525: Basic Counseling Techniques
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reflection of feeling BCT: allows therapist to demonstrate to the client that he is aware of the emotions the client is feeling and expresses empathy. RF emphasizes a clients emotion words and demeanor and may reflect them back to the client using similar phrasing. RF is a crucial skill bc it shows empathy, conveys the therapists understanding and makes the client aware of his own emotions, show that you understand what they are feeling Ex: 18 yr old girl reveals that she is having trouble fitting in and often sits alone in her room, the therapist responds by saying, "it sounds like you are feeling lonely and isolated from others" 1/34
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34 terms
Terms
Definitions
reflection of feeling
BCT: allows therapist to demonstrate to the client that he is aware of the emotions the client is feeling and expresses empathy. RF emphasizes a clients emotion words and demeanor and may reflect them back to the client using similar phrasing. RF is a crucial skill bc it shows empathy, conveys the therapists understanding and makes the client aware of his own emotions, show that you understand what they are feeling Ex: 18 yr old girl reveals that she is having trouble fitting in and often sits alone in her room, the therapist responds by saying, "it sounds like you are feeling lonely and isolated from others"
reflection of meaning
Freud, psychoanalysis. BCT: active listening technique. therapist paraphrases with emphasis on literal meaning (verbal/nonverbal) and confirms accuracy of RM. utilizing this technique shows client that you have heard not just the surface of their story but also the deeper meaning. RM highlights the clients core beliefs that guide their bx important bc it adds info to what the client has already said and conveys therapist understanding Ex: client explains that it frustrates her when business associates do not follow through with their work and how it bothers her when her friends do not call when they say they will, therapist responds with, "sounds like one your tenets is to keep your word by doing what you say you will do and that when others do not follow this guideline it frustrates you." or Ex: client, while smiling and happy and sitting up straight, "my husband killed himself last month"
reframing
BCT: therpaist gives alternate perspective of what client has said, positive/neg/or neutral. it is a manipulation of data through altercation of meaning or value that brings awareness to client and encourages exploration. Ex: the client believes everyohne who looks at her is making fun of her, the therapist reframes as admiration by the strangers instead, challenging her cognitions
open ended ?'s
BCT: important foundation skill to promote greater client disclosure. unlike closed ?'s, use how and what, avoid why, OEQ's can not be answered in one word, used to progress the client from generalizations to specifics, obtain more info, and
for clarification. OEQ are esp useful in the beginning of therapy bc it allows the client to tell their story in their own way and to focus on what is important to them Ex: instead of how many people are in your family, "tell me about your family" summarization
tool that brings together the major points of a convo that either brings about correction or confirmation of the info said. can be used to close the dialogue of a certain topic, encourage the client to probe further, or it can be used to bring together a clients circular points, an imp skill bc it ensures that the therapist has heard all the correct content and sorts out the main points w/o disregarding the clients affect. a versatile tool in that it can be used in the beginning to segue from last session to the current one , midway to tie together what has been discuess thus far, or at the end to bring session to a close
termination
final phase of therapy and therapist/client relationship. T can occur for numerous reasons; the clients goals have been met, no rapport etc. must be properly times and not abrupt and explained. make sure client knows it is not final and may return. handle carefully so client does not feel abandoned. should be viewed as positive. the process should be addressed in the IC document so client can expect what will occur.
trustworthiness
crucial characteristic, must believe in order to promote full self disclosure and yield positive outcomes. a reflection of the therapists honesty and openness and lends to client feeling therapist is dependable. vital in establishing rapport and a working alliance. teenage girl must believe in trustworthiness of dr that he will not tell parents
working alliance
BCT: coalition between therapist and client, getting together: psychoanalytic/client centered. a therapeutic relationship btwn therapist and client. consists of the client and therapist be active collaboraters in therapy and agreeing upon goals of tx and how to achieve goals. needs to be established early in therapy bc it is related to successful therapy outcomes. developing WA has not formula but can be achieved through warmth, empathy, and respect, if not formed in first few sessions, may not form 3 components agree to tx
agree on task to be achieved agree on engagement proxemics
Taber, 1966. distance/space btwn 2 people, office setup, foster a safe and comfortable environment, should not reveal too much about therapist personal life, include no physical barriers, ample seating, door access for therapist, white noise, soft lighting, consisent with the demographics of your pt pop
core conditions
Carl Rogers, client centered therapy: 3 factors clients must perceive therapists have in order to make counseling effective. empathy, authenticity/congruence, unconditional positive regard, stems from Rogers client based therapy, can be achieved through summarization and minimal encouragers
listening skills
BCT: crucial tool to help establish the core conditions, LS is actively attending/communicating with client in verbal and non verbal ways that promote client disclosure. an active process where it is also imp to be mindful of what is not said, ommision of content are just as imp, be responsive, w/o judgement, includes paraphrasing, minimal encouragers, perception checks Ex: client shakes his head while talking about wife's career, therapist says, " i notice you are shaking your head, what does that tell me?"
logical consequence
behaviorism/CBT tool to change bx, discuss the logical consequence if bx continues without intervention. a behavioral term that emphasizes the best course of action for altering a problem bx, may not be traditional punishment but rather a natural consequence, serves as a wakeup call and is important for developing understanding of the possible consequences of a bx and promotes self control Ex: beth did not show up for her 2nd therapy session and did not call in advance, therapist billed Beth anyway
paraphrasing
BCT; rephrases what client says, builds on it, blends the clients words with the therapists understanding. P is essentially giving the client feedback and should allow the client to further explore into their thoughts and feelings. good P includes what the client says and what they haven't directly expressed. p lets
the clients know the therapist is actively listening and gives them the client opportunity to correct any misperceived info. Imp: it illustrates how a client thinks of himself and others. facilitates reflective processing, and identifies what's wrong positive asset search
id of patients strengths, PAS is an element of bx analysis and is imp to evaluate bc the positive assets can be used to overcome bx problems and focus on client assets which may lead to inc self efficacy in therapy. id assets also facilitates th working alliance and establishes rapport, may be difficult but crucial to identify Ex: pt has extreme social anxiety but has great sense of humor
power dynamics
Rogers. the control and authority relationship btwn client and therapist, there is a natural power differential btwn therapist and client bc therapist controls schedule, $, records, and is the expert. T should always be in control and express professionalism but lessen the presence of PD through core conditions and listening skills to maintain therapeutic homeostatis and promote successful therapy outcomes. PD may also be influenced by SES, age, gender. use Rogers core conditions and active listening as well as appropriate self disclosure, imp to est at beg of relationship Ex: child comes into office and is afraid to disclose info to therapist bc he is an "authority figure"
client expectations
must be addressed in IC and in initial interview Imp: client expectations can be unrealistic. clients overall hope, anticipation, and assumptions for tx usually verbalized at beg, involves what they want to get out of tx such as goals and their rold and the couselors role in achieving goals, ensure clients expectations are realistic, adaptive, and appropriate. imp to where they are in their motivation to change to make sure proper interventions are used, CE are catalyst of therpay and helps determine direction and objective of therapy. Must understand IFR. Ex: client thinks therapy is a waste of money and therapists are a bunch of quacks, therapist will know how to approach client and be aware of client's mistrust
confrontation
BCT: calling attention to what you see, addressing discrepancies, invites client to think about bx of self and others, demands revelation on part of client, can be embarassing or
painful, if not careful may look like damaging rapport, could also create power struggle, timing is vital, "client is always right" so back track bc they may not be ready to explore that are yet, often used in middle to end of therapy Ex: jon said he has many girls interested in him, however, when therapist asked jon why he had not reciprocated interest in one of the girls jon became defensive as a result therapist backtracks, apologizes and leaves topic for another time congruence
Rogerian, client centered therapy, being consistent/genuineness, one core condition a therapy must possess, harmony in affect and appropriate observable response to a situation, mood, state, helps to express therapists genuineness and authenticity, encourages client to express self and know that they will not be judged, inner experiences match outer expressions, imp bc it helps maintain a working alliance by facilitating rapport, imp to asses bc if not congruent in thoughts, emotions, and bx's it could represent a conflict Ex: beth talks about her abortions, therapist says she is comfortable but avoids eye contact and interupts client
encouraging
BCT: active listening. any action that promotes client disclosure. verbal and nonverbal. client knows you are interested and wish to hear more Ex: teen client describes parents divorce, therapist nods while client is talking and follows with "go on, tell me more."
engagement
Rogers Client Centered Therapy: process of the therapist and client becoming involved and commiting to the therapy process, T focuses on the TFB tha tengage the client to participate actively in therapy and maintain their interest. the 1st step is to engage in conversation, lack of engagement often leads to premature termination, E is cultivated through the therapists expfressions of the core conditions. change, admisitrative factors, E is imp bc it is nevessary to the proccess and is th foundation of therapy Ex: child does not want to engage, therapist sits on floor and colors with child while they talk
focusing
BCT: redirecting client's attention to one goal at a time, part of structuring where the therapist can direct and redirect client at particular times. concentrating on or close/narrow attn to what is imp and what is currently being discussed, involves attending
to problems/feelings as they arise, ability to focus encourages the client to work on present problems where there are attainable goals vs focusing on past unchangeable ones, imp bc leads to direction in therapy which results in craetion of goals and plan to achieve Ex: although client said he wanted to talk about his recent traumatic combat experiences, the therapist had to maintain and redirect his attn to the combat encounters instead of small talk tha the was inclined to do self disclosure
when a counselor consciously shares personal info about their lives to a client bc they feel it would benefit the client , utuilize only when they think it will be beneficial, normalizes the clients bx, increases rapport, and enhances alliance, hoever whould be used w caution for the client may feel the therapist is taking the focus/attn off client, SD should be relevant and focused Ex; client in tx for loss of parent, feels no one understands, therapist discloses losing parent
stages of change
model used that outlines a clients readiness to change, developed by Prochaska and DeClemente, consists of : precontemplation, not aware/no desire/no problem contemplation, aware, not sure if want to change preparation, aware, talking about possible change action, takes action maintenance, made changes and works to prevent relapse relapse goes back to maladaptive bx tool to assess the clients level of motivation and helps guide the counselor to choose the best suited interventions, helps therapist meet the client where they are Ex: if an alcoholic can't admit that they have a problem, they aren't ready to change bx not likely at this point that they will stop drinking or go to a 12 step program
structuring
provides conceptual framework for therapeutic process explaining the points as they go along, appts, contact, fees, process, expectations, emergencies, confidentiality, outcomes, termination, informed consent is imp aspect of structuring, begins the foundation of relationship, ensures that client knows what to expect, creates comfort/safety and facilitates process and realtionship while providing guidance use at first session and then first 5 minutes of every session, summarize from last session, get into meat and potatoes, and
then conclude Ex: pt knew that although talking about something really emotional, by the end of the session she would be better bc that's how all th sessions are structured basic -id
lazarus 1997, multimodal therapy. 7 areas of consideration in a mulimodal approach to assessment: behavior, affective processes, sensation, imagery, cognition, interpersonal relationships drugs bio/chem factors, supposed to focus on these factors and how they impact the presenting problem, summarize core human elements, intervention should follow in response pattern. all significant signs/syjmptoms of distress can be assessed, might otherwise be overlooked Ex; if 1st response to anxiety is sensory (stomach ache) then relaxation/biofeedback intervention may be used 1st
clarification
foundation skill used to ensure complete understanding of client communication, used to avoid assumptions, shows client that they are being heard, C is imp to prevent misunderstandings which may deter progress Ex; client been telling therapist about her sons disruptive and rude bx toward her, she says she doesn't understand where she went wrong, therapist asks, "so you feel confused about how he ended up this way?" Ex: husband calls wife "pig", what does pig mean?
immediacy
Rogers. attending to problems and feelings as they arise, therapist reflects on an aspect of current feelings, thoughts or tx in therapy, increases warmth and empathy, Imp: if there is no response, client may perceive as judgement from therapist Ex: mary came to therapy to deal with issues in her marriage, during the initial interview, she began to cry when she was talking about her family and mentioned her father, the therapist caught this and asked her to talk more about her father as this was the immediate issue
interpretation
cognitive therapy. originally from freudian/psychoanalytic,
techinique used to draw an analysis of what the client is telling you, tell client and they can accept or reject analysis, meaning therapist gives to unconcscious thoughts and bx's, can be dangerous bc it can be incredibly inaccurate Ex: dream analysis, rorschah projective test orientation sensorimotor, concrete, formal operational, dialectic/systemic
piaget and ivey. concept involving assessmetn of client's cognitive interpretation of the problem. 4 levels based on piaget's cognitive developmental stages. sensorimotor: clients are in the here and now concrete: client gives multiple examples. therapist is unable to get a sense of the overall problem and must search for repeating key words and themes from the client formal-operational: client discusses patterns of feelings dialectic-systemic: client is able to predict/hypothesize about tx and performance these modes allow client to fluctuate and flow between them throughout their life process Ex: the client says, "i just know when i go home, i am going to have to get drunk because the wife will start nagging me about something" (dialectic-systemic)
clarification
BCT: used in non-directive therapy. active listening skill. the therapist provides a summary of what the client says, focusing on and clarifying its meaning. Imp: reduces the possibility of miscommunication and shows the client that they are being heard. Ex: the client says to the therapist that his teenage daughter is being "impossible", the therapist repeated, "you say that your daughter is impossible, describe to me what that means."
verbal tracking
an active listening skill. "parroting" verbally follow the lead of the client when making reflections or paraphrases. use key words that the client often uses. this skill is valuable in making client feel important and relevant and listened too. aids in therapist taking notes later. builds rapport. client: my dad hasn't been home lately therapist: so you said your dad hasn't been home lately
maslow's hierarchy of needs
a method of classifying human needs and motivations into five categories in ascending order of importance: physiological, safety, social, esteem, and self-actualization
spheres of influence
person problem and environment, way to conceptualize what is going, find out about them, their family, work, school, love life, morals, illness etc. when assessing an individual make sure you have understood them on all spheres...assessment technique Ex: by end of session one make sure you know all basic factual knowledge
capping
move client along from emotionally intense experience to a cognitive discussion pt was crying and crying and silent, so the therapist said this clearly was very upsetting to you, do you remember what you were thinking when this happened? or use humor, but risky
Helping Relationships - Counseling Techniques/skills
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Paraphrasing Restating the client's message to show or gain understanding.
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14 terms Terms
Definitions
Paraphrasing
Restating the client's message to show or gain understanding.
Interpretation
A technique that is used to uncover and suggest the meanings and relationships that are often underlying the apparent expression.
Restatement
Repeating what the client has stated with an emphaiss on the cognitive portion of the message.
Reflection
Repeating what the client has stated with an emphasis on the affective or feeling portion of the message.
Attending
Several behaviors including listening, engaging in eye contact and being psychologically present.
Immediacy
Dealing with what is going on in the counseling process at the present time.
Self-disclosure
The counselor shares personal affect and experiences relative to the client's issues.
Congruence
The counselor is authentic and integrated in session. Agreement between the client's behavior and his or her values and beliefs. Genuineness.
Empathic
The ability to experience the clien'ts subjective world including
Understanding
feelings and cognitions.
Silence
Has many meanings including quietly thinking, boredom, hostility, waiting for the counselor to lead or emotional integration.
Summarizing
The counselor or client brings together several ideas or feelings, usually following a lengthy interchange.
Confrontation
Occurs when the counselor identifies and presents discrepancies between the client's verbal and non-verbal behaviors or between the counselor's and client's perceptions.
Concreteness
Dealing with issues in specific terms rather than in vague generalities.
Unconditional Positive Regard
Acceptance: The counselor is caring without condition and is neither evaluative or judgmental
Key Techniques of Theories
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Psychoanalytic interpretation, dream analysis, free association, access unconscious conflicts leads to insight and assimilation of material by the ego
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11 terms Terms
Definitions
Psychoanalytic
interpretation, dream analysis, free association, access unconscious conflicts leads to insight and assimilation of material by the ego
Adlerian
use the persons (subjective) experiences over techniques, life history, data interpretation, encouragement, new possibilities
Existential
gain understanding first, then use techniques pulled from different approaches (no testing)
Person-Centered Attitude of therapist is important: active listening, reflection of feelings, clarifying, being there (no testing) Gestalt
intensify experiences and integrate conflicting feelings,I/Thou dialogue (no testing)
Behavior
homework assignments, questions, modeling reinforcement techniques, social skills, self-management
Cognitive Behavior
socratic seminar, debate beliefs, homework, gather data, coping skills, thinking patterns, role play, confront faulty beliefs
Reality
evaluate present behavior to see if willing to change, client doesn't like present behavior then they make plan to change, commit to following
through Feminist
gender-role analysis, journal writing, challenging beliefs, psychodrama
Postmodern
change talk- time in clients life when problem was not a problem, scaling questions, narrative stories, write letters
Family Systems genograms, questions, setting boundaries, issuing directives, change in short tim
