Stages of psychological counseling and their features

When making an appointment with a psychologist, most people want to immediately understand how the psychological consultation will take place, how many meetings there will be and when they will feel better. But, touching the inner world of other people, a psychologist cannot give answers to all these questions in advance. After all, it is unknown what the problem is connected with, how deeply it is rooted in the soul. Working with each person goes through certain stages of psychological counseling. You will now learn about each of them.

In this article:

Getting to know each other and establishing trust Defining the problem Clarifying the purpose and additional points Concluding a contract Consulting work Completion

Getting to know each other and establishing trust

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The first stage of psychological counseling is aimed at establishing contact between the psychologist and the person in need of support or help. This contact should be confidential, such that it allows the client to relieve fears, tension, and open up to the psychologist.

Any consulting work begins with a request. You call or write to a consultant, introduce yourself, make an appointment, and perhaps briefly voice the problem. The way you were received at this stage, what impression was created, can already set you up for further cooperation or, conversely, force you to look for help elsewhere.

By the way, you are not the only one who worries before meeting with a psychologist. While waiting for you, he also spends a lot of time thinking about what the consultation will be like, whether he can help you.

Direct acquaintance occurs during the first meeting. You see a person's eyes, his smile, his behavior. You feel that now he is busy only with you, he has turned off calls, instant messengers, and computer. His gaze and body are directed at you. Perhaps he repeats some phrases after you, clarifies points, sometimes jokes or tries to make you relax.

And you really feel that they are listening to you and trying to understand you. This is the basic feeling that, like a key, opens the door to trust.

Nowadays, many consultations are carried out online. Because of this, communication may be poorer - some gestures and movements will disappear. However, thanks to the principles of active, empathic listening, and the behavior of the psychologist, you will still feel that you can trust him.

Main stages of psychological counseling

The entire process of psychological counseling from beginning to end can be represented as a sequence of main stages of counseling, each of which is necessary in its own way during counseling, solves a particular problem and has its own specific characteristics. Depending on which aspect of psychological counseling becomes the main one for the client, psychological counseling takes on a diagnostic, research, informational (educational), developmental, correctional, educational or psychotherapeutic orientation.

As we noted above, each of these aspects, if it becomes the main motive of psychological counseling, forms a certain focus of psychological counseling, while other aspects become its subordinate aspects. At the same time, in any psychological counseling all its sides are present, more or less expressed, sometimes latent. Let us illustrate what stages researchers distinguish, focusing on various aspects of psychological counseling.

In our opinion, the consulting model proposed by R.S. is of an informational and recommendatory nature. Nemov, which identifies the following main stages of psychological counseling (R.S. Nemov, 2001):

1. Preparatory stage. At this stage, the consulting psychologist gets acquainted with the client based on the preliminary record available about him in the registration journal, as well as information about the client that can be obtained from third parties, for example, from a psychological consultation worker who accepted the client’s application for consultation. At this stage of work, the consulting psychologist, in addition, prepares himself for the consultation, doing almost everything that was discussed in the previous section of this chapter. The work time of a consultant psychologist at this stage is usually from 20 to 30 minutes.

2. Setup stage. At this stage, the consulting psychologist personally meets the client, gets to know him and gets ready to work together with the client. The client does the same for his part. On average, this stage in time, if everything else has already been prepared for the consultation, can take from 5 to 7 minutes.

3. Diagnostic stage. At this stage, the psychologist-consultant listens to the client’s confession and, based on its analysis, clarifies and clarifies the client’s problem. The main content of this stage is the client’s story about himself and his problem (confession), as well as psychodiagnostics of the client, if there is a need for it to clarify the client’s problem and find its optimal solution. It is not possible to accurately determine the time required to carry out this stage of psychological counseling, since much in its determination depends on the specifics of the client’s problem and his individual characteristics. In practice, this time is at least one hour, excluding the time required for psychological testing. Sometimes this stage of psychological counseling can take from 4 to 6–8 hours.

4. Recommendation stage. The consulting psychologist, having collected the necessary information about the client and his problem at the previous stages, at this stage, together with the client, develops practical recommendations for solving his problem. Here these recommendations are clarified, clarified, and specified in all essential details. The average time usually spent on completing this stage of psychological counseling is from 40 minutes to 1 hour.

5. Control stage. At this stage, the consulting psychologist and the client agree with each other on how the client’s practical implementation of the practical advice and recommendations he has received will be monitored and evaluated. Here the question of how, where and when the psychologist-consultant and the client will be able to discuss additional issues that may arise in the process of implementing the recommendations developed is also resolved. At the end of this stage, if the need arises, the counseling psychologist and the client can agree with each other about where and when they will meet next time. On average, work at this final stage of psychological counseling takes place within 20–30 minutes.

If we summarize everything said above, we can establish that on average it may take from 2–3 to 10–12 hours to complete all five stages of psychological counseling (without the time allocated for psychological testing).

The psychotherapeutic focus of psychological counseling can be noted in the counseling model proposed by M.K. Tutushkina and her colleagues, who note that regardless of whether a one-time consultation is carried out or prolonged work is carried out in the form of a series of psychotherapeutic sessions, counseling can be considered as a dialectical process that includes a number of stages (Tutushkina M.K., 2001):

1 . Conclusion of a contract between the client, from whom a voluntary order for consultation is received, and the consultant, who agrees to provide assistance, ensuring safety and support during the consultation.

2 . Clarification of the request and analysis of the problem situation . At this stage, the consultant needs to navigate the client's problem, listening carefully, using open-ended questions, paraphrasing and asking again to obtain reliable information. At the same time, the consultant reflects on his own feelings and those of the client, helping him to dive deeper into the problem and approach setting a psychotherapeutic goal.

3 . Reframing the problem and setting a psychotherapeutic goal, clarifying the contract. At this stage, as the conditions and situation of the problem arise are clarified, the client’s feelings and attitudes towards it are analyzed, the essence of the problem is determined, that is, the psychological difficulty that prevents the client from finding a way out of the current situation. In this case, the main thing is the client’s own awareness of the essence of the problem from a psychological point of view vision.

4. Finding ways to solve the problem. At this stage, it is necessary for the client to agree to explore his own psychological difficulties, search for and take responsibility for the decisions he makes.

During the counseling process, the client experiences changes that can, to one degree or another, affect his personality and life in general. In any case, the client is given the opportunity to gain new experience, and the more deeply he realizes this, the more favorable the consequences of the consultation will be for him, and therefore its effectiveness.

The educational and corrective nature of the focus of psychological counseling can be noted, in our opinion, in the approach proposed by A.F. Bondarenko, in this regard, at each stage of the counseling process, the psychologist solves the corresponding problems (Bondarenko A.F., 2000):

First stage. The stage of entering a situation of psychological assistance.

The main tasks of the psychologist at this stage, fundamental to establishing a working relationship, are as follows:

— supporting the client’s motivation to work together;

— clarification of the true (realistic) possibilities of psychological assistance and correction of unrealistic expectations;

— expression of readiness to understand, accept the client and provide him with possible psychological assistance;

— trial setting of goals for psychological assistance and determination of approximate deadlines and results of work;

— elaboration, if necessary, of one’s own difficulties in work associated with possible countertransference or emerging projections.

The stage of action and living in a situation of psychological assistance.

Includes working with the client’s personal material: experiences, relationships, feelings, dreams, value meanings.

The psychologist’s possible tasks arise from the logic of his actions and the phenomenology of the client’s experiences, among them:

— ensuring emotional response;

- elaboration and symbolic satisfaction of certain frustrated needs;

— creating conditions for insight and catharsis;

— reinforcement of the desired direction of action (retraining);

— providing conditions for personal reflection and living in a situation of free and responsible choice.

The stage of entering a new experience.

This is the stage of personal transformation and attempts to join a different way of living life, free from previous misconceptions and problems.

This leads to the following possible tasks in the activities of a psychologist:

— emotional and existential support;

— reinforcement of tendencies towards personal reorientations and transformations;

— assistance in coping with personal and situational anxiety caused by changes in the life world;

— elaboration of value-semantic or behavioral obstacles blocking the implementation of necessary actions.

The stage of entering everyday life with enriched new experiences.

This is the final stage of work.

Its significance is reflected by the specific tasks facing the psychologist:

- encouraging the client and emphasizing the time boundaries of both the traumatic issue and the end of the advisory process;

— analysis of elements of dependence in the client’s behavior and assistance in achieving independence and self-sufficiency;

— redefining and rethinking the situation of psychological assistance as an opportunity for a person to understand his own motives, values, goals and choices;

— finding the “golden mean” between the tendencies of overprotection, patronage and emotional detachment from the client.

Each stage has its own duration. The consequences of counseling can be considered in terms of changes occurring in the client's personality and the degree of his satisfaction with the results of counseling.

R. Kochunas, referring to V. E. Gilland, proposes the structure of the psychological counseling process in the form of a system model, which places emphasis on the research and training nature of psychological assistance (Kochunas R., 2000):

This systemic model, covering six closely related stages, reflects the universal features of psychological counseling or psychotherapy of any orientation.

1. Research problems . At this stage, the consultant establishes a rapport with the client and achieves mutual trust: it is necessary to listen carefully to the client talking about his difficulties and show maximum sincerity, empathy, and care, without resorting to assessments and manipulation. The client should be encouraged to in-depth consider the problems he has encountered and record his feelings, the content of his statements, and non-verbal behavior.

2. Two-dimensional problem definition . At this stage, the counselor seeks to accurately characterize the client's problems, identifying both the emotional and cognitive aspects of them. Problems are clarified until the client and consultant reach the same understanding; problems are defined by specific concepts. Accurate identification of problems allows us to understand their causes, and sometimes indicates ways to resolve them. If difficulties or ambiguities arise when identifying problems, then we need to return to the research stage.

3. Identification of alternatives . At this stage, possible alternatives for solving problems are identified and openly discussed. Using open-ended questions, the consultant encourages the client to name all possible options that he considers appropriate and realistic, helps to put forward additional alternatives, but does not impose his decisions. During the conversation, you can create a written list of options to make them easier to compare. Problem-solving alternatives should be found that the client could use directly.

4. Planning . At this stage, a critical assessment of the selected solution alternatives is carried out. The counselor helps the client figure out which alternatives are appropriate and realistic in terms of previous experience and current willingness to change. Creating a realistic problem-solving plan should also help the client understand that not all problems are solvable. Some problems take too long; others can be solved only partially by reducing their destructive, behavior-disrupting effects. In terms of problem solving, it is necessary to provide by what means and methods the client will check the realism of the chosen solution (role-playing games, “rehearsal” of actions, etc.).

5. Activity . At this stage, a consistent implementation of the problem solving plan occurs. The consultant helps the client build activities taking into account circumstances, time, emotional costs, as well as understanding the possibility of failure in achieving goals. The client must learn that partial failure is not a disaster and should continue to implement a plan to solve the problem, linking all actions with the final goal.

6. Rating and feedback . At this stage, the client, together with the consultant, evaluates the level of goal achievement (the degree of problem resolution) and summarizes the results achieved. If necessary, the solution plan can be clarified. When new or deeply hidden problems arise, a return to previous stages is necessary.

This model, which reflects the consultation process, only helps to better understand how specific consultation occurs. The actual consulting process is much more extensive and often does not follow this algorithm. The identification of stages is conditional, since in practical work some stages overlap with others, and their interdependence is more complex than in the presented diagram.

As we see, the direction of psychological counseling is determined not only by structural characteristics (goals, subject matter, leading activities of the client and consultant, role position of the psychologist), but also by procedural ones, one of which is the sequence of its stages.

Problem Definition

The next stage of psychological consultation is related to understanding the problem. A client who comes to a psychologist talks about what worries him. The psychologist asks clarifying questions. This is one of the longest stages; sometimes it can stretch over several meetings.

This is due to the fact that any problem usually has long roots. You shouldn't be afraid of this. Discovering the causes plays a huge therapeutic role, allowing you to understand how and why the problem arose and determine ways to solve it.

For a psychologist, this stage means as much as compiling a medical history for any other doctor.

Analysis of techniques and techniques used by the psychologist during the session

In today's session I used the following techniques:
Techniques

Clarification of the goal and additional points

Once the problem is identified, the goals of the consultation are formulated. Even if a person comes with one question, others are revealed as the conversation progresses, and therefore there may be several goals for counseling. Among them there are short-term, medium-term and long-term.

For example, a young woman came to a psychologist and complained that she could not organize her day. She is constantly busy, worries that she doesn’t have time to do anything, and worries about little things. It also turned out that she was quarreling with her husband and could not find contact with the child.

Working with this woman will have several goals, and each will take its own period of time:

Psychological counseling

• Determine your own resources - the client did not always fail to cope with her life. Once upon a time there were bright, happy moments. Besides this, even now she has the power to do what only she can do.
• Normalize your emotional state. The causes of restlessness and anxiety are determined, and a regime is discussed that will allow for more rest and distribution of responsibilities in the family.
• Restore relationships with family through a more reasonable distribution of responsibilities, streamlining family ties and interests. At some stage, family counseling may be required.
• Improve self-esteem, including through discussing past successes and identifying your own interests.

At this same stage, it is advisable to determine the location of consultations and the frequency. If the psychologist to whom the client came feels that the issue is not within his competence, it is better to suggest visiting another specialist.

Scheme for collecting psychological history

There are three main blocks of information about the client: 1. Demographic information : client’s age; Family status; profession; education. 2. Current problems and disorders : occurrence, development and duration of difficulties; events in life caused by the emergence, exacerbation and resolution of problems; age at which problems arose; changes in personal relationships (especially towards significant people), changes in interests, deterioration in physical condition (sleep, appetite) caused by the emergence of problems; the immediate reason for the client’s request; previous attempts to resolve problems (on your own or with the help of other specialists) and results; medication use; family history (especially mental illness, alcoholism, drug addiction, suicide). 3. Psychosocial history (significant interpersonal relationships): early childhood (circumstances and birth order, main educators, family relationships); preschool period (birth of brothers and sisters, other significant events in the family, first memories); junior school age (successes and failures in studies, problems with teachers and peers at school, family relationships); adolescence and youth (relationships with peers, people of the opposite sex, parents, successes and failures at school, ideals and aspirations); adulthood (social relationships, job satisfaction, marriage, family relationships, sex life, economic living conditions, loss of loved ones, age-related changes, alcohol and drug use, psychological and existential crises, plans for the future).

Consulting work

As soon as all questions and conditions are determined and accepted, the consulting work begins. The methods and techniques used depend on the problem, its severity, and relevance:

• The process can use art therapy, drama therapy, and narrative practice. These methods are relevant for identifying underlying problems and their painless resolution.
• Conversation is used, discussing the positions of different parties in conflicts.
• When working with problem behavior and aggression, new ways of responding to difficult situations are developed.
• In case of fears, self-doubt, anxiety, it is important to understand the client’s past - what kind of relationship there was with parents, whether there were any difficulties with adaptation.
• If there are problems in relationships in the family, with peers, or colleagues, group trainings and family counseling can be used.
• Questions of the meaning of life can be effectively discussed from the perspective of existential therapy.

Types of counseling

Most often, once at the reception, a person has no idea of ​​the real reasons for his difficulties. A consulting psychologist helps him clarify the situation and understand the situation in all relationships.

Depending on the nature of the difficulties and characteristics of the client, counseling is possible in different forms:

1. Production. Aimed at motivating staff, increasing management efficiency, eliminating conflicts and improving interactions in the workforce.
2. Professional. Relates to career guidance issues. Assessments of a subject’s predisposition to one or another type of activity, and whether he or she has the necessary qualities.
3. Family. This includes issues of relationships during the premarital period, work with couples during their life together, and assistance in situations of divorce. Parents with problems with their children and spouses who have not found mutual understanding with their in-laws or in-laws can turn to a specialist.
4. Personal. Individual intimate issues - difficulties in interacting with others, interpersonal conflicts, increased anxiety, loss of meaning in life.

Based on other characteristics, the following types of counseling can be additionally distinguished:

• correspondence (remote) and contact (face-to-face);
• group and individual;
• psychological, pedagogical and business;
• problematic and crisis.

Completion

The ideal outcome of psychological counseling is a completely happy client, free from problems and ready for a new life. To even get closer to this ideal, intermediate results must be formulated as part of the consultation process.

This approach allows you to make timely adjustments to the consulting process, identify current problems, clarify many issues, and change work tactics.

The stages of psychological consultation are steps by which a person, in collaboration with a psychologist, solves internal problems and comes to a feeling of well-being and success.

Conditions for the effectiveness of consultations with a psychologist

The specificity of psychological counseling is that it becomes effective if a number of factors are combined:

1. Specialists consider the problem comprehensively and do not focus on solving immediate problems, which most often have a temporary effect. A psychologist should focus on resolving deep internal conflicts.
2. The qualifications of consultants allow you to create an atmosphere of trust and establish relationships that allow you to obtain all the required information about the problems and inner world of the client, and use the methods of influence that are required to achieve the desired result.
3. A person who seeks help behaves prudently and disciplinedly: attends all meetings, performs independent work to the required extent, and provides reliable information about his conditions.
4. The methods of influence and the structure of the consultation are based on the individual characteristics of the client’s personality.
5. The psychologist is not able to do the work for the client. Therefore, the motivational part remains the most important for all consulting work.

Ticket 13, 14. Psychology of grief

Grief reactions are a normal human reaction to any significant loss. The greatest losses, objectively and subjectively, for the individual are those associated with the awareness of one’s own mortality and the death of a loved one. The process of grief in literary sources (Vasilyuk, 2002) is often called the work of grief. This is, in fact, a lot of internal work, a huge mental labor of processing tragic events. So, grieving is a natural process necessary to let go of a loss or mourn a death. Conventionally, “normal” grief and “pathological” grief are distinguished.

Stages of “normal” grief:

1. Shock stage

. Tragic news causes horror, emotional stupor, detachment from everything that is happening, or, conversely, an internal explosion. The world may seem unreal: time in the perception of the grieving person may speed up or stop, space may narrow.

Typically, a complex of shock reactions is interpreted as a defensive denial of the fact or meaning of death, protecting the griever from confronting the loss in its entirety at once.

2. Denial stage

(search) is characterized by disbelief in the reality of the loss. A person convinces himself and others that “everything will change for the better,” that “the doctors were mistaken,” that “he will be back soon,” etc.

At this time, it can be difficult for a person to maintain his attention in the outside world; reality is perceived as if through a transparent veil, through which the sensations of the presence of the deceased often break through: a face in the crowd that looks like a loved one, a doorbell rings - the thought flashes: it’s him. Denial is a natural defense mechanism that maintains the illusion that the world will change according to our yes and no, or better yet, remain the same. But gradually the consciousness begins to accept the reality of the loss and its pain - as if the previously empty inner space begins to be filled with emotions.

3. Aggression stage

, which is expressed in the form of indignation, aggressiveness and hostility towards others, blaming oneself, relatives or friends, the treating doctor for the death of a loved one, etc.

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Being at this stage of a confrontation with death, a person can threaten the “guilty” or, conversely, engage in self-flagellation, feeling guilty about what happened.

The picture of experiences is significantly complemented by reactions from the clinical spectrum. Here are some of the possible experiences during this period: Changes in sleep. Panic fear. Changes in appetite accompanied by significant weight loss or gain. Periods of unexplained crying. Fatigue and general weakness. Muscle tremors. Sudden mood changes. Inability to concentrate and/or remember. Changes in sexual desire/activity. Lack of motivation. Physical symptoms of suffering. Increased need to talk about the deceased. Strong desire to be alone.

The range of emotions experienced at this time is also quite wide; the person experiences the loss acutely and has poor self-control. However, no matter how unbearable the feelings of guilt, feelings of injustice and the impossibility of further existence may be, all this is a natural process of experiencing loss. When anger finds its way out and the intensity of emotions decreases, the next stage begins.

4. Stage of depression (

suffering, disorganization) - melancholy, loneliness, withdrawal into oneself and deep immersion in the truth of loss.

It is at this stage that most of the work of grief occurs, because a person faced with death has the opportunity, through depression and pain, to look for the meaning of what happened, rethink the value of his own life, gradually let go of relationships with the deceased, forgive him and himself.

In the phase of acute grief, the mourner discovers that thousands and thousands of little things are connected in his life with the deceased (“he bought this book”, “he liked this view from the window”, “we watched this film together”) and each of them captivates his consciousness in “there-and-then”, into the depths of the stream of the past, and he has to go through pain in order to return to the surface (Vasilyuk, 2002).

Paradoxically, pain is caused by the grieving person himself: phenomenologically, in an attack of acute grief, it is not the deceased who leaves us, but we ourselves leave him, break away from him, or push him away from ourselves. And this self-made separation, this own departure, this expulsion of a loved one: “Go away, I want to get rid of you...” and watching how his image actually moves away, transforms and disappears, and actually causes mental pain. The pain of acute grief is not only the pain of decay, destruction and death, but also the pain of the birth of a new one. The formerly divided existence is united here by memory, the connection of times is restored, and pain gradually disappears (Vasilyuk, 2002).

The previous stages were associated with resistance to death, and the accompanying emotions were mainly destructive.

5. Stage of accepting what happened

. In literary sources (see J. Teitelbaum, F. Vasilyuk) this stage is divided into two:

5.1. Stage of residual shocks and reorganization.

At this phase, life returns to its groove, sleep, appetite, and professional activity are restored, and the deceased ceases to be the main focus of life.

This stage, as a rule, lasts for a year: during this time, almost all ordinary life events occur and then begin to repeat themselves. The anniversary of death is the last date in this series. Maybe this is why most cultures and religions set aside one year for mourning.

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5.2. "Completion" stage. The normal experience of grief that we are describing enters its final phase after about a year. Here, the griever sometimes has to overcome some cultural barriers that make the act of completion difficult (for example, the idea that the duration of grief is a measure of love for the deceased).

One of the biggest obstacles to the normal functioning of grief is the often unconscious desire of the griever to avoid the intense suffering associated with the experience of grief and to avoid expressing the emotions associated with it. In these cases, you get “stuck” at any of the stages and painful grief reactions may occur.

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