First, identify the sin at the root of the issue. Remember, all issues are ultimately spiritual issues, and there is always a sin at the core of each issue. Sometimes the core sin has led to other sins, and you must cut through these sins to find the core sin, the sin that is begetting the other sins. For example, one of the most frequent of the other sins is lying, which is occurring to cover up the core sin. Another example is that many times when someone has been sinned against, it isn't the being sinned against (slander, abuse, defrauding, swindling, etc) that is the issue; but it is the unforgiveness (toward the perpetrator or God, or both) in the victim that is the core sin. Go after finding that core sin like a heat-seeking missile, because it will be the key to bringing healing and closure to the issue.
Second, determine if the person you are counseling is willing to deal with the core sin, willing to confess it as sin, willing to renounce it and repent from it, and willing to let it go. If they are not willing to confess it as sin, and/or deal with the sin, then no amount of counseling will help them. Many people who are unwilling to deal with their sin, are what I call chronic counselees; and much like the women in II Timothy 3:7 who are always learning, but are never able to come to the knowledge of the truth, these people (men and women) are always in counseling, but are never able to achieve healing. Pornography comes to mind, in that many who are involved will admit that it is a sin, but never come to the point where they are wanting and willing to let it go. Unforgiveness is also a sin that many are not willing to confess or deal with.
Finally, many times the primary issue is a salvation issue, and we also see this many times in those who are chronic counselees. There are many who think they are a Christian, who claim to be a Christian, but are not. These people do not have the spiritual capacity to understand Biblical counseling, nor do they have the spiritual capacity to obey the Scriptures (I Corinthians 2:12-16, Romans 8:5-8), and therefore cannot apply the Scriptures to their life and situation. In counseling you need to try and determine where the person is spiritually, so do not start off assuming the person is a Christian. Even though I have listed this last, it something that should be paramount in your mind as you begin the counseling process. A good healthy dose of the gospel during the counseling process is good for all, both saved and unsaved. For the saved it is a reminder of what God and Christ have done for them and their standing before them, and for the unsaved it is the key to begin the process of healing that starts with their very own soul (Jeremiah 17:4).
There are many complicated emotional and mental issues that people are dealing with, and I am not making light of them; however, most often, we find that the issues are understood and can be resolved by determining where the people are in relation to the components I have mentioned above.
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