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CFN9885 - SECTION 5: COMMON PROBLEMS FOR BEGINNING CLINICANS

Experience has shown that clinicians tend to have some common problems when they first begin counseling, although even veteran clinicians will probably find that some of these problems can still occur in their practices. (Nystul, 2003).

- Focusing on the first issue in a session: Clinicians should be careful not to focus exclusively on the first issues that arise in the initial counseling session. It is important to do a thorough intake and assessment to get a clear overall picture of the client’s current life situation and then, working with the client, decide what problems to focus on in the work together.
- Over-diagnosing or under-diagnosing clients and overlooking physical or medical issues: Clinicians should do a thorough assessment including making referrals to physicians, psychiatrists, substance abuse clinicians, educational specialists, nutritionists, and other assessment professionals.
- Not examining the issues that you, the clinician, bring to the counseling: It is important for clinicians to examine such issues as why you became a clinician; feelings and behaviors that make you uncomfortable; how you view human nature and people’s abilities to make changes in their lives; and how you live your own life.
- Having perfectionist tendencies: The art of counseling involves the creative application of approaches and technique to each counseling situation and it also involves acknowledging when something is not working and the willingness to try other approaches.
- Having unrealistic expectations: Clinicians, working with their clients, should develop realistic intermediate and long-term goals that are subject to evaluation and change, depending upon the progress the client is making.
- Getting carried away with the latest technique: While it is important to stay up to date on the latest techniques, it is also important to evaluate the techniques and integrate them into current counseling approaches and techniques that have proven to be effective.
- Getting lost in the counseling process: While clinicians need to be flexible and respond to the needs of each client, they also need a consistent theoretical perspective or orientation which guides the work with each client.
- Assuming that change is simple: It can be very difficult for clients to give up the known, even if it is causing them distress, and to risk the uncertainties of making changes in their lives.
- Assuming that you know clients’ feelings, thoughts, and behaviors: Clinicians should view clients as strangers and let them educate you on what they are feeling and thinking.
- Not paying enough attention to race, ethnicity, gender, and sexual orientation: These factors influence clients in different ways and clinicians need to be aware of their influence on clients’ thought, feelings, and behaviors.
- Asking too many questions: While asking clients questions is often very appropriate, excessive questioning conveys to clients that their job is to be passive and respond to the clinician’s questions. “Why” questions, in particular, can make clients feel defensive because they ask clients to explain or justify their behavior or feelings.
- Not paying enough attention to what the client is saying and doing: It is important to pay close attention to clients’ verbal and nonverbal behaviors and to create a counseling atmosphere where clients are encouraged to fully express themselves.
- Using inappropriate phrases: While there is probably no right or wrong way to do counseling, clinicians should try to avoid using empty phrases such as “I know how you feel” or “I hear you” or phrases that will make the client feel reactive or defensive such as “Why did you ____?” or “Let me tell you what I would do.”
- Taking things too personally and becoming too emotionally involved: The clinician/client relationship is a unique relationship and while clinicians should be emotionally involved with their clients, they should also maintain their objectively, as well as appropriate professional boundaries.
- Negative feelings need to be eliminated: A goal of counseling is not to eliminate negative feelings in the client. Rather, the goal of counseling is to help the client develop situation-appropriate feelings, some of which may be appropriately negative.
- Being uncertain about self-disclosure: While there are no hard-and-fast rules for self-disclosure, a basic guideline would be to examine why the client is asking the clinician for personal information and/or why the clinician feels giving personal information is appropriate with this client at this time. For more in-depth information on this aspect of counseling, you may wish to look at yourceus.com's course on Therapist Self-disclosure: Uses and Misuses: A Guide for Mental Health Clinicians.
- Being uncertain about confidentiality: It is important that clinicians have a thorough knowledge of the confidentiality and reporting requirements of their profession and their state, and a clear understanding of their application - even when it goes against the wishes of the client.
- Not being willing to ask of yourself what you ask your clients to do: While clinicians ask their clients to assess themselves, they should also be willing to engage in self-assessment - to identify their own strengths and weaknesses that can either promote or inhibit the counseling process.
- Giving premature advice or problem-solving: Telling the client how to solve their problems, especially early in the counseling relationship, fosters dependence on the clinician and discourages the client from becoming actively involved in solving their own problems.
- Not knowing your limitations: It is important for clinicians to know their limitations in terms of what types of clients and/or problems they are most qualified to counsel or treat, and be willing to consult with other professionals and/or make appropriate referrals when needed.
- Being hesitant to ask for help: It is important for clinicians to actively seek professional advice, consultation, and supervision and to keep up with the literature in the field to be constantly trying to improve your counseling.

 

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