Counseling: What Is It, Exactly?

Written and verified by the psychologist Judith Francisco.

Last update: 21 December, 2022

In difficult situations, like when a child is sick or a family member passes away, counseling can help. Like Viktor Frankl once said, attitude is a personal choice. Therapists help their patients with their attitudes when times are tough.

Viktor Frankl was an Austrian psychiatrist of Jewish origin who survived three years in concentration camps, including Auschwitz and Dachau. After that experience, he wrote books and often concluded that in spite of everything, there is always a reason to live. One thing psychologists do is ask the right questions to find out what their patient believes are his reasons for living and help him find the light at the end of the tunnel.

Counseling: a relational tool

Psychological counseling consists of making the patient think through questions so that he can make the best decision for him and, ultimately, his health. The goal of counseling is to maximize the patient’s level of competence at the lowest possible emotional cost. To do this, the therapist will start from three basic attitudes: warmth, presence, and compassion. In addition, the fundamental skills are:

• Emotional management: Emotions are natural. Recognizing and accepting them are the first steps. In counseling, the therapist will teach the patient to manage his emotions.
• Effective communication: The therapist should not be authoritarian or paternalistic with the patient. It is not about giving orders or overprotecting him. It is about giving him autonomy and tools so he can make decisions and solve problems on his own.
• Containment and emotional support: Emotions surrounding suffering are strong and varied. They should not be stopped, but rather legitimized and accompanied.
• Problem-solving: A decision-making process that the patient and therapist do together.

Counseling: effective communication in four steps

For effective communication between the counselor and the patient:

• Stop and connect with yourself. It is important that the counselor focus on the present by connecting with their breathing. This will give them time to respond to the patient well.
• Validate. Validation means listening to the patient’s emotions and empathizing. It means legitimizing the patient’s perspective and making him see that his behavior has valid cause. When he feels accepted and validated, communication channels open. The counselor may not agree with the patient’s opinions or behaviors, but they can understand and validate them.  They should resist the reflex to correct and tell the patient what to do, instead understanding the patient’s needs and concerns, listening to them, and helping them take action.
• Ask. This step is the foundation of counseling. The idea is for the professional to ask open, strategic questions that help the patient reflect and make good decisions. Some open questions that can facilitate communication are: What do you know about your illness? What do you want to know about it? How do you feel? How can I help?
• Discuss. Dialogue is the means to inform and share perspectives with the patient. It is quite useful to use constructive criticism and suggest changes. The counselor may start by describing the problem and expressing the feelings produced by the problematic behavior. Then, they may offer alternatives and suggest one.

The problem-solving model

Finally, to help make decisions with the patient, the following model of problem solving can help. The model is broken down into the following steps:

• Orientation towards the problem. This has to do with the attitude the patient takes when confronted with the problem. This attitude could be avoidance, impulsiveness, pro-activity, etc. Once the patient’s attitude is identified, the therapist encourages a positive attitude, changing the problem into a challenge and encouraging personal growth.
• Define the problem precisely by exploring perspectives of both the patient and the counselor.
• Search for alternatives. Brainstorming is one method.
• Balance pros and cons of each option generated during brainstorming.
• Choose the option that is most appropriate.
• Act. Carry out a plan, step by step. The stages must be easy and feasible so that the patient doesn’t give up.
• Re-evaluation. Once the chosen plan has been carried out, the therapist and patient then go over how it went. If the problem improved due to a certain behavior, it will be reinforced. If it didn’t, the next step is to think about why and what to do about it.

In short, the tools above are designed to encourage the patient to make his own decisions and feel responsible for his own life. Only then is it likely that change will occur and last. If the patient is not consulted about what they feel and think, and the professional takes the reins on everything, then any solution will not be sustainable.