Using_a_Small-Steps_Approach_to_Counselling

Advanced Certificate in Christian Counselling Assignment 8 Judy Watson Criterion E3.3 Using a small-steps approach as a tool to change a counsellee’s behaviour has many advantages: it is relatively easy to understand, gives the counsellee control, is effective in dealing with problems and builds on success, amongst others. Kath*, the mother of two school-aged children, Isabel and Jodie, had been referred to me by her GP at the start of the Easter holidays, because she was feeling ‘low’ and he felt she might benefit from having a health visitor to talk to. As we got to know each other better, Kath revealed that she suffered from agoraphobia and had not been able to walk to the shops or the children’s school for almost a year, but she longed to go out and be a ‘normal’ mum. Isabel was due to leave Primary School the following year, and Kath said she was desperate to go and see her in her last Christmas play there, and to see her younger daughter, Jodie, taking part too. She was afraid that if her husband Ken was away she would not be able to get there –she had tried walking to school with her next-door neighbour Louise a few months previously, but had a panic attack as she stepped outside her front door, and had to go back inside. I thought that a small steps approach might be the most effective way to help Kath, and explained it to her. Kath understood that this was a way to help her make a start on overcoming her problem, and said she was willing to try it, provided she had support. We talked about who she could ask to provide the support she needed, and she decided that Ken, Louise, and I would each have a part to play. The strength of the small-steps approach was that it not only gave Kath control, but also encouraged her to involve co-workers such as family and/or friends in the process, increasing the possibility of success. Another strength of the step-by-step approach is that the counsellee ‘owns’ the process. Kath identified her long term goal, which was to be able to walk to the school with Louise to see the children’s Christmas play. I asked her to think what her first step, or small goal towards achieving it might be. She talked about a number of possibilities, such as going next door to have coffee with Louise, or chatting to her outside her house, leaving the front door open. However, when I asked her what she thought she could really manage without feeling ‘panicky’, she said they all seemed too difficult for her to try at present. We talked about what she did when she was inside and the girls were out in the garden, and she said she often watched them, but with the window closed. She decided her first small step would be to stand for five minutes at the open window to watch the girls playing outside, and we agreed that she would do this in two days time. A great strength of the small step approach is that the counsellee takes responsibility for doing something to address a problem rather than feeling helpless or overwhelmed by it. Kath had evaluated her own ideas, dismissed them as too difficult, and settled on an initial small step that was easily accomplished, but which was enough to encourage her to make a start on dealing with her presenting problem. Another strength is that the goal is both specific and measurable, so we agreed that I would telephone Kath on the second day to find out whether she had achieved it. She reported that she had watched the girls from the open window each day and for twice as long on the second day as on the first, so she had accomplished two small steps right at the start of the process, as I pointed out to her, praising her for her commitment and progress. Kath’s self-confidence was boosted by her success, which is another great strength of the small steps approach. Other strengths of the small steps approach are that counsellees are responsible for achieving their small, practical and measurable goals, and they can easily explain their goal to other people so that they know exactly how to support them. Kath and I agreed that I would visit her again at home the following week to discuss her next goal, but in the meantime she agreed to tell Ken and Louise what she was aiming to achieve, and also keep a record of what her small steps were and when she achieved them, so that she could see how much she had accomplished over time, and could share her progress with Ken, Louise and me. Reviewing her progress and sharing it with others gave a further boost to Kath’s confidence Kath and I worked together for over six months, and she did achieve her long-term goal to walk with Louise to the school to see her daughters in the Christmas play. However, the small steps approach has some weaknesses: it is time-consuming and requires a high level of commitment and patience from counsellee and counsellor; there is a risk of setbacks and consequent discouragement if a small step is not realistic; it is task-oriented and does not explore any links between the counsellee’s past experiences and the current problem experienced. Kath experienced a setback after a few months of excellent progress, when she felt ready to take a much bigger step. She set herself the goal of walking alone to the Post box just a few yards up the road, but felt ‘panicky’ after she had walked about half way there, and had to return home, which undermined her confidence considerably. We agreed that although she had made excellent progress and had felt so confident that she had wanted to set a new goal, under the circumstances it might be better for her to go back a couple of stages until her confidence returned. She went back to standing outside chatting to Louise for a few minutes each day for a few days, then progressed to walking to the Post Box with her. Another weakness of the approach is that it is time-consuming for both counsellee and counsellor. Kath had to accomplish all the usual activities associated with being a housewife, wife and mother as well as coping with a fairly long-term time-consuming process that relied very much on her patience, cooperation and motivation to continue with it, while I had a busy case-load to manage, as well as being highly active in supporting Kath through home visits and telephone contacts. Because we had focused on achieving her goal, Kath and I had never explored when or why she had become agoraphobic. I think this was another weakness of the step-by-step approach because it did not explore the underlying reasons for Kath’s fears and feelings, leaving her without real insight into them and so potentially at risk of having to face other problems in the future. Also, although counsellee autonomy and ownership is a great strength of this approach, it can also be a weakness if the counsellor has not communicated the risks of over-confidence well enough to the counsellee. The success of the small steps approach for Kath relied to some extent on my ability to support her in setting realistic and achievable goals for herself, and I learned a valuable lesson for my future work with clients on the one occasion when I was not able to do so. * All names have been changed to protect client confidentiality Judy Watson 8/2/11