requires high self-awareness, one of most advanced skills
can deepen the trust of the relationship, present tense, here and now
communicate your feelings and concerns about what is occurring in the counseling relationship btw you and the client as it occurs in the session
attending to issues that could interfere w/ relationship in unresolved or unaddressed
ask "will it help them grow" "will it facilitate change?" "will it help work toward goals?"
models to recognize and express feelings
clarify a reaction you had to client's story
response to use in a multicultural situation when the client accuses you of bias
demonstrates cultural competency- response to address cultural differences btw you and client
addressed issues of dependency
Steps to formulate Immediacy
active listening, spiraling down
reflect on one of the 3, 1. your own thoughts and feelings 2. your awareness of some behavior or feeling being expressed nonverbally by the client 3. feelings or thoughts about how you are experiencing the relationship
communicate specific effect (feelings) of the situation on you, relevant to the topic the client is talking about. Here and now
own feelings and reactions, remain nonjudgmental and non defensive,
invite discussion and resolution (is that something you've heard before?)
"this is not meant to be offensive, but I want to make you aware of..."
What is the difference between immediacy and feedback?
Immediacy is about the relationship in counseling and how I am experiencing you...in the moment. "I feel sad when you talk about your traumatic experience."
through immediacy clients can become aware of how their behavior affects other people.
Feedback is observations and descriptions, not just about the counselor.
What is Giving Information?
the verbal communication of giving data and facts about people, activities, events, resources, alternative outcomes, or procedures
might include making referrals to social services or community resources
must match client's needs and goals
must be clear, direct, specific, concise, and concrete
must be at a point where client is most receptive (timing is important)
What are Evans' 5 types of Information giving responses?
1. orienting statement-knowledge based, overview of counseling, intro to a service
2. Instructions or directions-test instructions, info describing something and how to carry it out
3. Feedback- test results, performance review, outcomes
4. Alternative perspective- info about alternative frames of reference describing the situation, half-full or half-empty
5. Informational statements- overview of info seeking, occupational information, description of community resources, info about events, resources, etc.
When do clients need info? 4
When they do not know options
when clients aren't aware of possible outcomes of a choice or plan
to correct invalid or inaccurate information or dispel myths
to help clients examine issues they have been avoiding
What is advice giving? 6
when counselor gives expert opinion and hopes client will follow suggestions
recommending or prescribing a solution or course of action
lecturing and preaching
counselor doesn't listen to client's story
counselor is assuming to know all parameters of the problem
even though they may ask for advice, they really don't listen to it, they do what they want to do anyway...
"I have a hunch that you already thought about what you should do, and you want validation."
3 Differences between advice and information giving
Info - could, might, presenting info about issues, the decision is left up to client
Advice- should, must, recommending or prescribing solution
What is assessment?
gathering info about client and problem
What are examples of formal assessment?
Mental status exam (MSE)
info from medical records
interview family, teacher
info from legal system
what is informal assessment?
ongoing assessment each week, assessing progress toward goals
What is the rule for the 1st session?
Need to spend as much time as possible working on the relationship- get basic info and then work on relationship...if you give clients time to tell you their story, you will get it
What are the 5 steps in Young's roadmap of helping?.
1. Relationship building
3. Goal Setting
4. Intervention and Action
5. Evaluation and Reflection
What are 4 basic techniques to elicit relevant info for assessments?
3. Constructing Interviews
4. Genograms (family tree for 3 generations)
What are the 10 reasons to spend time assessment? Young
1. Help determine is client is a good candidate for the help you provide
2. Assessment gives crucial info to plan useful and realistic goals
3. helps clients discover events related to the problem
4. helps us to understand the impact of the client's environment on mental health
5. helps us recognize the uniqueness of individuals
6. uncovers the potential for violence
7. reveals critical historical data
8. can highlight strengths, not just weaknesses and pathology
9. helps clients become aware of important problems
10. helps the helper choose which techniques to use
3 pros of assessment
a tool to alert you to dangerous behavior, substance abuse, and psychotic symptoms
gives insights into a client's functioning in areas you may not be aware of asked about
can use to back up diagnosis and use to make accurate diagnosis
4 cons of assessment
not the only way to get at the truth
puts labels on clients
inappropriate for those who are different culturally than those for whom the test was intended
reveals little beyond what could be learned in a couple of sessions talking
What are the 7 guidelines for referring clients for testing? (Young)
1. Trigger questions indicates violence, severe mental disorders, substance abuse, or suicide.
2. Client is evasive or unreliable, could be personality issue of antisocial behavior, incarcerations, hospitalizations, domestic violence or substance abuse
3. Client has a physical condition that might be causing problem-
4. Client's problems seem to stem from ability to remember things- might have neurological difficulties
5. When client has difficulty reading and writing- could indicate learning disabilities or pervasive developmental disorder
6. Client seems to be functioning poorly but does not provide enough info to make a diagnosis or conversely appears to have symptoms of several disorders- may need testing to determine which issues are most central.
7. when you are unconvinced about a previous diagnostic label
How do you organize info to make diagnosis?
gather info, sort into problems, then prioritize problems and match with treatment strategies
identify client's strengths as well as areas for concern in each domain
talk about test results
Where do I go after spiraling down?
invite client to open up and engage in self-examination w/in the safe relationship
challenge client to go deeper and disclose about a lot of topics
assessment- use skills interview, observe, questions, and genogram to gather crucial data about history, environment, problem, etc.
now we set SMART goals
change the problem into goals to be worked on and met through the helping process.
What are SMART goals?
S- specific, concrete, and positive, what they are working toward (will be able to...)
M-measurable, everyone must be able to agree when goal is met, mutual do it together
A-attainable, something they can actually do, culturally relevant
T-time oriented, when are we supposed to have met goal?
increase, improve, maintain, establish
What is the miracle question?
If you were to wake up tomorrow and the problem is gone, what would you be doing?
What makes you ______________? (happy, feel good about yourself,)
What does that look like?
Reflect meaning, then help to set goals
What are the 5 stages of change? (Evans)
1. Precontemplative- unaware they have a problem or aware, but don't want to do anything about it, or want others to change to solve it.
2. Contemplation- begin to acknowledge they have a problem, but not yet committed to change, no method of dealing w/ problem has been developed.
3. Preparing for Action- decide to work toward goal and actively developing an action plan
4. Action- execute the action plan
5. Maintenance- clients actively work to maintain the change made during the action phase.
How do you focus on the client? 3 ways
1. when reflecting, do not blame others for client's feelings or behavior, "you feel" not "others feel" prevents client from blaming others and external circumstances
does not encourage passive acceptance of behavior, but challenges client to become responsible for the problem and the ability to do something about it
develop insight and take responsibility for feelings
What is the importance of goal setting?
once you set goal, you don't talk about anything else in the rest of the sessions, you are focused on this goal
that's why it's important to set the right goal
have to work w/ clients to get it right.
when counseling is over, client will be able to....
then choose strategies to achieve goal...
________________ drives your strategies and interventions.
How do you evaluate the effectiveness of counseling?
program evaluation- school counseling curriculum
global measures and specific symptom measures (beck depression scale, etc)
subjective scaling and self report (ask client to write down how many times he felt anxious)
monitoring by outside support (parents, staff, etc.) measureable
client satisfaction forms
goal attainment measures- chunk goal and describe goal in pieces talk about strategies w/ client and get their feedback.
Counseling is a process because...
every relationship is defined by beginning and end
loss or threat of loss is what brought client to counseling- loss of relationship, physical (tangible) loss, psychological or emotional loss
like other relationships, counseling will end
5 questions to ask yourself when thinking of terminating.
1. Is the presenting problem under control?
2. Has client reduced the initial level of distress by developing better coping skills?
3. Has the client achieved greater self-awareness and better relationships?
4. Are life and work more enjoyable for the client?
5. Does the client now feel capable of living without the therapeutic relationship?
How to terminate counseling relationship.
Want to help them to become their own therapist in the future
a transition rather than an event
a symbolic conclusion, an acknowledgement that the relationship had importance and that reality dictates that it end
a reflective moment in the history of counseling relationship
helping client to acknowledge what he has achieved during counseling
determining the nature or timing of any future contacts and/or referrals
takes place in 2 or 3 sessions
How to terminate
Must give adequate preparation and opportunity to work through thoughts and feelings about ending the relationship (time for counselor to use immediacy and talk about your feelings w/ client)
maintain therapeutic gains and prevent relapse
think about work that needs to be done in the future (support group, religious groups,)
talk about the nature and timing of any future contacts and referrals, door is not closed, if they need to come back it's ok.
write a termination summary report
When might you have resistance to termination?
clients who are unable to verbalize their anxiety about stopping counseling
a way to suggest their uneasiness to end counseling-backslide, regression, act out
don't get caught up in behavior, listen to message underneath,
use advanced challenging skills-fading, interpret behavior, consider extending time, plan follow-up meeting
What about unplanned endings/ premature termination?
1/3 of all clients do not return to counseling after 1 or 2 sessions
no single characteristic can predict premature termination
appears to be associated w/ a deterioration of the therapeutic relationship or a flight to health
many possible reasons- money, transportation, work, relationship, etc.
What is the medical model for designing a treatment plan?
diagnose, which is basis for determining treatment client will receive.
What is the theoretical orientation model for designing a treatment plan?
based on theory counselor subscribes
those who take an eclectic or integrated approach can utilize the techniques of different theories
What is the REPLAN model?
goal oriented treatment planning model using the 6 curative factors
does not conflict w/ making a DSM4 diagnosis or using theoretically oriented models
a brief treatment model, but not incompatible with long term
What are the 3 steps in REPLAN?
1st step- set goals
2nd step- use curative factors to set up strategies,
3rd step-revisit every 6 weeks, to move to new problems as old issues are resolved
R in REPLAN?
develop and maintain a therapeutic bond
being culturally sensative
using skill of immediacy
E in REPLAN
Enhancing Efficacy and Self-esteem
focus on client strengths
decrease irrational beliefs and develop more realistic ones- decrease negative self-talk
move clients to pay more attention to their strengths and abilities
countering-identify the negative self talk and replace it with positive
Assertiveness training- done well in groups, so they have a chance to practice
What is the difference between Self-efficacy and self-esteem?
Efficacy is the expectation that one can perform a specific task, usually tied to certain tasks and experience
Self-esteem is like self-worth, a feeling that one has the right to exist that one is basically good and worth to live, self-approval.
What are 7 irrational beliefs? (Ellis)
1. need to loved and approved by everyone
2. one should be competent and achieving in all aspects
3. certain people are bad and they should be punished
4. it's awful and a catastrophe when things aren't the way we want them to be
5. human unhappiness is externally caused and we have no control over terrors or disturbances
6. it's easier to avoid life's difficulties and self-responsibilities than to face them
7. one's past history is an all important determinant of present behavior
What are the 5 steps of countering?
1. Do a brief assessment-self-monitoring
2. identify the negative thought patterns and core beliefs- using the self monitoring assessments, chose 3 or 4
3. identify Effective counters- way of talking back to oneself and disputing self criticism, to be effective, it should be consistent with client's beliefs, NOT a list supplied by counselor
4. Test counters and modify them- evaluate counters in session
5. Practice and Report-follow up and gauge progress and seek more effective counters,
What are precautions when teaching countering?
some are more potent than others- counselor may suggest words that might refine it or make it more effective, and produce more self-confidence
counters should be realistic- not just affirmations, but really should dispute negative ideas
counter should be in the same mode of thought as the thought it's disputing- angry thoughts should be countered with compassionate ones, passive with assertive,
shorter counters tend to be more effective than longer ones
What are the 3 steps to thought stopping?
1. Stating the thought
2. Creating a startling interruption
3. substituting a new thought
What is the P in REPLAN?
Practicing new behaviors
psychoeducational approach- they need basic knowledge- get rid of old habits and replace with new ones
Imagery- practice in session
Psychodramatic role play- special training required, client acts out past situation using others in group
Role play- not about the past, but about the future, something you need to learn, social skills, etc.
Homework-practice new behavior btw sessions, replace old habit by practicing new behavior- bibleotherapy, creative arts, don't give self-help books, shifts responsibility to client
aids- someone in client's social network and have them come in and discuss, works w/ children and their parents
journaling, blogging, client can find insight, make sure it's client specific expectation
What are the 3 precautions of role playing?
1. Stage fright- insufficient warm up time, inadequate preparation time, client's lack of confidence, inadequate reassurance from counselor
2. Very powerful, so client and helper may be unprepared for the strength of the emotion that is evoked- most of time in scenes from past...not in practicing for new behavior
3. because most helpers focus on client's thoughts and feelings, we sometimes have trouble thinking in dramatic terms. Show instead of tell, the helper learns more about the context of behavior
What are the 7 steps to role playing?
1. warm up
2. scene setting
3. selecting roles and role reversal
5. sharing and feedback
7. homework and follow up
Why give homework?
provide follow up or treatment continuance btw sessions
turn insight and awareness into tangible behaviors and prevent helping from being a place to unload one's feelings
transfer of training to real world situations
shift of control from the helper to the client, so they attribute progress to his own effort, greater efficacy and esteem will result
What are types of homework?
Journaling or record keeping
What are precautions with homework? 5
1. HW that have high probability of success should be chosen, esp. early in the relationship to keep client's hope alive. client learns that change is gradual
2. HW strategies should be individually tailored for each client
3. Practicing regularly is important, 10 min per day instead of 60 at once
4. HW should be simple and fit easy into lifestyle
5. As client progresses, HW should increase in difficulty or discomfort.