Chapter 9: Counseling and Guidance

9.1 Overview

Counseling and guidance (C&G) is the most important service provided during rehabilitation and in some cases may be the only substantial service needed.

A qualified counselor provides C&G throughout the rehabilitation process to:

  • promote a successful relationship between the consumer and counselor; and
  • help the consumer achieve his or her rehabilitation goal.

C&G is short-term and problem-centered. It is not therapy. Refer a consumer who needs intensive counseling to an appropriate resource.

9.2 Outcome of Counseling and Guidance

The outcome expected from counseling and guidance for a consumer during rehabilitation is to encourage the consumer to make decisions about the services that the consumer will receive and to be responsible for those decisions.  

The counselor works one-on-one with the consumer to:

  • understand the consumer’s problems;
  • recognize the consumer’s potential; and
  • follow a plan of self-improvement leading to the best possible outcome and personal and social adjustment.

Rehabilitation counselors are professional counselors. While their goals, roles, and skills may be similar to those used by other counselors, rehabilitation counseling often poses additional challenges related to the consumer’s disability. Disability related challenges must be identified so that counseling strategies can be incorporated into the counseling relationship to help the consumer.

Counseling and guidance is important to the success of our consumers. The rehabilitation counselor’s knowledge of disability issues, available program services, and community resources can help the consumer decide how to overcome barriers.

Counseling and guidance is a core rehabilitation service and written in the Individualized Written Rehabilitation Plan as a planned service.

Counseling and guidance is an essential component of any case that is closed as successfully rehabilitated and this component is documented in the case file.

9.3 Informed Choice and Counseling and Guidance

Counseling and guidance includes information and support services to help the consumer make an informed choice. For more information about informed choice, refer to Chapter 2: CRS Principles, 2.6 Principles of Informed Choice.

Counseling and guidance is provided to assist the consumer in making informed choices and is offered throughout the rehabilitation process, from application through case closure. Counseling and guidance must be included as a planned service on every consumer’s Individualized Written Rehabilitation Plan.

Informed choice is a decision-making process in which the consumer analyzes relevant information and selects a primary goal, intermediate rehabilitation objectives, services, and service providers. Information about services and programs is provided to the consumer whenever it is necessary for the consumer to make an informed choice. A partnership between the consumer and the counselor empowers the consumer to make decisions that result in a successful rehabilitation outcome. 

9.4 Ethics of Rehabilitation Counseling and Guidance

Understanding the principles in the Code of Professional Ethics for Rehabilitation Counselors (the code) is critical to the ethical decision-making process. The code outlines the elements of professional relationships that promote and protect the spirit of caring and respect for individuals with disabilities.

The code comprises the following six basic principles of ethical behavior. See Chapter 2: CRS Principles, 2.5 Building Ethical Relationships.

CRS counselors who violate the code are subject to the actions defined by agency policies for performance management. Counselors certified through the Commission on Rehabilitation Counselor Certification, are also subject to a commission action.

9.5 The Scope of Rehabilitation Counseling and Guidance

The essential aspects of counseling and guidance are:

  • the continual assessment of the consumer’s progress throughout the rehabilitation process;
  • identifying the consumer’s rehabilitation needs and providing the consumer with information to meet those needs;
  • helping the consumer develop compensatory strategies to reach a successful outcome;
  • addressing issues as they arise; and
  • assisting the consumer in learning the options and resources for dealing with various problems related to the consumer’s disabilities.

Counseling and guidance includes helping the consumer to:

  • understand his or her disability and related impediments;
  • understand physical and mental restoration procedures;
  • get accurate information to make an informed choice;
  • make informed choices from among alternative goals, objectives, services, and service providers;
  • identify strengths on which to capitalize to achieve the goal,
  • acquire new skills;
  • develop a realistic action plan to address a problem;
  • use rehabilitation technology;
  • develop residual capabilities;
  • identify and use community resources and relevant support services;
  • resolve barriers impacting the consumer’s planned rehabilitation needs, such as resolving transportation issues, child care issues, or family issues;
  • modify the consumer’s attitudes and behaviors;
  • develop self-advocacy skills;
  • cope successfully with disability related stressors; and/or
  • maintain progress toward the rehabilitation goal.

Counseling and guidance helps consumers learn to identify and use their options and resources to handle problems related to their disabilities. Learning to adapt to personal limitations and capitalizing on individual strengths leads to an improvement in self-esteem. The counselor encourages the consumer by establishing a relationship of mutual respect within which the counselor can both support and challenge the consumer to develop the skills needed to achieve positive outcomes.

9.6 The Frequency of Counseling and Guidance

Base the frequency and extent of counseling and guidance on such factors as:

  • the complexity of the case;
  • the consumer's disability;
  • the consumer's adjustment to the disability;
  • the consumer’s progress or lack of progress toward his or her planned goals;
  • diagnostic information;
  • the need to engage the consumer; and
  • the need to maintain a working partnership.

The effective use of the counselor’s time in addressing the barriers identified by the assessment will allow the counselor to provide a level of counseling that is sufficient to meet the consumer’s goals and objectives.

When the consumer appears to have severe thought disturbances or need an unusual amount of counseling, refer the consumer to another agency, such as a local Texas Department of State Health Services center, university psychology clinic, or other resource.

9.7 Documenting Counseling and Guidance

Counseling and guidance is documented in a series of case notes throughout the rehabilitation process. Effective counseling and guidance, and the documentation that follows it, helps to tell the consumer’s story.

Use a case note titled "counseling and guidance" in ReHabWorks to document that counseling and guidance is provided.

When counseling and guidance is provided in addition to another activity that requires documentation, such as resetting a PIN, document the two activities in separate case notes to ensure that a reviewer can tell that both services were provided.

Review the most recent case note before contacting the consumer to ensure that all issues are addressed.

9.8 Counseling and Guidance as a Substantial Service

Counseling and guidance must be an essential component of any case closed as a successful closure and needs to be documented in the case file.

If counseling and guidance is the only rehabilitation service, the case can meet the criteria for a successful closure only if documentation in the case file shows that counseling and guidance was provided as a substantial service.

Ensuring that counseling was a substantial service may include focusing on topics that:

  • help the consumer understand his or her strengths and limitations in relation to his or her disability and impediments;
  • explore with the consumer any transferable skills and how he or she may apply them in overcoming impediments;
  • help the consumer select and/or maintain suitable and realistic goals by providing information that allows the consumer to make informed choices;
  • maximize the consumer’s self-awareness regarding barriers to productivity and possible reasonable accommodations;
  • empower the consumer through confidence building;
  • assist the consumer in developing the self-advocacy skills needed for taking responsibility for his or her continued success; and
  • provide the consumer with information about relevant support services and facilitate access to those services.