development. Psychoanalysis seeks to uncover the secrets of the human psyche hidden in the unconscious mind. Psychoanalysts attempt to develop a relationship of transference with their clients, in which the clients relate to their analysts just as they did to their parents in childhood. During this process the client's defense mechanisms are identified and replaced with healthy behavior patterns. Psychoanalysis usually takes many years to complete with 1-3 sessions every week.

Psychodynamic: This model does not follow Freud's idea of psychosexual development. However, stages of social development over the life span are still important in this model. Lifetime experiences are examined and defense mechanisms are identified. The client is helped in learning appropriate decision-making skills and behaviors. Psychodynamic therapy often involves long term therapy, but not as long as psychoanalysis.
The psychoanalytic and psychodynamic approaches propose that our childhood experiences can strongly influence our reactions in the present without our even realizing it. This does not mean that our present behaviors are the fault of our parents, nor that our past determines our future. However, it does provide us with information necessary and helpful for changing the negative influences of our past.

Client-centered or Rogerian: Carl Rogers believed that reality for the individual is the sum total of one's experiences and perceptions over a lifetime. According to Rogers, the goal of achieving one's potential can be attained in counseling provided that the therapist provides an atmosphere of genuineness, unconditional acceptance, and empathy. The counselors are non-directive in that they refrain from sharing their own beliefs, values, or opinions with the client. They offer neither approval nor judgment of the client's decisions. This also is long-term therapy.

Behavioral: This model is very "scientific" in nature in that the counselor and client only work on what can be observed and measured. A problem behavior is observed; a plan for changing it is implemented; progress is measured and reported. Behaviorists believe that individuals are shaped by their environment. Some behaviorists believe that we learn through conditioning. Others believe that we can learn by observing the behaviors of others and the consequences of those behaviors. In either case, the theory is that, if the antecedent or the consequence of the client's behavior is changed, then the behavior of the client will be changed as well.
Family Systems: This model views problems as belonging to the family rather than to any one individual. Each family member both influences and is influenced by the other members of the immediate family and the extended family. Sub-systems are identified within the family. Family of origin issues is studied. Genograms are used to chart behavior patterns and experiences across several generations of the extended family. Even though there may be a focus client, the entire family is involved in therapy, so that dysfunctional family interaction patterns can be changed.

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Elements in counseling process        

Counseling involved two individuals; it’s a communication between the Counsellor and the counselee.

  • Counsellor – a professionally trained person who can assist or help the counselee.
  • Counselee – a person who seeks help or needs assistance.

Mutual respect, rapport and satisfactory relationship should be established. Counsellor should be friendly and cooperative with counselee. Counselee should have trust and confidence over the Counsellor. Counsellor should have thorough experience and sound knowledge with counseling process.

Elements that hinder counseling process

  • Passing moral judgement on clients’ behavior of feelings.
  • Taking more ...

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