The counselling process: rapport to termination

The first two stages in words, the four opening scripts and the assessment table, are on The first sessions. Stages three to six are worked below the diagram.

A worked example: A 22-year-old named Rohan presents with insomnia and exam anxiety. In stage two, his counselor assesses: he can no longer concentrate, he avoids friends (a maintaining loop), and his mother's encouragement is a protective factor. The counselor uses this to build the 4-P formulation rather than jumping straight to techniques.

Test yourself

Build a 4-P formulation: a 19-year-old with panic attacks that began after her SEE results, whose mother had "nerves", whose family now lets her avoid every bus, and who is close to her grandmother and good at tailoring. Then write one SMART goal with her.

The curriculum's first task is not a skill but a space. Most of it costs nothing.

• Private: quiet, not overheard, door closed unless the client prefers it open, a "session in progress" sign if interruptions are common.
• Comfortable and safe: chairs at the same level, no desk between you, light and air that do not tire; nothing sharp or harmful within reach; child-sized furniture if you see children.
• Non-threatening: sit at an angle or side by side, about an arm's length or more, tuned to the person and the culture.
• Tidy: tissues, water and paper to hand; clutter raises tension.
• Accessible and respectful: reachable for a wheelchair; gender-appropriate seating; nothing on the walls that could offend.
• Warm: a greeting and a calm voice set the mood before any technique does.
• Quiet devices: phone silent; if you record or use video, it works and the client knows.

Core problem (task 17). Weigh each problem the client named by impact, urgency, and the client's own priority. Then ask, do not announce: "From what we have discussed, the work stress, the arguments at home and the poor sleep all seem linked to the anxiety."

Never let a hidden but serious issue sink below the client's stated priority.

Formulation and strategy (task 18). The curriculum's four factors are vulnerable, triggering, maintaining and protective. Sort what you learned into four boxes, write a working hypothesis, and say it back for correction.

"Your anxiety started after you lost the job (the trigger), but it continues because you avoid people and stay in (what keeps it going). At the same time you have a sister who encourages you (a strength). So we could take small steps back toward people, lean on your sister, and work on the thoughts that stop you applying for work."

Strategies match factors: defuse the trigger, break the maintaining loop, build on the protective corner. Keep it simple, share it, and update it when new facts arrive.

Goals (task 19). Short-term steps inside a long-term aim, owned by the client, SMART. Vague: "I want to feel better." Workable: "For the next two weeks I will try a relaxation exercise every night before bed and keep a simple sleep diary." Then check: "Does that sound manageable?" A goal too big discourages; adjust it as life changes.

Implement and evaluate (tasks 20 and 21). Teach the technique in the room, agree when and how often it is practised, and review it next session. Drop what is not working; one or two strategies at a time, never a list.

Evaluation is a conversation, not a form: "From your side, how have things changed since we started? Which areas feel better, and which still need work?" Compare with the first assessment, take the client's view as central, and count small steps as progress.

Follow-up and termination (tasks 22 and 23). Ending is planned from the start. Say in advance that sessions will close, review what was gained, make room for feelings about ending, and agree a plan for future rough patches.

"You are managing your challenges much better now, so we can begin to close our sessions. Before we finish, let's go over the skills you have built."

Follow-up is agreed together, for example at one, three and six months, by visit or phone, and stays voluntary: it checks that gains hold and catches a relapse early, without making the client dependent.

When the relationship itself wobbles (task 24). Six common strains appear: lost trust, resistance, dependency, a clash of values, a boundary crossed, a misunderstanding.

Name the tension rather than ride over it: "It seems there has been some discomfort in our sessions lately. I value your honesty, so could we talk about how you are feeling about our work together?" Then revisit roles and confidentiality, stay consistent, keep the boundary, take it to supervision, and refer if the alliance cannot be repaired.