Dr Manju Antil (Counselling Psychologist and Psychotherapist)

Counselling, in both individual and dyadic contexts, is a dynamic, person-centered, and goal-oriented process grounded in psychological theory, research evidence, and ethical practice. While the fundamental structure of counselling remains consistent across modalities, the nuances of the process evolve based on the setting (individual vs. dyad), client characteristics, cultural context, and theoretical orientation.

This article revisits the classical phases of counselling—intake, rapport building, assessment, goal setting, intervention, evaluation, and termination—with a focus on the skills and advanced techniques employed at each phase in both individual and dyadic settings (e.g., couples counselling, family dyads, therapist-client dyads).

1. Phase One: Initiation and Contracting

Historical/Theoretical Context:
This phase finds its early roots in the psychoanalytic tradition of Freud (1900s), where the "analytic frame" was critical. Carl Rogers (1951) later emphasized the importance of setting a non-judgmental climate, forming the foundation of Person-Centered Therapy (PCT).

Skills & Techniques (Individual and Dyadic):

• Informed Consent & Contracting: Clarifying expectations, explaining confidentiality, structure, and goals of counselling.

• Process Orientation: In dyadic counselling (e.g., couples therapy), orientation includes clarifying dual roles, addressing triangulation, and discussing neutrality.

• Use of Intake Forms and Psychosocial History: Structured tools to gather background, assess risk, and initiate the therapeutic alliance.

• Therapeutic Framing: Establishing the boundaries (temporal, spatial, emotional) that define the counselling relationship.

Key Considerations: Cultural responsiveness, sensitivity to power differentials, and early identification of transference or resistance.

2. Phase Two: Establishing the Therapeutic Relationship

Core Theory:
Carl Rogers’ triad of empathy, unconditional positive regard, and congruence forms the bedrock of the relationship (Rogers, 1957). Bordin (1979) conceptualized the working alliance in three dimensions—goals, tasks, and bond.

Advanced Counselling Skills:

• Dyadic Attunement: In couples or parent-child counselling, attention is paid to the emotional synchrony between the parties. Techniques include mirroring and emotion coaching (Gottman, 1999).

• Socratic Dialogue and Existential Presence: Especially useful in individual counselling, encouraging reflection and agency.

• Cultural Countertransference Awareness: Being attuned to one’s biases when forming therapeutic alliances, especially in intercultural dyads.

Goal: Develop a secure attachment bond with the client(s), facilitating openness and vulnerability essential for deeper therapeutic work.

3. Phase Three: Assessment, Diagnosis, and Formulation

Theoretical Evolution:
The assessment phase was formalized with the emergence of clinical psychology post-WWI. Modern approaches combine both idiographic (individual case formulation) and nomothetic (structured assessment tools) frameworks (Kazdin, 2003).

Techniques & Tools:

• Clinical Interviewing (MSE, CASE Approach): Mental status exams (MSE) and Chronological Assessment of Suicide Events (CASE) interviews.

• Psychometric Testing: Use of tools like MMPI-2, Beck Depression Inventory (BDI-II), and IPIP-NEO for personality profiling.

• Cultural Formulation Interview (CFI): Per DSM-5 guidelines, particularly essential in multicultural or multilingual dyads.

• Narrative and Life Charting: Techniques that allow co-construction of the client's story—useful in both individual therapy and dyadic relationship mapping.

In Dyadic Settings: Genograms, interaction pattern mapping, and emotional reactivity analysis are used to understand relational schemas.

4. Phase Four: Goal Setting and Change Planning

Framework:
Drawing from Locke and Latham’s Goal-Setting Theory (1990), this phase translates insight into intention. Prochaska and DiClemente’s Stages of Change Model (1982) is widely used here.

Advanced Practice:

• SMART and HEART Goals: In dyads, HEART (Honest, Empathetic, Achievable, Relevant, Time-sensitive) goals foster mutual understanding and accountability.

• Collaborative Formulation (CF): A CBT practice where client and counsellor co-develop a visual map of thoughts, behaviors, and emotions.

• Relational Contracting: In dyads, agreements on communication, conflict management, and emotional boundaries are made explicit.

Skill Focus: Motivational interviewing, therapeutic negotiation, and strengths-based planning.

5. Phase Five: Intervention and Psychotherapeutic Techniques

Theory-Based Modalities:
This is where the choice of theoretical orientation becomes pivotal—CBT (Beck), REBT (Ellis), DBT (Linehan), ACT (Hayes), EFT (Greenberg & Johnson for dyads), or psychodynamic approaches.

Techniques (Selected for Individual and Dyadic):

• CBT: Thought records, behavioral activation, exposure tasks.

• Psychodynamic Tools: Free association, transference analysis, dream work.

• Emotionally Focused Therapy (EFT): Widely used in dyadic settings for emotional bonding and attachment repair.

• Somatic and Mindfulness Approaches: Body scan, grounding, trauma-informed care.

• Systemic Interventions: In dyads, circular questioning, reframing, and role-reversal (as in Satir’s Conjoint Family Therapy).

Homework and Between-Session Tasks: Essential for skill consolidation, particularly in CBT and ACT.

6. Phase Six: Evaluation and Review

Historical Lens:
Early counselling often neglected evaluation. Modern evidence-based practice mandates continuous outcome monitoring (APA, 2006).

Strategies:

• Session Rating Scales (SRS) and Outcome Rating Scales (ORS): Client-generated metrics.

• Re-administration of Tests: Comparison with baseline scores to evaluate change.

• Feedback-Informed Treatment (FIT): Allows mid-course correction of techniques and relational ruptures.

• In Dyads: Conflict check-ins, intimacy progress scales, emotional expression audits.

Skill Use: Reaffirming client agency, celebrating success, and addressing any therapeutic ruptures.

7. Phase Seven: Termination and Follow-Up

Theory:
Freud (1917) emphasized the role of endings in psychoanalysis. Mahler’s separation-individuation theory also offers insight into the psychological tasks of closure.

Termination Techniques:

• Therapeutic Rituals: Letter writing, summarizing sessions, memory books in long-term therapy.

• Relapse Prevention Planning: Especially in addiction, trauma, and couple therapy settings.

• Future Planning: Providing maintenance strategies, booster sessions, or referral networks.

Special Focus in Dyads: Exploring the relationship's future trajectory, setting ground rules for post-therapy interaction, and evaluating relational healing.

Summary Table of Phases and Techniques

Case Illustration

Case Study: Individual vs. Dyadic Counselling

• Individual Case (Anxiety Disorder):
  R., a 27-year-old woman, presented with panic attacks and workplace stress. Rapport was built using empathy and congruence. CBT-based formulation revealed catastrophic thinking and avoidance behavior. Thought records and exposure hierarchies were introduced. After 14 sessions, she reported decreased panic frequency and improved assertiveness.

• Dyadic Case (Marital Distress):
  S. and A., a couple married for 6 years, sought therapy for conflict over parenting. EFT was used to enhance emotional attunement. Genograms revealed intergenerational trauma in A.’s family. Conflict resolution strategies and emotional labeling tasks were introduced. By session 10, improved communication and intimacy were noted. Termination included a joint letter of gratitude and follow-up scheduling.

Conclusion

The counselling process is an evolving therapeutic journey deeply embedded in theoretical, ethical, and humanistic foundations. For both individual and dyadic contexts, each phase—from initiation to termination—demands a refined orchestration of theory-informed skills, relational presence, and cultural competence. Advanced practitioners not only tailor interventions to unique client needs but also integrate ongoing evaluation, flexibility, and self-reflective practice. As the field advances, the synthesis of neuroscience, cultural psychology, and digital tools further enriches the landscape of counselling, promising more inclusive, evidence-based, and impactful therapeutic experiences.