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Examining Counseling

January 31, 2013

Examining Counseling

Beyond providing ample time in the first session, it is what the counselor does that matters. Some counselors are quite active in the counseling process and others are more passive where they allow the client to lead the disclosure of content.

Counselors who let the client lead the disclosure of content facilitate their comfort and sense of safety to enable deeper and more meaningful disclosures over time. The client puts their information out into the air, like stars in the night. Those stars form constellations. The constellations are the connections between life events from which we take meaning. In theory, how we have made those connections (or not made them) and the meaning we extract may be contributory to our issues of distress. Over time and throughout the process, the client can review the alignment of events and may come to re-align the connections between events to form new constellations. This is the process of insight – seeing the same steam of events from another vantage point to extract a different meaning.  This process can take weeks to months and even years to produce relief from distress.

In my practice I see many persons coming from that approach to counseling who over time, have been unable to make those new connections and where as a result, their problems continued and at times intensified. These folks seem to need a more guided and directive process.

My approach is quite different. I am active in the counseling process. I am of the view that the counselor can ask questions to facilitate the disclosure of content and suggest different connections between the life events, such that new connections can occur more rapidly.

When meeting folks for the first interview, I routinely conduct an extensive individual and family history taking procedure, trans-generational in nature and probing for issues related to mental health, physical health, addictions, violence/abuse, quality of relationships, developmental histories, personality styles, etc. I am looking for or assessing issues that may be either contributory or intervening variables to the presenting problem.  I choose to meet with folks for an extended session averaging 3 hours to enable this rich data collection procedure.

So, the process hinges upon a good history, trans-generational in nature and from a bio-psycho-social perspective.

My note-taking involves developing a genogram and plotting the data (the information obtained from the client in response to direct questions) on the genogram as delivered by the client. The picture this presents is remarkably revealing to me as practitioner and more importantly, to the client. With picture in hand, making connections between various issues, understanding the aetiology of certain problems and determining a reasonable course of treatment options can be self-evident.  My role involves helping the client interpret the data and picture if not already self-evident.

Some problems are not psycho-social and may have their roots in biology whilst other issues may be the outcome of early developmental issues. This approach typically provides for enough data to therefore make reasonable a formulation with respect to the presenting problem.

Some may consider this a more medical model and I wouldn’t disagree.

Imagine the patient’s frustration seeing a physician who is only reflective or non-directive when that patient is in distress and seeking active treatment? The patient reasonably expects the physician to take the necessary tests, provide a diagnosis and suggest a treatment plan. I act similarly.

My experience is that clients, whom I see, appreciate this forthright approach. The outcome as per my clients’ feedback is that they typically experience relief sooner than in more traditional approaches to counseling. I continue to practice in this manner only owing to the feedback from my clients. Many clients are amazed at how much they can learn about themselves and their issues so quickly.

A common refrain from my clients is expressed by this one client:

“Gary actually asks questions, lot’s of questions, more than any other therapist I saw before and then he gives you feedback on what he learns about you. In one session, I learned more with him than in years of therapy with anyone else.”

Please note, I am absolutely NOT helpful to everyone. I am helpful to about 92% of people who see me, albeit to varying degrees. I am quite unhelpful to 8% of people I see. Despite being able to offer feedback on the basis of the data provided, persons with whom I am unhelpful are apt to hold onto their beliefs/views of the problem and their solutions even when not working.

Bottom line: I hope all counselors can articulate their approach and that they examine their own work to determine how best to meet their client needs. There are many conventions/standards or more simply the usual ways of doing things in our profession. I think it’s good to shake things up a little and self-examine too.

I am Gary Direnfeld and I am a social worker.

Gary Direnfeld, MSW, RSW

(905) 628-4847

Gary Direnfeld is a social worker. Courts in Ontario, Canada, consider him an expert in social work, marital and family therapy, child development, parent-child relations and custody and access matters. Gary is the host of the TV reality show, Newlywed, Nearly Dead, parenting columnist for the Hamilton Spectator and author of Marriage Rescue: Overcoming the ten deadly sins in failing relationships. Gary maintains a private practice in Dundas Ontario, providing a range of services for people in distress. He speaks at conferences and workshops throughout North America.

If your relationship is faltering, then set it as your priority.

Read: Marriage Rescue: Overcoming ten deadly sins in failing relationships.

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  1. Sabina Ubell, LCSW permalink

    Terrific way to get information and use it in work with clients. My 1st post- graduate job was in a family service agency where we were trained in using the Bowen genogram. Often it provided great relief to a client when clearly the issue(s)/dysfunction were transgenerational. How to you manage your time in this day of managed care?

  2. Thanks for your comment Sabina.

    I am 100% in private practice where the client pays me directly for service. No third party payer means I can structure my practice as I deem appropriate. Admittedly, not everyone has the luxury of practicing in this manner.

    • Sabina Ubell, LCSW permalink

      Hi Gary,
      By the way, I too am very active in my sessions. It’s great that you have private pay clients. Unfortunately, my clients have limited ability to pay my full fee. My referrals are either through EAPs, managed care and Medicare – which is a nightmare for me. That’s a whole other story.

      You’ve given me much to think about. With the new CPT codes, I can probably do extended intakes over several sessions and code them as full hours. This would give me the opportunity to again use the genogram, which I’ve abandoned years ago, due to the pressures of managed care.

      By the way, my 1st job was with Jewish Family Service in NYC, where Ackerman was the chief of psychiatry and developed family systems theory.Then he left JFS and started the Ackerman Family Therapy Institute. I was at JFS for 5 years. It was a great experience with ongoing weekly training.
      Sabina Ubell

  3. Thanks for this post! I too find genograms to be terrifically helpful in fully understand my clients and their context. I have also found it very helpful to turn the process of creating a genogram into something of an art project that I create with my clients. I use large paper or poster board, lots of colored markers and have even used stickers, photos from magazines, glitter, feathers and the like. This creative process really engages the client, especially younger ones. I also find that I garner information from processing the client’s choices of color, pictures, or decoration. Whether a well-organized chart, or a glitter-enhanced “family tree,” a genogram is both a great tool!
    Sarah Stoune, LPC-intern

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