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  • Tom Dunsdon

presenting issue

Hi guys and welcome to my latest blog post, again let me apologise for this being published slightly later than normal, in truth I had intended to set this post up to be published automatically as I was away and only returned home in the early hours of today but due to my lack of technical knowledge (which will surprise no one who works with me), I didn’t quite manage to achieve that!

Today we will be looking at how to identify a client’s presenting issue or issues and this will be based on working from a person centred approach which is my core training.

Without further ado, on with the post…….


It is very important to identify a client’s presenting issue(s) as quickly as possible; this should be the main aim of the initial consultation between therapist and client. Although this may be the main aim of the initial consultation, in practice this may not be the case and could indeed take many weeks for this to be uncovered. To do this, it is important for the therapist to identify and understand the clients “here and now”, this is to say the client will present themselves with a problem they believe themselves to have at this moment.

To understand the clients “present” or” here and now” there are several key aspects we must seek to understand:


1. Why has the client chosen to seek therapy now, is their reasons internal or external?

It is possible the client has had a problem for some time, so why have they chosen to seek help now? Was it of their own accord or have they been referred by an employer or a friend? Is there a long-standing problem and issue which has just arisen, or do they just feel the need to explore themselves? I’m sure this last point is one that resonates fully with many therapists as the road to becoming a therapist is one of self-discovery and exploration.


2. Their current consciousness or awareness of any present concerns.

This is to say how is the client presenting their issue, is it a large problem consisting of many different aspects, e.g. “my life is just falling to pieces and I’m not very happy in many walks of my life”, or is it a more specific issue such as “I wish to be more calm and confident when speaking to someone I find attractive’? It is important to say here that if the therapist believes they have identified a problem they do not feel equipped or qualified to deal with, they should seek help from their supervisor and make sure the client is referred on to more suitable therapy/treatment.


3. Their overall sense of self.

How does the client present themselves? Are they confident or shy, calm or anxious and what does their body language and presentation say about them?


4. Their beliefs and values including their beliefs about therapy and what they understand about the process.

Here the therapist will need to gain information about the clients overall belief system, what they believe to be true about life and how is this effecting their current reality. On a personal note here, last year I had a case study where a very simple belief by my client turned out to be the catalyst for many problems they had experienced throughout their life. That simple belief was that “everyone should be nice to them”. I believe this to be a very good example of the idea laid out above.


5. What they expect or feel the goal, or any solution of therapeutic help will be.

Here the therapist will need to find out and manage the client’s expectations of therapy. Some clients may believe they understand the therapeutic process and some may come with no idea at all. It is imperative that the therapist discoveries and manages these ideas and expectations which can be done in the initial consultation with discussion and the setting of professional boundaries.

So now we have looked at some of the main principles involved when assessing a client’s presenting issue, I will briefly discuss how I work with this but remember this is just my opinion and many therapists may work differently.

When working with a client to further investigate their presenting issue, I am big advocate of using my active listening skills coupled with open questions. It is important here to get the balance right; you do not want the client to feel as if you are interrogating them. It is important to make them feel relaxed and calm and to let them know that this is a safe place and allow them time to get to where they want to be. I like to think that as a counsellor it is our role to help them along the path and sometimes point the possible routes but it is the client’s role and choice to walk it. Once you believe you have an understanding of what the client has said, it is important to paraphrase and be sure you have understood the client. This should help build a good therapeutic relationship with a good rapport.


So does the person entered approach have strengths and weaknesses?

The simple answer to this is yes of course it does, as does any other approach. I below I have tried to discuss this a little further.

The main strength to PCT is that it is client lead therapy, this is to say that as a PCT therapist we create an environment that allows the client to feel safe and secure and to explore the issues they are having in an environment where they will not be judged or criticised for the beliefs or issues they are facing. With this approach it allows the client to take control of their own destiny and this can give them a sense of being empowered and help build confidence to resolve the issues they are having. For PCT to be fully affective and to be at its most beneficial it is imperative that there is a strong rapport between therapist and client, this must be one of mutual respect focused solely on the client and with all appropriate professional boundary’s intake.

PCT does have some weaknesses, the weaknesses of the model will depend on the client and whether the goals that the client wants to reach are SMART, that is:

S-specific

M-measurable

A-attainable

R-realistic

T-timely

It is here where the therapists and client’s rapport & communication is so important. To develop goals that are smart both parties must be on the same wavelength in terms of strategies and ideas. Goals should reflect that changes are actually working. PCT, as the name suggests is centred on the client, if the client is unable to make or understand these SMART goals then there is very little chance that there will be any deal of success with the therapy. Also clients who would like a counsellor to offer them extensive advice, to diagnose their problems, or to analyse their psyches will probably find the PCT approach less helpful as this is not in line with the core values of PCT.

The purpose of PCT is to allow the client to become fully aware of their feelings surrounding one or several issues. When practicing PCT, it is important to create a warm and safe environment where the client will not be judged. It is the role of the therapist to engage their active listening skills such as pay attention, reflection, clarifying and summarising. It is also important for the therapist to keep open body langue towards the client and maintain a degree of mirroring without the client becoming aware of this. To finish this post I would like to say that as long as a therapist works with all their professional and ethical boundary’s in place and anything they do is with the client’s best interest at heart, then any approach can and will be beneficial to some degree.

Well guys that about wraps things up for today, all that’s left for me to do is wish you all a very Merry Christmas and Happy New Year, as always any questions, comments or if you simply would like to suggest a topic for future posts please get in contact. My next post should be out on Friday the 27th assuming I’ve not overdone the festivities to much!

Many thanks, enjoy the holidays,

Tom.

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