Dr Manju Antil (Counselling Psychologist and Psychotherapist)

I. Historical Evolution of Counselling Techniques

Counselling, as a structured professional activity, has undergone significant evolution over the last century. The early 20th century marked the birth of clinical psychology and the professionalization of guidance and counselling. Frank Parsons (1909), often called the “father of guidance,” pioneered vocational counselling, emphasizing understanding the individual, the world of work, and the logical connection between the two. Sigmund Freud (1923), meanwhile, introduced psychoanalytic interviewing as a method of uncovering unconscious conflicts through free association. Carl Rogers (1951) revolutionized counselling with his client-centered approach, highlighting the importance of empathy, congruence, and unconditional positive regard.

Modern counselling integrates insights from diverse approaches: psychodynamic, cognitive-behavioral, existential, narrative, systemic, and trauma-informed perspectives. Techniques in contemporary counselling are no longer limited to diagnosis and advice-giving; rather, they are embedded in a holistic framework of understanding the client’s narrative, co-constructing meanings, and promoting psychological growth and self-efficacy (Corey, 2016).

II. Interviewing: The Foundation of Therapeutic Engagement

1. Establishing Rapport

The initial phase of counselling is centered around building rapport—a climate of psychological safety, warmth, and mutual respect. Without rapport, even the most skilled interventions may fail. According to Carl Rogers (1957), the presence of genuineness, unconditional positive regard, and accurate empathic understanding forms the basis for a healing therapeutic relationship.

Case Example: In counselling an adolescent girl experiencing body image issues, the counsellor’s non-judgmental and validating stance in the first session allowed the client to disclose experiences of cyberbullying, which she had not shared with anyone before.

Rapport formation involves:

• Active listening
• Open body language
• Minimal encouragers ("I see", "Go on")
• Reflecting feelings and summarizing content
• Establishing boundaries and confidentiality

A culturally competent counsellor is also sensitive to non-verbal cues, power dynamics, and language barriers, especially in Indian settings where hierarchical relationships and stigma around mental health are prevalent.

2. Structured and Semi-Structured Interviewing

Interviewing is both an art and a science. The counsellor must strike a balance between allowing spontaneous expression and gathering specific information.

Types of Interviews:

• Unstructured Interviews (used in psychodynamic therapy)
• Semi-structured Interviews (most common in counselling)
• Structured Clinical Interviews (used for diagnosis, e.g., SCID, MINI)

A semi-structured format may include questions about:

• Presenting problems
• Psychological and physical health history
• Developmental milestones
• Family background
• Socio-economic status
• Educational and occupational history
• Substance use and risk behaviors

Empathic exploration should guide the questions, allowing the client to feel in control of the narrative.

III. Case History Taking: Reconstructing the Psychosocial Landscape

Case history taking is a vital technique that allows the counsellor to reconstruct the client’s developmental, social, psychological, and medical history, offering insights into both protective and risk factors.

Essential Components of Case History:

1. Demographic Information: Age, gender, occupation, marital status, cultural background.
2. Presenting Problem and History: Duration, triggers, and perceived cause of the problem.
3. Family History: Genogram, family structure, significant life events.
4. Developmental History: Birth complications, early attachment patterns, schooling, peer relationships.
5. Medical and Psychiatric History: Past diagnoses, hospitalizations, medications.
6. Academic and Occupational History: Strengths, setbacks, aspirations.
7. Social and Interpersonal Context: Friendships, romantic relationships, support systems.
8. Substance Use: Tobacco, alcohol, recreational drugs.
9. Legal and Financial Issues: If relevant to stress levels and support.
10. Coping Patterns and Strengths: Spirituality, hobbies, resilience factors.

Clinical Note: A 45-year-old male seeking counselling for depression initially appeared to have a workplace burnout. However, detailed case history revealed a long-standing pattern of emotional neglect in childhood, poor father-son relationships, and perfectionism, indicating the underlying developmental origins of his depressive schema.

IV. Gathering Psychological Information: A Multidimensional Inquiry

Once rapport is established and the case history is obtained, the counsellor engages in gathering psychological data from both verbal and non-verbal channels. This phase is not a mechanical checklist but a dynamic process guided by clinical judgment and theoretical orientation.

Domains of Psychological Functioning Explored:

• Cognitive Functioning: Thought content, attention, memory, beliefs, delusions.
• Emotional Functioning: Mood, affect, range and appropriateness of emotions.
• Behavioral Observations: Eye contact, psychomotor activity, speech rate.
• Interpersonal Patterns: Relational styles, boundary management, empathy.
• Personality Traits: Introversion/extraversion, impulsivity, neuroticism.
• Defense Mechanisms: Denial, projection, intellectualization.
• Coping Skills: Problem-focused vs emotion-focused coping.

Standardized Tools (if needed):

• Beck Depression Inventory (BDI)
• State-Trait Anxiety Inventory (STAI)
• MMPI-2
• Rorschach Inkblot Test (for psychodynamic assessment)
• Clinical Interview Schedule (CIS)

This phase must also include a cultural formulation, especially in a multicultural country like India where explanatory models of illness may vary significantly.

V. Analysis of Information: Clinical Formulation

Clinical formulation is the cornerstone of counselling. It is the counsellor’s theory of the case—a narrative that explains the client’s distress in psychological terms, rooted in past experiences and current functioning.

Types of Formulation Approaches:

• Psychodynamic: Early attachment, unconscious conflicts, defenses (McWilliams, 1999).
• Cognitive Behavioral (CBT): Interaction of thoughts, feelings, and behaviors (Beck, 1976).
• Narrative: Meaning-making through stories and metaphors.
• Trauma-Informed: Impact of trauma on self-concept, regulation, and safety (Herman, 1992).

5Ps of Case Formulation (Macneil et al., 2012):

• Presenting Problem
• Predisposing Factors
• Precipitating Factors
• Perpetuating Factors
• Protective Factors

Case Example: A 21-year-old female with panic attacks was initially thought to be suffering from agoraphobia. Upon formulation, it was discovered that her fear stemmed from a history of sexual assault in adolescence and invalidation by caregivers. This changed the therapeutic approach from exposure therapy to trauma-informed safety work.

VI. Tentative Diagnosis: A Hypothetical Construct

A tentative diagnosis is a provisional classification of the client's condition based on DSM-5-TR (APA, 2022) or ICD-11 (WHO, 2022). It is always subject to change as the counsellor gathers more data and observes progress.

Steps in Arriving at a Tentative Diagnosis:

1. Match symptoms with diagnostic criteria.
2. Rule out medical causes and substance-induced disorders.
3. Consider differential diagnoses.
4. Assess the severity, duration, and impairment.
5. Integrate cultural and developmental factors.

Ethical Considerations:

• Avoid labeling that may harm the client’s self-concept.
• Ensure the client understands the diagnosis.
• Use diagnosis as a tool for intervention, not stigmatization.

Illustration: A college student complaining of laziness and poor concentration was diagnosed with ADHD. However, after thorough interviews and observation, the final tentative diagnosis was Persistent Depressive Disorder with features of an avoidant personality style.

VII. Conclusion: The Art and Science of Counselling Assessment

In counselling, each phase—interviewing, case history taking, psychological information gathering, analysis, and tentative diagnosis—is not an isolated technique but part of an integrated clinical process. The goal is not merely to categorize, but to understand, empower, and facilitate change. A skilled counsellor navigates this terrain with both scientific acumen and human sensitivity, ensuring that each client feels seen, heard, and respected.

The richness of these techniques lies not only in their theoretical precision but in their adaptability to diverse human experiences. They form the diagnostic canvas upon which therapeutic journeys are painted—one brushstroke at a time, with empathy, ethics, and evidence.

Select References

• American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR).
• Beck, A. T. (1976). Cognitive Therapy and the Emotional Disorders. Penguin.
• Corey, G. (2016). Theory and Practice of Counseling and Psychotherapy. Cengage Learning.
• Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136.
• Herman, J. L. (1992). Trauma and Recovery. Basic Books.
• Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). Is diagnosis enough to guide interventions in mental health? BMC Medicine, 10(1), 111.
• McWilliams, N. (1999). Psychoanalytic Case Formulation. Guilford Press.
• World Health Organization. (2022). International Classification of Diseases, 11th Revision (ICD-11).