Psychology

Counseling may be defined as therapy through talk and expression of feelings and thoughts. Rogers (2007, p. 85) defines counseling as a relationship between two people in a democratic atmosphere of understanding and respect, and that most counseling sessions fail because of the failure to establish such a relationship. A counselor listens to a clients needs, responds appropriately and mediates to achieve the outcomes that the client desires. Counseling skills are more of an art than a science and should be combined with genuine concern and empathy for the patients and their families. Skills such as listening and reflecting cannot be taught and can only be acquired through experience and a genuine desire to help another person. It is different from plain communication because counseling requires some form of action afterwards in the hopes of positive change. (Nelson-Jones 2005, p. 19) As such, counselors must always be vigilant against imposing their own personal value systems and be reflective in their practice, constantly monitoring for personal reactions and thoughts that might mar the therapy (Rennie 1998, p. 5).

Among the most basic of counseling skills include the ability to make effective and positive communication with the client and for the client to be, regardless of the context with which the counseling is being sought (Sanders 1996, p. 4). Anybody can use counseling skills to help another person, but counseling is formal, with specific goals and outcomes. It is also bound within certain contract of ethical practices of confidentiality and professionalism. (Bond 2000, p. 33)

Integrative Counseling
The integrative theory of counseling, as the name implies, involves the fusion of several school of thoughts about counseling. It collates the best practices among diverse ideas in order to provide the best experience for the client as well as the counselor. Counseling as a general concept, may be defined as therapy through talk and expression of feelings and thoughts. Rogers (2007, p. 85) defines counseling as a relationship between two people in a democratic atmosphere of understanding and respect. A counselor listens to a clients needs, responds appropriately and mediates to achieve the outcomes that the client desires. Counseling skills are more of an art than a science and should be combined with genuine concern and empathy for the patients and their families. Skills such as listening and reflecting cannot be taught and can only be acquired through experience and a genuine desire to help another person.  It is different from plain communication because counseling requires some form of action afterwards in the hopes of positive change. (Nelson-Jones 2005, p. 19) As such, counselors must always be vigilant against imposing their own personal value systems and be reflective in their practice, constantly monitoring for personal reactions and thoughts that might mar the therapy (Rennie 1998, p. 5).

Because patients are unique in terms of their illness and personal circumstances, counselors should be able to use a variety of techniques depending on the situation of the patient, and this is the essence of integrative counseling. The cornerstone of any counseling is based on the presumption that mental and emotional illnesses are related to how people perceive and respond to life events and situations, and as such, are largely functions of the persons coping mechanisms (Clark 2007, p. 108). Counselors should be able to apply knowledge of psychotherapy to reduce the emotional and psychological distress of the patient as well as the distress of their loved ones. These techniques are part of a long-term management and intervention program because their benefits take months to manifest and require constant and consistent provision of support from the counselors.

Theories of Counseling
What is confusing about counseling theories is that is so easy to create one, while anchored on another. The basic ones include psychoanalysis introduced by Freud. Initially, Freud maintained that behaviors are motivated by repressed sexual desires. Later, this psychoanalysis was reconstituted to mean that man behaves out of certain emotional, social, or physical need. The behaviorist theory led by Watson and Skinner believes that man reacts to a system of rewards and punishments, that their behaviors are responses to the perception of consequences. The third is the humanistic theory where the counselor is perceived to act as a catalyst in order to bring the client to a sense of clarity and self-empowerment. The rest of the theories are just variations on these three basic theories of counseling. (Gregoire  Jungers, 2007, p. 61)

All three have their own merits and are responsive to the times when they were created. None is better than the other. I do not believe that counselors should rigidly subscribe to one idea alone. Counseling deals with human beings, who are inherently mutable and cannot be boxed into certain theories. Each client is his or her theory and story because each life is unique in its circumstances. To impose one type of theory is to deny the inherent uniqueness of individuals.

Gestalt The Whole Person
Gestalt counseling and therapy follows a humanistic approach to psychotherapy. That is, dealing with problems that make up human life, e.g. love, fear, pride, self actualization, belonging, individuality, and creativity among others. A cornerstone of this form of counseling is that it encourages the free-flowing awareness (Joyce and Sills, 2001) of ones thoughts and emotions. When the clients are able to acknowledge and deal with their personal issues, the individual comes to a better understanding of himself and others as well. (Joyce and Sills, 2001) It is also person-centered meaning that it lends itself more to personal relationships in the client-therapist interaction and the main goal is to push the client to a state of realization of ones self. The Gestalt therapy is more realistic and rational as compared to other therapies that focus on past events that may not have any relevance to the clients current situation. (Clarkson, 2001)

In Gestalt therapy, the therapist affirms orgasmic trust between herhim and the client as well as nurtures or encourages the client to be confident and have a faith in their own thoughts. The hallmark of Gestalt therapy lies in the ability of a client to articulate feelings and own his freedom and limitations so as to live a fulfilling life and contribute to the lives of the others. (Clarkson, 2001) Genuineness is essential in the Gestalt counseling or therapy session. This means that the therapist should not exhibit a facade or a professional front.  It is all about being you in this therapy and indeed, this increases the odds of the client experiencing constructive growth and behavioral change. The therapist-client relationship is transparent letting each other in on the flowing emotions in the here and now moment and even when a client may feel uncomfortable to let out some feelings or attitudes, this should not happen on the part of the therapist. (Clarkson, 2001)

Another core concept in the Gestalt relationship between client and clinician is that of unconditional positive regards to the client. Notably, human beings tend to relate better with some individuals than others.  It may therefore be difficult to show acceptance and positive regards to some clients especially when the feelings they express are contrary to the therapist morals and values. Nonetheless, Gestalt therapy points out that therapeutic healing is more likely to occur when the client has positive regards for the client, irrespective of the current feelings or emotions being expressed i.e. anger, hate, fear, pride, disgust, confusion and so on. That is, the therapist should prize the clients in a total rather than a conditional way (Rogers, 1980, p 115 -116).

Empathy is perhaps the most important and facilitative aspects of the gestalt psychotherapy (Rogers, 1980). That is, herhis ability to sense the feelings and meaning to feelings expressed by the client and communicate them back in an understanding way. (Adams, 1986) The therapist must explore the clients world and classify underlying meanings that the clients may be oblivious of. In this client- therapist relationship it is all about listening, active listening and understating for that matter. (Joyce and Sills, 2001)  The session is characterized by non-judgmental, sensitive communication. In cases where these feelings are not understood then seeking clarification using a paraphrase of the client word expresses understanding and leads to self awareness, for example, I hear your say that you are unable to understand why you are always furious with your wifehusband, why do you think that is the case (Adams, 1986)

The Therapeutic Relationship
How then a therapist should perceive a client Frankfurt (1971, p. 6) defines a person as a creature with the capacity to fulfill needs and desires in ways that indicate free will and reasoning. The person is able to identify these needs and desires and acts in deliberation and free will in order to achieve such desires. The person, acting in such capacity, is fully aware of the motivations that lead him or her to such actions. A person is a unique creature and stands apart from other animals because humans have the ability to deliberate on desires and make the appropriate choices and actions based on their free will. The persons free will and reasoning enables him to make appropriate actions and whether to repress these desires or pursue its fulfillment. Unlike animals that are driven by instinct and basal needs, a person has the ability to exercise his free will and reason and make a choice on what actions to take. Raz (2006, p. 3) elevates the concept of personhood further to emphasize the role of reason in the exercise of free will. Raz maintains that it is reason that determines if an individual is truly using his free will or not. Given a variety of desires and needs, the person, guided by reason, decides on what desires to act on, if at all. The choices are based on the individuals ability to evaluate and prioritize desires and recognize motivations and ascribe to them values of right and wrong. (Watson, 1987, p. 217) All these things, a counselor must keep in mind to best provide the help needed.

The Dignity of Self and the Roles of the Counsellor
As far as counselling is concerned, the main task of the counsellor is to facilitate the self-discovery and to empower the client to make positive choices that would change his or her life for the better. Much of the job of a counsellor is all about uplifting the individuals sense of personhood and help the client claim that sense of personal responsibility and empowerment. Of course this can only be achieved by subscribing to Carl Rogers core conditions of counseling. First, counseling can only be achieved with direct, personal and psychological contact second, that the client is assumed to be in a state of vulnerability or weakness that requires outside intervention or help third, that the therapist is the stable factor in the relationship and thus provides the anchor for the relationship to progress and achieve its goals fourth, the counselor of therapist has sincere benevolent feelings for the client irrespective of their differences in values and beliefs, fifth, that the therapist has a genuine understanding or empathy for where the client is coming from or the clients frame of reference and last, that the positive feelings of the therapist towards the client is made known and clearly felt by the client. (Barrett-Lennard 1998, p 86). All of these core conditions are based on the fundamental ideas of a persons basic liberties and rights and these are implicit to a therapeutic relationship, only brought to formality by Rogers (Thorne 2003, p. 36).

Reflections
Indeed the main task of a counselor is to be able to help the person feel empowered. Rather than making the individual feel helpless, the best counselors give their clients the sense of control and decision over their own lives. As much as possible, the counselor must leave very little footprints in their clients lives because the guidance that they give creates an empowered individual capable of self-determination and self-actualization. The journey towards liberation is not solely the clients responsibility alone. While ultimately the choice to do so is in the client, such a choice cannot be arrived at without the counselors help (Prout  Brown 2007, p. 223).  Indeed the job of a counselor requires extraordinary people skills because it involves the treatment of an emotional malady, which is already complex all by itself. I am cognizant of the many issues that can sometimes get in the way of the proper dispensing of counseling and therapy.

As with any other type of relationship, the success of a counselor-client relationship is dependent upon mutual trust and respect. Of course, the therapeutic relationship between counselor and client is unique because of the dynamic of power that exists between the two. Given the nature of therapeutic situations, patients often feel helpless, emotional, and rarely have time to deliberate their decisions. Control and power is perceived to be in the hands of professionals such as counselors, whose decisions can decide matters of that have profound effects of a persons quality of life. There is always an imbalance of power in a counselor-client relationship (Feltham 1999, p. 9) and it is so easy to fall into a dictatorial relationship. As such, counselors should demonstrate sensitivity, empathy, and they should exhaust all means to make patients feel that they control their decisions, especially decisions regarding their own body and their life. The perception of power is based on the counselors clinical and professional expertise and the ability to help a patient in distress. By virtue of their education and experience, counselors are thus able to provide care and healing services to patients. Counselors themselves do not make claim to that power, it exists naturally when patients seek their help and expertise. 

When there is an imbalance in power, then it is but natural to assume that patients or clients put their trust in the power of counselors and other health care professionals to give them the assistance that they need. Therefore it is very important that counselors live up to this trust and the responsibilities of power. To do so, counselors must have the competencies and skills needed to provide therapeutic services. This is the reason why minimum standards of competencies and education are required before counselors become clinical practitioners. Of course it is not enough that counselors pass standardized exams they must constantly engage in learning as newer, better modalities of practice come to light. An important part of this knowledge is the ability to acknowledge limitations and the willingness to seek help from other professionals in order to provide the client with the best possible care. The power to help necessitates the ability to ask for help as well if it means saving a life or improving the quality of life of patients.

Another important element of trust is the expectation of professional conduct. Counselors are expected to behave within a certain code of conduct as prescribed by their profession. This includes the provision that counselors are expected to at all time maintain appropriate professional boundaries in and therapeutic relationships with clients, and that all activities and discussion are related to the health needs of the patient. This includes the implicit agreement that all exchanges between client and counselor are confidential and that such confidentiality cannot be breached, unless the client becomes a danger to himself or to another person. It is only within these strict provisions can confidentiality between client and counselor be broken. The law generally protects such confidentiality, but will also uphold the need to break it. (Jenkins 1997, p. 128)

Another component of a counselor-client relationship is respect. A big part of respect is the ability to suspend any form of judgment and focus on the clinical task at hand. Whether we agree or not, counselors are also prone to passing judgement, especially since they are not the ones facing the illness. What is important is that these judgements and feelings should not be allowed to affect the counselors clinical decisions. Often counselors are preoccupied with dispensing their duties and addressing the specific mental and emotional needs of the client, that they have the tendency to forget to consider the whole patient.

Indeed a therapeutic relationship is highly focused and purposeful. The centre of all endeavours is the achievement of therapeutic goals. A big part of this relationship is the ability to use positive communication to achieve such ends. For a therapeutic communication be successful, counselors must be able to present themselves in a manner that is professional and credible. A big part of communication in a therapeutic relationship is non-verbal or based on actions. Normal communication is not always possible depending on the situation of the client, and counselors must be able to explore other avenues of communication without diminishing the essence of the message. Patients constantly judge counselors based on their manner and character, and a therapeutic relationship can only be established if the patient feels comfortable with the counselor. To do, counselors must convey a sense of warmth and genuine concern, framed within a professional demeanor (Clark 2007, p. 47).

In light of all these things, it is therefore important that counselors have a solid sense of self before they can present themselves properly to their clients and establish a successful therapeutic relationship. All of the previous elements are based on the counselors intimate knowledge of themselves and see their duties as counselors in the context of the clients experiences. Of course counselors must judgments on clinical knowledge. However, as Carper (1978) argues in her work, there are other forms of knowing apart from clinical or scientific knowledge, and these other forms of learning have equal weight and importance in this profession. It is not enough that counselors are trained in the science of therapy and psychology. Equally important, perhaps even more so when dealing with disturbed individuals, is that counselors have the emotional sensitivity to gain the trust of their patients and make them feel that their counselors only have their best interests at heart.

Conclusion
Counselors must take a holistic or client-centered approach in order to keep their clients highly functional in spite of their emotional and mental impairments. By employing a client-centered approach, counselors are thus able to design a program that is tailor-made to adapt to the individuals unique needs and circumstances and this can only be achieved by nurturing a relationship that encourages open communication, communication wherein clients are willing to bare their innermost fears and emotions (Feltham 1999, p. 24).   Counselors provide for their clients needs by lessening their disabilities and  dependency, while advocating for the dignity of the person as human beings, regardless of age, gender, race, sexuality, social class, education, lifestyle, and religious or political beliefs. In simple terms it means that in a counseling relationship, the expertise of the counselor takes a backseat behind the patients needs. Counselors must serve to facilitate instead of dictate, and thus create a democratic atmosphere where the counselor and client are engaged on equal ground (Barrett-Lennard 1998, p. 53).

Indeed the ability to listen and respond to human distress are attributes that humanity must have in order to survive. Such attributes are especially essential in therapy as well, especially for counselors who are front liners in providing care that makes a direct impact of the lives of people. Of course professional knowledge is a given, but in order for this to be of any help to anyone, counselors must have the sense of self that will help them maneuver through different kinds of situations and navigate a successful and effective therapeutic relationship.