<H20:特別選抜>
The goal of the first stage of counseling is to ensure that both helper and client fully understand the problems that individual is facing.
Many people who seek counseling may feel so overwhelmed by a variety of problems and their emotional sequelae that they are unable to identify or prioritize specific issues that need resolving.
It is essential that the helper does not repeat this error and that due attention is given to the process of problem identification.
Health care workers all too frequently present ‘standard solutions’ to ‘standard problems’ without consideration of the actual problems faced by the individual.
Overweight individuals are presented with diet sheets, people with arthritis are given standard information on limb mobilization, and so on, frequently with little consideration to the circumstances or history of the person receiving them.
In the case of the overweight individual, for example, providing a diet sheet implicitly suggests that the problem is one of ignorance of the dietary changes necessary to lose weight, and that the solution is one of information provision.
Rarely is the problem so simple.
Egan identified a number of strategies appropriate to each stage of the counseling process.
In the first stage, these are primarily ones that promote the client’s effective exploration of their problems, and include direct questioning, verbal prompts (‘Tell me about…’), minimal prompts (‘Uh-hu’) and empathic feedback.
Egan state that the use of open questions should be maximized, and that any direct question should generally be followed by a less directive method of encouraging consideration of the problem.
Some examples of this process are given in a sample of dialogue involving a man recently identified as having high cholesterol levels but who has not been able to achieve the suggested dietary changes:
Helper: So, you haven’t been able to achieve your goal of changing your diet.
Mr.B: No. I’m just the same as before. No luck as usual.
Helper: You've been here before then?
Mr.B: Yes. I don't know… It all seems such a problem. I set off with food intentions, and want to change my diet - but it all seems to fall apart. And I don't really know why.
Helper: Hmmmm. Perhaps it would help if we looked in a bit more detail at some of the times when things have gone wrong.
Mr.B: O.K. Well, thinking back to yesterday, I asked my wife to get us a salad for dinner and then my kids staeted on and said they didn't want any more of the 'rabbit food', and I suppose I gave in and said we'd eat something different.
Helper: You looked quite frustrated when you were telling me about that.
Mr.B: Well, it can get very annoying as it's often the kids or my wife that seems to decide what I eat. But they haven't got my problems. They don't seem to understand why I want to eat the things I do. They never compromise!
Note that in this brief example, the helper has begun to identify the factor contributing to Mr.B’s problems through the use of only one direct prompt, with the other interjections involving reflective feedback.
PR
