16 Apr 2018

BY: Anna Keyter

Assessment / Couple Counselling / Depression / Online Counselling / Online Counsellor / Online therapist / Online Therapy

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The Process Model of Helping

The Process Model of Helping (PMH) as introduced by Clara Hill (2014), can be defined as three stages of intervention: Exploration, Insight, and Action.  It incorporates client-centred, psychoanalytic, and cognitive–behavioral approaches. The PMH foundation (exploration stage) is based on the client-centred model due to its facilitative aspects of helping (Hill, 2014). People seek help for various reasons, whether it is problems with peers or living with parents. The goal to find therapy is based on difficult situations (Carkhuff, 1987), by addressing sensitive issues clients can understand themselves in new ways.

When the self-concept and ideal-self are similar (congruent) self-actualisation (optimal-self) can be achieved (Chodorkoff, 1954). Through a supportive relationship, the congruent and incongruent perception of the self that stems from interactions with others (previous experiences) can be addressed. People have an innate need for self-actualisation which refers to the need to reach their full potential (Rogers, 1959). Hill (2014) highlights the facilitative and healing aspects of helping in terms of using skills (natural ability and learning), creating facilitative conditions (empathy, warmth and congruence) and self-awareness (knowledge and insight).

Stage 1 | The Exploration Stage

Maslow (1968) was the first to use the term ‘self-actualisation’ when it came to a person’s ability to become what he or she is capable of becoming. According to Hill (2014), the exploration phase is based on the client-centred model, hence the focus is on attending, observing, listening and exploring thoughts and feelings. Rogers (1961) suggested that it was important to focus on building nonjudgmental therapeutic relationships, listening to the clients’ narratives and assisting them to experience feelings. The helper would display skills by observing non-verbal and minimal verbal behaviours, exploring by using restatements, asking open questions and considering feelings through reflections, disclosures and open-ended questions (Hill, 2014).

Stage 2 | Insight Stage

Summarising from Hill (2014), in some instances, stage one may be all a helpee needs to make important changes. However, in other situations, the exploration stage is the foundation on which to build the insight stage. Insights draw on the psychodynamic and attachment models. Psychodynamic theories do not focus on behavioural change, but look deeply into troubling issues such as early relationships, the importance of early childhood experiences and place emphasis on defence mechanisms. During the insights stage, the goals are to foster awareness (challenge), facilitate insights (probe, interpret, disclose insights), and working on the therapeutic relationship (immediacy). This stage set the foundation for the action stage where Hill departs from psychodynamic models and applies behavioural theories.

Stage 3 | Action Stage

According to Hill (2014), the action stage is the practical section of the PMH. There are two reasons action is needed, firstly people seek assistance to feel better or change behaviours. The second, to consolidate new thinking patterns into existing schemas and to ensure old habits do not resurface. This part of the intervention still has a client-centered underpinning, and the helper remains a supporter and coach and does not give advice. Hill (2014) draws on Behavioural and Cognitive theories including learning and treatment strategies. The Goals of the Action stage is to explore new behaviours, deciding on and developing new skills, assisting clients to evaluate and modify action plans and processing feelings about change. Types of action include relaxation for behaviour change, rehearsal, and decision making. Helper skills are displayed through open action questions, providing information and feedback to clients, advising on the process, directing guidance and disclosing strategies.


Hill’s (2014) aim was to provide a helping model, integrating affect cognition and behaviour as a framework for exploring helpee concerns, gaining insight into their issues and enabling them to make desired changes. The Three-Stage Model is based on an eclectic perspective (integrating diverse philosophies), that is grounding practice and theory on the philosophies of Rogers, Erikson, Maheler, Skinner and Ellis & Beck.

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Castonguay, L.G. & Hill, C. (2017). How and why are some therapists better than others?: Understanding therapist effects. Washington: American Psychological Association. 

Corey, M. S. & Corey, G. (2006). Groups: Process and practice (7th ed.). Belmont, CA: Thompson Higher Education.

Cozolino, L. (2004). The making of a therapist. New York, USA: W.W. Norton & Company.

Hill, C. E. (2009). Helping skills: Facilitating exploration, insight, and action (3rd ed.). Washington, DC: American Psychological Association.

Hill, C. E. (2014). Helping skills: Facilitating exploration, insight, and action (4th ed.). Washington, DC: American Psychological Association.

Rogers, C.R. (1959). A theory of therapy, personality and interpersonal relationships, as developed in the client-centered framework. In S. Koch (ed.). Psychology: A study of science. (pp. 84-256). N.Y.: McGraw Hill.

Rogers, C. (1961). On becoming a person. London, United Kingdom: Constable Publishers. Available online library (2004 ed)


09 Mar 2018

BY: Anna Keyter

Assessment / Treatment

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Critical perspective on Scientist-practitioner Model
Why a critical perspective on Scientist-practitioner Model?

With the DSM 5 changes, there is a renewed international reflection on the scientist-practitioner model also known as the medical model.   Mental and medical health professionals, as well as researchers, are familiar with the scientist-practitioner concept.  This article will take a moment to reflect on the true meaning of the scientist-practitioner in counselling.

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08 Mar 2018

BY: Anna Keyter

Assessment / Treatment

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Counselling Assessments using DSM-5 Diagnostic Tool

Counselling Assessments using DSM-5 Diagnostic Tool:

Main reasons for Counselling Assessments using DSM-5 Diagnostic Tool;

The DSM (also known as the Medical Model) stands for Diagnostic and Statistical Manual of Mental Disorders.  The latest addition is the DSM-5 and is distributed by the American Psychiatric Association.  Interestingly, there is a parallel classification system that was developed by the World Health Organisation, called the International Statistical Classification of Diseases and Related Health Problems (ICD-10).  Psychologists and Psychiatrists use these diagnostic tools to a large degree for medical insurance purposes.

DSM-5 Definition of Mental Health

A mental disorder is a syndrome characterised by clinically significant distur­bance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes un­derlying mental functioning. Mental disorders are usually associated with signif­icant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behaviour (e.g., political, religious, or sexual) and conflicts that are primarily be­tween the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.

Various Criticisms of the DSM-5

Not Focused on Culture

Renato Alarcón from the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine (1), highlighted the limitations of current diagnostic practice.  Criticisms include the relevance of culture during diagnosis.  He mentions that the cultural content should be taken into account during psychiatric diagnosis and the main, well-recognised cultural variables, including adequate family data, explanatory models, and strengths and weaknesses of every individual patient should be considered.


Furthermore, Professor Winfried Rief (2) is concerned that the DSM is a “profit-making, lucrative franchise for the APA.”  What is concerning is that 25% of the American population qualifies for a psychiatric diagnosis yearly.  In addition, 50% will be diagnosed with a psychiatric disorder in their lifetime.   By defining milder conditions in the DSM-5, it distracts from attending to the severely mentally ill.


Ben-Zeev, Young and Corrigan (3) published a paper on the stigma associated with mental illness.  They found that a psychiatric diagnosis can have devastating effects on the lives of mentally unwell people, their families and carers.  Whats more, they highlighted three types of negative outcomes (1) public stigma (2) self-stigma, and (3) label avoidance.

In defence of the DSM

Frances and Widiger (4) describe the DSM-V as the best current tool for diagnosis.

Our classification of mental disorders is no more than a collection of fallible and limited constructs that seek but never find an elusive truth. Nevertheless, this is our best current way of defining and communicating about mental disorders. Despite all its epistemological, scientific and even clinical failings, the DSM incorporates a great deal of practical knowledge in a convenient and useful format. It does its job reasonably well when it is applied properly and when its limitations are understood. One must strike a proper balance.

So where to from here?

Whilst not all counselling professionals focus on the DSM-5 criteria, it will remain the main diagnostic tool for many psychologists and psychiatrists for years to come.  Medicalising mental well-being is a major concern of the DSM-5.  In practice, the DSM-5 should be treated as a tool rather than be-all and end-all.  When using the DSM-5 as a diagnostic tool, be mindful of the long-term effects it can have on people.

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(1) Culture, cultural factors and psychiatric diagnosis: review and projections

(2) DSM-5 – Pros and 

(3) DSM-V and the stigma of mental illness

(4) Psychiatric Diagnosis: Lessons from the DSM-IV Past and Cautions for the DSM-5 Future




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