Process and problem identification in psychological counseling

First visit reception and data collection and arrangement

To understand and evaluate the problems of help seekers and lay the foundation for forming a preliminary diagnosis.

Understand the client's problems and ensure that the client understands the following contents: what is psychological counseling, how to conduct psychological counseling, what problems psychological counseling mainly solves, and what problems psychological counseling cannot solve.

Explain the principle of confidentiality in psychological counseling repeatedly, and promise the responsibility of the psychological counselor, and explain that once the psychological counselor leaks, the helper has the right to resort to law.

Second, psychological diagnosis.

? After sorting out and analyzing the clinical data of visitors, counselors must make a general judgment on the severity and classification diagnosis of psychological and behavioral problems of visitors, which is called preliminary impression. Basically determine the weak links in visitors' psychological activities, and then evaluate the severity of visitors' psychological problems and the current general mental health level. The counselor determines whether the problem of the helper meets the scope of psychological counseling and whether the counselor can help the helper solve the problem by himself. If it doesn't belong to the category of psychological counseling, or it doesn't belong to the field of psychological counseling, the psychological counselor suggests that the helper seek psychological counseling from the corresponding institution or consultant.

Health psychological assessment

1. Experience standard: refers to a person's subjective experience and inner world, mainly including whether he is in a good mood and whether his self-evaluation is appropriate.

2. Operating standard: The process and effect of psychological activities are investigated through observation, experiment and measurement, and the core is efficiency. It mainly includes the efficiency of personal psychological activities and personal social efficiency or social function. For example, the efficiency of work and study, the harmony of interpersonal relationships, and so on;

3. Development criteria: pay attention to the longitudinal investigation and analysis of individual psychological development.

Combine the three standards and conduct a comprehensive investigation.

In addition, Guo Nianfeng's 10 standard can be evaluated.

Diagnosis of general psychological problems

1. analyze whether there are organic lesions as the basis for the problem of help seekers.

2. According to the psychological principle of distinguishing between normal and abnormal, analyze the insight and psychotic symptoms of help seekers, which are different from psychotic problems.

3. Analyze the types of inner conflicts of help seekers and distinguish them from neurosis. Normality: Inner contradictions are caused by real life, work pressure, mistakes and other factors. Conflict is normal, so bad emotions (such as boredom, regret, regret, self-blame, etc. ) are experienced.

4. Analyze whether the emotions of the help-seekers are generalized and whether they are different from serious psychological problems. From beginning to end, the stimulating factors of bad mood are limited to the initial event, and even other events related to the initial event will not cause this kind of bad mood.

5. The duration of psychological problems and the influence of psychological, physiological and social functions of people seeking help.

A bad mood lasts for a month without interruption, or a bad mood lasts for two months without self-resolution.

The negative emotional reaction is still under a considerable degree of rational control, which can always maintain normal behavior and basically maintain normal life, study and social interaction, but the efficiency has declined.

6. Form a preliminary diagnosis.

General psychological questioning is a psychological unhealthy state that is stimulated by realistic factors, lasts for a short time, and the emotional response can be controlled rationally, without seriously damaging social function, and the emotional response is not universal.

Because major life events have a strong stimulating effect on help seekers, they have a greater impact on help seekers. We can't simply treat it as a general psychological problem because its emotional problem lasts for a short time. We should be ready for consultation or even referral at any time according to the development of the psychological state of the parties.

Diagnosis of serious psychological problems

1. analyze whether there are organic lesions as the basis for the problem of help seekers.

2. According to the psychological principle of distinguishing between normal and abnormal, analyze the insight and psychotic symptoms of help seekers, which are different from psychotic problems.

3. Analyze the types of inner conflicts of help seekers and distinguish them from neurosis.

The cause of serious psychological problems is the strong realistic stimulus that threatens individuals. Internal conflicts are normal.

For young people, events related to personal development prospects are generally high-intensity stimuli.

4. Analyze whether the mood of the helper is generalized, and if so, analyze the specific performance of generalization.

Generalization: The painful emotion can be triggered not only by the initial stimulus, but also by the stimulus similar and related to the initial stimulus, that is, the reaction object is generalized.

When generalizing emotions, we should pay attention to the difference between generalization and the influence of emotions on people.

Emotion is a kind of emotional persistence, which affects other activities of the subject, such as being criticized and taking it out on others;

To sum up, things that are similar in nature to those that initially cause emotions can also induce the same emotions. Obviously, the key to emotion is persistence, and the key to generalization is induction.

If you are depressed most of the day for more than two weeks, it will be distinguished from the depressive episode of mood disorder.

5. The duration of psychological problems and the influence of psychological, physiological and social functions of people seeking help.

The analysis of painful emotions lasts for more than two months and less than six months intermittently or continuously.

The stronger the stimulus, the stronger the response. In most cases, it will lose rational control for a short time, and the pain will gradually weaken in the subsequent duration, but it is difficult to get rid of it simply by relying on "natural development" or "unprofessional" intervention; It has a certain degree of influence on life, work and social interaction.

6. Form a preliminary diagnosis.

Serious psychological problem is a kind of psychological unhealthy state with strong initial emotion, long duration and comprehensive content under the stimulation of relatively strong realistic factors.

It is not difficult to diagnose serious psychological problems. The key is to distinguish them from neurosis.

The focus of identification is "the nature of inner conflict" and "the course of disease".

Serious psychological conflicts are normal and the duration is limited to half a year.

Diagnosis of neurotic psychological problems

Neurosis is a kind of mental disorder, which is mainly manifested in lasting psychological conflict. Patients feel or experience this conflict and feel deeply painful, which hinders their psychological or social functions, but there is no verifiable organic pathological basis.

Six characteristics:

1) Psychological conflict of consciousness (deformation: relevance of real events, morality).

2) Have mental pain.

3) insist.

4) Neurosis hinders the psychological and social functions of patients.

5) No organic lesions.

6) Have self-knowledge.

The nature of conflict: normal and deformed.

Normality: related to real events, involving events recognized by everyone. It has obvious morality.

Deformation: irrelevant to reality or trivial. There is no obvious moral color.

Deformation is judged as a neurotic psychological problem. Normal form is not judged. For more than three months, and ≥6 points, serious social function degradation, mental pain, mental illness.

Pay attention to the distinction: the concept of emotion and generalization: emotion is a kind of emotional persistence that affects other activities of the subject, such as being criticized and angry at others; To sum up, things with similar attributes can also induce the same emotions at the first time. So the key to emotion is persistence, and the key to generalization is induction.

Psychological disorders related to stress:

1) stress disorder: also known as reactive mental disorder or psychogenic mental disorder, it refers to a group of mental disorders caused by abnormal psychological reactions mainly caused by psychology, society (environment) and factors.

Acute stress disorder: after severe mental shock, it occurs within minutes or hours, with a course of several hours to several days.

The main manifestations are: consciousness disorder, narrow range of consciousness, disorientation, lack of coherence in speech and slow perception of surrounding things; There may be personality disintegration, strong fear, psychomotor excitement or psychomotor inhibition.

2) post-traumatic stress disorder

Also known as delayed psychogenic reaction, it refers to the delayed and persistent mental disorder after the patient suffers from a strong or catastrophic traumatic event.

The incubation period from trauma to onset can range from weeks to months. The course of the disease is fluctuating, most of which can be recovered, a few of which can turn into chronic, many of which can last for several years, and finally turn into lasting personality changes.

The main manifestations are: 1) repeated traumatic experiences; 2) selective forgetting of traumatic experience; 3) In the context of continuous numbness and emotional dullness, it occurs in activities and situations where others are alienated, unresponsive to the surrounding environment, lacking pleasure and avoiding traumatic experiences. 4) Often appear autonomic nervous overexcitation, accompanied by excessive vigilance and insomnia. 5) Anxiety and depression are accompanied by the above-mentioned manifestations, and there may be suicidal thoughts.

3) Adaptation barriers:

In the adaptation period of major life changes or stressful life events, subjective pain and emotional disorders often affect the performance of life and behavior. Generally within 1 month after encountering a life event, and generally not more than 6 months. For example: mourning, separation, immigration, refugees, enrollment, new parents, personal goals, retirement, etc.

Main manifestations: 1) Depression, anxiety, brain anxiety, or complex emotions. 2) Feeling unable to cope, plan or maintain the status quo. 3) The ability to handle daily affairs is impaired to some extent. 4) It may be accompanied by conduct disorder, especially for teenagers.

Third, determine the consulting plan.

After the counselor has diagnosed the type and severity of the problem of the visitor and the causes of the problem, the counselor will negotiate with the visitor to solve the problem first, then solve that problem, introduce the psychological counseling techniques and methods adopted, and negotiate the time, period and cost of psychological counseling. Agree with customers on effective consulting objectives and projects.

Four. Consulting objective

Requirements belong to the category of psychology, which are positive, concrete or quantitative, feasible, evaluable, accepted by both parties and unified at multiple levels. The general consultation stage is divided into three stages: the first stage (initial stage)-the diagnosis stage; The second stage (mid-term)-consulting stage; The third stage (later stage)-consolidation stage.

Verb (verb's abbreviation) negotiation scheme: Both parties should negotiate in an atmosphere of mutual respect and equality.

Including: 1, consulting target;

2. The principle and process of specific psychological methods or techniques of consultation.

3. The effect and evaluation method of consultation.

4. Specific responsibilities, rights and obligations of both parties.

5. Frequency and schedule of consultation.

6. Consulting related expenses

7. Other issues and related explanations

Sixth, psychological counseling.

In the case that the consultant and the client agree on the consultation questions and the use plan, the consultant will hold a consultation conversation with the client's questions. The techniques that counselors may use include cognitive correction, behavioral therapy and psychoanalysis.

Depending on the use method, the consultant may assign homework to the helper or train the helper. The time needed at this stage is often related to the type of problems, the number of problems, the consulting technology and the cooperation of the helpers. If the problem of the helper is long-term, if psychoanalytic techniques are used, and if the helper does not complete the homework as required by the counselor, the number of consultations in these cases may be longer.

7. When the consulting goal is reached or the customer is unwilling to continue consulting, the consulting is over. Finally, the consultant and the helper jointly evaluate the consulting effect. For a period of time after the consultation, we will also contact the help seekers to find out their improvement.

The evaluation of the consulting effect is centered on the consulting goal, and only when the consulting goal is achieved can the consulting effect be directly reflected.

Eight. Dimensions (indicators) of consulting effect evaluation

1. Self-evaluation of counseling effect by help seekers

2. The recovery of the social function of the parties.

3. People around you, especially family members, friends and colleagues' comments on helpers.

4. Comparison of psychological measurement results of visitors before and after psychological consultation.

5. Observation and evaluation of psychological counselors

6. The improvement degree of some symptoms of the subjects.

Nine, psychological evaluation report content:

Clinical data verification

General survey method (ask family and friends)

Assess patients' psychological, physiological and social functions.

Summary and record of key contents.

Related material

Nature and cause analysis.

Summary:

The main difference between psychological counselors and doctors is that medical students are called symptom diagnosis, and psychological counselors also need to find out the causes of psychological problems. Diagnose the cause. Doctors don't need it. In addition, there is more than one reason, so it is necessary to evaluate its role in causing psychological problems (different schools have different analysis strategies and reasons, so they should be used flexibly according to different people).