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The Raisin Experience

Observe a raisin with each of your senses in turn

Brings your focus to the present moment and what you are experiencing in that moment

Can be done with any food

The Park Bench Exercise

Sitting on a park bench, observe but do not engage with each person who walks by

Apply this principle to your thoughts, feelings, sensations, and surroundings

Application for mindfulness:

Student life

Personal life

Self-care for the therapist

Tool for clients

Mindfulness Application Research

American Mindfulness Research Association website (goamra.org) contains meta-analysis articles on the effects of mindfulness on various areas

This is a growing tool for both counsellors and laypeople and the body of research is ever-expanding

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Mindfulness means maintaining a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment.

Requires acceptance - non-judgmental awareness of your thoughts and feelings.

Benefits of mindfulness, according to research:

Improves your immune system

Increases positive and decreases negative emotions and stress

Changes your brain in areas linked to learning, memory, emotion regulation and empathy

Improves your memory and attention

Boosts empathy and self-compassion

Improves relationship satisfaction

Reduces anxiety, aggression, anger, hostility, and mood disturbance

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"It's about living your life as if it really mattered, moment by moment by moment." (Jon Kabat-Zinn, The Stars of Our Own Movie)

Pay attention to your breathing

Pay attention to what you are seeing, hearing, smelling, tasting, and touching

Pay attention to bodily sensations

Acknowledge that your thoughts and emotions are fleeting and do not define you

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1. What is the primary function of challenging?

a. Helping clients test reality and invest what they learn to create a better future

b. Helping clients clarify concerns

c. Helping clients appreciate their futures by understanding how their past has confused them

d. Helping clients construct a public face

2. According to Egan, invitations for clients to self-challenge should

a. involve a mix of challenge and support

b. be abrupt to capture the client’s attention

c. be soft and apologetic

d. be avoided

3. In helping, the term “blind spot” refers to which of the following?

a. Aspects of ourselves that we fail to see or choose to ignore

b. Aspects of others that we can see that they cannot

c. Problematic aspects of ourselves that can never be fixed

d. Precious parts of ourselves that reflect the saying “ignorance is bliss”

4. Advanced empathy is designed to help the helper to ________________.

a. respond more deeply to covert meanings in a client’s communication

b. communicate the deepest level of the helper’s commitment to the client

c. achieve a higher level of credibility with resistant clients

d. develop the most current clinical skills in psychotherapy

5. Egan recommends that helper self-disclosure typically be used ____.

a. selectively, carefully, and flexibly

b. to model openness and honesty

c. early in counselling to establish rapport

d. at the same level for all clients

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1. Which is the best definition of the term “working alliance?”

a. The network of mental health professionals supporting one client

b. The relationship between the client and the organization that provides their mental health services

c. The collaboration between client and helper based on their agreement to counselling goals and tasks

d. The identified skills and competencies required to work as a counsellor

2. Which of the following is most accurate regarding the collaborative nature of the relationship between the helper and the client?

a. Both the helper and the client have work to do in the problem-management and opportunity-development stages and tasks, and both have responsibilities related to outcomes.

b. The client needs to be as expressive and clear about problems as possible.

c. The helper must follow the stages and tasks of the helping process so that the client can be guided toward a successful outcome.

3. ______________ is a helper’s ability to understand the client from his or her point of view, and to communicate this understanding to the client when appropriate.

a. Empowerment

b. Empathy

c. Diversity

d. Working alliance

4. A distinguishing characteristic of a sound therapeutic alliance is

a. shared goals created in collaboration with the client

b. client’s access to an extensive support system.

c. an emphasis on personal growth and spirituality.

d. a clinician who uses caring confrontations.

5. During an intake, counsellors are primarily interested in

a. Obtaining information about the scope of the client’s problem(s) and relevant aspects of the client’s background and present situation

b. Solidifying a therapeutic alliance

c. Orienting the client to the therapy that will take place in future sessions

d. Verifying the client’s insurance or other means of payment for future sessions and categorizing the client’s problems

6. Which of the following is not a diversity and multicultural competency for a helper?

a. Understanding and appreciating diversity in its many forms and categories

b. Helping clients from other countries accept Canadian values to assimilate

c. Identifying and challenging one’s own cultural and personal-culture biases

d. Tailoring interventions with clients in ways that are sensitive to diversity

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Short answer questions will likely test overall comprehension and ability to synthesize what we've learned. I wonder if the short answers will ask us something like, "in a paragraph, discuss how an effective helper might begin a session with a new client." Or maybe there will be a short case study and we'll be asked to "identify the client's strengths, problem areas, and blind spots" or something to that effect.

Clarification around the distinct differences between working relationship and therapeutic relationship

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Empathic Responding: Work at Mutual Understanding

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Empathic Responding: Work at Mutual Understanding

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Chapter 5 Learning Objectives (p. 129)

1. Explain the importance of responding skills in developing relationships with clients.
2. List the three dimensions of all responding skills.
3. Synthesize ways counselors can communicate empathy in therapy.
4. Use empathy wisely to achieve therapeutic goals.
5. Recognize the shadow side of responding.

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Master the Art of Probing and Summarizing

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Master the Art of Probing and Summarizing

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Chapter 6 Learning Outcomes (p. 159)

1. Explain the power of nudging.
2. Define the types of effective probing.
3. Use summaries to provide focus and direction.
4. Describe the shadow side of communication skills.

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1. History of Counselling & Intro to Ethics (session 1-2) outcomes:

1. Define counselling

2. Discuss events and practices leading to the emergence of counselling

3. Discuss developments in psychological treatment approaches

4. Define ethics

5. Discuss benefits of following a code of ethics

6. Discuss general ethical principles and guidelines

7. Describe ways that setting can impact a client's experience in therapy

8. Discuss elements that should be considered in designing a therapy office

9. Evaluate elements of a therapy office

2. Ingredients of Successful Helping (session 3-5) outcomes:

1. Discuss the role that the client and the contextual factors of the client's life play in contributing to successful therapy

2. List ways that the therapist can use client characteristics to promote positive therapeutic outcomes

3. Discuss client characteristics that affect therapeutic outcomes

4. Discuss the role that the following play in contributing to successful therapy:

define success in terms of life-enhancing outcomes

the therapist

working alliance*

communication skills

cognition, behaviour, and emotions

feedback

beliefs, values, norms, and moral principles

decision making

treatment models

5. Describe Egan's Problem Management Framework

3. Shadow-Side of Helping (session 6) outcomes:

*Define the therapeutic alliance / working alliance*

Discuss the conditions necessary for a therapeutic alliance

Discuss strategies for fostering a therapeutic alliance.

Explain the purpose of an intake interview.

Use a standardized intake form to role-play an intake interview.

*Describe the role of the values that drive the helping relationship:

respect,

empathy,

diversity,

self-responsibility, and

action

Give examples of guidelines for incorporating the values of respect, empathy, diversity, self-responsibility, and action in counselling.

Reflect on your personal and professional values.

4. Intake Communication Skills (session 8-9) outcomes:

1. Four Elements of Dialogue

Discuss the four elements required for dialogue

2. Active Listening

3. Forms of Poor Listening

Identify forms of poor listening

5. SOLER (session 10) outcomes:

1. Explain the five aspects of SOLER

visibly tuning in

2. Discuss ways that people communicate non-verbally

non-verbal communication channels

6. Responding to Clients (session 11) outcomes:

1. Discuss dimensions of responding

2. Recall the basic formula for empathic understanding

3. Discuss guidelines for responding to clients accurately

4. Discuss guidelines for responding to clients with empathy

5. Describe the process for checking the accuracy of your understanding and recovering from misunderstanding the client

6. Discuss shadow forms of responding and strategies to avoid them

7. Prompting Probing Summarizing (session 13-14) outcomes:

1. Define prompt

2. Define probe

3. Give examples of verbal and nonverbal prompts

4. Discuss guidelines for using probes in therapy

5. Describe the goals of summarizing

6. Discuss optimal times to engage in summarizing

8. Client Challenge / Self-Challenge (session 16) outcomes:

1. Explain the role of challenge in counselling

2. Discuss the targets of challenge

3. Discuss common blind spots and strategies for inviting clients to challenge them

4. Discuss guidelines for effective invitations to self-challenge

5. Discuss blocks to challenge and strategies to avoid them

The Goals of Challenging

Targets of Challenge

9. Mindfulness (session 18-19) outcomes:

1. Define mindfulness

2. List the benefits of mindfulness

3. Discuss ways to practice mindfulness

4. Identify applications for mindfulness in therapy

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Mindfulness is a nonjudgmental awareness of one’s thoughts, feelings, sensations, and surroundings in the present moment

Research shows that mindfulness can improve immunity, mood, memory, attention, and more

Mindfulness can be used for your own self-care as a student and a therapist and taught to your clients

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Targets of Challenge

Self-defeating mindsets

Self-limiting internal behaviour

Self-defeating expressions of feelings and emotions

Dysfunctional external behaviour

Distorted understanding of the world

Discrepancies between thinking and acting

Unused strengths and resources

Predictable dishonesties of everyday life

Goals of Challenging

Help clients challenge themselves to

Change ways of thinking, expressing emotions, reacting, and acting that keeps clients mired in problem situations and prevent them from identifying and developing opportunities

Become partners with the client in helping them challenge themselves to:

Find opportunities in their problems

Discover unused strengths and resources, both internal and external

Invest these resources in the problems and opportunities of their lives

Commit themselves to the actions needed to make it all happen

In summary, the goals of the challenge are:

To change patterns keeping clients mired in problem situations and prevent them from identifying and developing opportunities

To partner with the client in helping them challenge themselves

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All helping is a mixture of support and challenge

Challenging without being supportive will result in an unpleasant confrontation, alienating your client

Being supportive without challenge can end up empty and counterproductive

Find the right mixture between support and challenge is essential for a change to take place

Good counsellors also help their clients test reality by challenging them and their assumptions

Certain patterns of congruency and discrepancy between client and counsellor facilitate change. There is a significant boy of research suggesting that congruency between counsellor and client enhances the therapeutic relationship, whereas discrepancy between the two facilitates change (Trevino, 1996, p. 203)

Claiborn (1982, p. 446) concluded that the presentation of discrepant points of view contributes to positive outcomes by changing "the way the client construes problems and considers solutions." (cited by Trevino, 1996, p. 203)

"We must say difficult things to clients in plain nonjudgmental language." (Finn, 2005)

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1. What two basic issues cause most people to seek the helping process?

a. Problem situations and unused opportunities

b. Depression and alcoholism

c. Missed opportunities and anger

d. Problem situations and anxiety

2. Though there are many ingredients in helping, what is ultimately one of the key predictors of successful therapy?

a. The client’s ability to clearly understand the problem

b. The client’s freedom from emotional baggage

c. The client’s development of cognitive and behavioural skills

d. The client’s participation in the therapeutic endeavour

3. According to the research, what is the second most important ingredient in successful therapies (after client factors)?

a. Therapist factors (e.g., experience)

b. The quality of the relationship between the client and the therapist

c. The timing of therapist interventions

d. Scientifically based approaches to helping

4. Feedback is important in the helping process. Which is the best practice regarding feedback?

a. One-way feedback from the client to the therapist

b. One-way feedback from the therapist to the client

c. Two-way feedback between the client and the therapist

d. Every client is different, sometimes no feedback is needed

5. The tasks of Stage I of The Skilled Helper approach developed by Egan all have to do with which of the following?

a. The client’s past

b. The client’s present situation

c. The client’s future goals

d. Integrating the client’s past, present, and future

6. Which of the following is important to understand in using helping models?

a. Other helping approaches (outside the problem-management process) are not needed, as they unnecessarily complicate things.

b. Helpers should have a specific model for each disorder/problem that clients are trying to manage.

c. Staying current with research in the helping professions is typically pointless, given the current fads and tendency to replicate ideas.

d. Helpers need to share the helping process to help clients be in the driver’s seat for making decisions.

7. The acronym ADDRESSING is important because:

a. It can improve the counsellor's cultural competence

b. It helps counsellors understand the effect of their client's address on their personality

c. ADDRESSING provides an all-inclusive treatment modality

d. About 25% of therapists describe themselves as being culturally challenged

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Nudges can be used as a way of subtly influencing your clients to meet these goals. Nudging is an intervention on the part of the therapist that "predictably alters behaviour without forbidding any options" in the form of prompts, probes, and summarizing.

1. Prompting

brief verbal or nonverbal interventions designed to let clients know that you are with them and to encourage them to talk freely.

come in the form of:

bodily movements, gestures, nods, eye movement or change of facial expression

Vocal or verbal prompts include the use of responses such as "um," "uh-huh," "sure," "yes," "I see," "ah," "okay," and "oh"

2. Probing

designed to provide clarity and move things forward at any stage of the helping process

come in the form of:
- "statements," indicating the need for further clarity
- "requests," for further information or clarity
- "questions," in the form of what? why? how? (open-ended)
- "single words or phrases used as questions or requests

3. Summarizing

help clients summarize the main points of a helping interchange or session is a skill that can be used to provide focus and direction and challenge clients to see things from different points of view

Can be used to:
- Warm up the client
- Refocus scattered thoughts and feelings
- Bring the discussion of a particular theme to a close
- Challenge the client to explore a theme more thoroughly

When:
1. At the beginning of a new session
2. During a session that is stalled
3. To wrap up a session that is coming to a close

Benefits of having the client summarize
- keeps the ball in their court
- helps them own their own stories and remain active in the therapy process
- allows them to pull together salient points and move on in their time
- can help clients notice their own progress/how far they've come, such as in the last therapy session you are having together

What to avoid
- Do not overwhelm clients with the contents of a summary (be brief and concise)
- Do not use summaries to "build a case" against a client or someone they are referring to
- This is not a test - the counsellor should provide help as needed
- Summarize in a way that provides a neutral way to move forward instead of being stuck on a theme

You influence your clients to help them to meet the following goals of helping:
- Discuss difficult problems
- Develop new, life-enhancing perspectives on themselves, others, and the world
- Work on the core issues
- Explore possibilities for a better future
- Choose and commit themselves to problem-managing goals
- Explore ways of achieving these goals
- Engage in effective and efficient action needed to accomplish all of this

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Three dimensions of responding:

1. Perceptiveness

2. Competence/Know-how

3. Assertiveness

Recipe for empathic responding:

“you feel…because…,” it’s important that you use the correct family of emotions and the right intensity of the emotion.

The four main families of emotions can be grouped under the following headings: sad, mad, bad, glad

Any of these emotions can vary from low to high in intensity

Distinguish between expressed and discussed feelings

Expressed feelings are the feelings felt by the client during the session

Discussed feelings are feelings the client felt at the time of the event they are describing

Your client may have felt terrified of taking an action when they took it (discussed feeling) but sitting in front of you, they may be feeling elated that they did it (expressed feeling).

Read and respond to feelings and behaviour embedded in client’s nonverbal behaviour.

Often clients are unable to communicate their feelings, emotions, and moods with words

You might be able to infer their emotional state from their non-verbal communication

They may appear sad, anxious, apathetic, or worried. You can reflect that back to them to move the conversations forward.

Be sensitive in naming emotions

Some clients may be hesitant to talk about their emotions. It might be too threatening for them to get in touch with their emotions, or it might be culturally unfamiliar for them to do so.

You might need to begin with responding to their experiences rather than feelings. The goal, however, will be to bring the client’s feelings into focus.

Use variety in responding to client’s feelings and emotions. You can respond with:

Single words

Different kinds of phrases

What is implied in behavioural statements

What is implied in the client’s experiences

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Egan's recipe for tuning in and demonstrating that you are present with your client:
S - sit squarely
O - open posture
L - lean in
E - eye contact
R - relaxed

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Non-Verbal Channels of Communication:

1. Bodily behaviour - posture, body movements, gestures

2. Eye behaviour - eye contact, staring, eye movement

3. Facial expressions - smiles, frowns, raised eyebrows, twisted lips

4. Voice-related behaviour - tone, pitch, volume, intensity, inflection, spacing of words, emphases, pauses, silences, fluency

5. Physiological response - pace of breath, blushing, paleness, pupil dilation, perspiration

6. Physical characteristics - fitness, height, weight, complexion

7. Space - at what distance a person chooses to be during conversation

8. General appearance - personal grooming and attire

The Helper’s Internal Conversation

To be an effective helper, you need to listen not only to the client but also to yourself, paying attention to your “internal conversation”

Internal conversation includes your nonverbal behaviour, your feelings and your emotions.

The internal conversation may be about yourself, your client or the relationship

It goes on all the time. An effective helper uses it as a tool for helping.

It can help you identify what you can do to further assist the client and also what is hindering your ability to assist them.

Take care not to become preoccupied - listen to yourself on a “second channel.”

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1. Four elements of effective dialogue

1. Cat-hat party!

Connecting

Collaborating

Turn-taking

Mutually influence

2. Visibly tuning-in

1. Active Listening as Foundation of Understanding:

Tuning in serves the purpose of understanding your client and is a part of active listening

Active listening reflects the fact that listening is a goal-oriented task that requires:

Intent

Focus

Effort

2. Forms of Poor Listening:

Non-listening - listening without being engaged, tuned out.

Partial listening - listening to only some of what is said, missing the main points

Audio-recorder listening - listening at a surface level only, able to repeat what is said but missing the underlying message

Rehearsing - focusing on what you will say next rather than fully listening to the client

3. Non-verbal communication

1. Non-Verbal Behaviours Help:

Regulate conversations

Communicate emotions

Modify or nuance verbal messages

Provide important messages about the helping relationship

Give insights into self-perceptions

Provide clues when clients or counselors are not saying what they are thinking

2. Non-Verbal Channels of Communication:

Bodily behaviour - posture, body movements, gestures

Eye behaviour - eye contact, staring, eye movement

Facial expressions - smiles, frowns, raised eyebrows, twisted lips

Voice-related behaviour - tone, pitch, volume, intensity, inflection, spacing of words, emphases, pauses, silences, fluency

Physiological response - pace of breath, blushing, paleness, pupil dilation, perspiration

Physical characteristics - fitness, height, weight, complexion

Space - at what distance a person chooses to be during conversation

General appearance - personal grooming and attire

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1. Respect

2. Empathy

3. Diversity

4. Self-Responsibility

5. Action

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Embedded in therapy

Embedded in people - a "human universal," familiar and logical to people across cultures

Poses 4 questions for clients:

1. What is going on?

2. What does a better future look like?

3. How do I get there?

4. How do I make it all happen?

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1. Focus primarily on the client and the contextual factors of the client's life

2. Define success in terms of outcomes with life-enhancing impact for the client

3. Describe what an effective therapist looks like

4. Develop and working alliance with the client

5. Acquire and use the communication skills at the heart of the therapeutic dialogue

6. Integrate the basic principles related to cognition, behaviour, and emotions

7. Use feedback to improve the effectiveness of the helping sessions and client's change efforts

8. Come to grips with the role that beliefs, values, norms, and moral principles play in the helping process

9. Help the clients review poor decisions and execute life-enhancing decisions

10. Adopt a treatment model aligned with the universal problem-management process

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Guidance (1890s-1915)

developed out of attempts to improve the lives of those adversely affected by the industrial revolution

influenced by the social welfare reform movement, spread of public education, and changes in population makeup including an influx of new immigrants

Jesse B Davis pioneered the institutionalization of guidance in schools & primary audience was schoolchildren

focused on understanding one's character, moral consciousness, and interpersonal relations

Vocational Guidance (1915-1940)

Pioneered by Frank Parsons, who suggested 3 factors be considered when (primarily young) people were making career decisions:

knowledge of work,

knowledge of self, and

matching of these through "true reasoning"

based on simple logic and lacked philosophical or psychological foundation

adopted the psychometrics movement developed during WWI and trait factor psychology, which granted it more legitimacy

overreliance on testing; creating labels; lacked self-determination; authoritarian; popular until WWII

Counselling (1945-today)

evolved following WWII, offering guidance to "the person as a person" as vocational guidance transformed into career development

more person-based rather than problem-based

dominated by Carl Roger's client-centred counselling

defined as "a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals"

Early Methods:

Freud - 1900s neurologist; "the talking cure" (hypnosis > free association); ​key concepts unconscious mind, defenses (i.e. repression, resistance), drives, projection, transference; analytic technique of interpreting dreams & "Freudian slips"

Freud's significant students ("CASO" acronym) included:

Carl Jung - animus/anima, personality archetypes, Analytical Psychology

Alfred Adler - social relationships and innate growth

Sandor Feranzi - emphasized active therapist-client relationship; first to name countertransference

Otto Rank - emphasized the relationship between mother and child

Carl Rogers - “Father of Counselling” championed person-centred therapy 1940s

relationship as central

empathetic understanding

unconditional positive regard

congruence

Behavioural Theories

treatment for anxiety-based behaviour problems; popularized in 60s & 70s

John Bowlby - attachment theory; secure vs insecure

Watson - 1913; Behavioural Theory

Pavlov - 1903; Classical Conditioning

Skinner - 1938; Operant Conditioning

Eysenck - among first who applied learning theory and conditioning techniques to therapy

Wolpe - 1958; Systematic Desensitization for phobias

Cognitive Theories

Ellis - 1955; Rational Therapy including ABC Model; became Rational Emotive Behaviour Therapy in 1993

Beck - 1960s; developed Cognitive Therapy aroun schemas

Rogers - Person-Centred Therapy where therapeutic relationship is paramount

Humanistic-Existential Theories

grew from ideas of existential philosophers such as Kierkegaard, Friedrich Nietzsche, Martin Heidegger, Martin Buber, Jean-Paul Sartre

Viktor Frankl - 1946; Logotherapy focused on search for meaning

Humanistic-Gestalt Theories

developed by Fritz & Laura Perls in the 40s and 50s

Goals of Gestalt are

raising the client's awareness

enlarging the client's choice

helping the client to make full contact with themselves and their environment

the role of the therapist is that of a facilitator, emphasizing the client's self-support rather than their reliance on the therapist

Integration

by 1936 there was interest in integrating therapeutic models

Theoretical integration - merging two or more models

Common factors approach - identifying factors most commonly associated with positive outcomes across models

Technical eclecticism - an atheoretical approach wherein the best therapeutic technique is selected based on the presenting problems

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Ethics is a system of moral principles that guide behaviour.

General Ethical Principles:

1. Nonmaleficence and beneficence - doing no harm and promoting client well-being

2. Autonomy - supporting clients toward making their own wise decisions and respecting client diversity and agency

3. Justice - acting fairly

4. Fidelity - fulfilling commitments to clients and to the profession

5. Confidentiality - maintain whenever possible and use thought and care in circumstances where you must break confidentiality; inform clients upfront of the circumstances under which you cannot maintain confidentiality

6. Professional Responsibility - practice within your scope of competence and present your credentials accurately; commit to lifelong learning, development and improvement of competence and skill; maintain professional relationships and use collaboration/consultation well

7. Evaluation, Assessment & Interpretation - use interventions that are within your scope of competence and appropriate for the client's needs, for the betterment of the client

Following a code of ethics:

Lends strength and credibility to the profession

Guides professional decision making

Gives clients information about what a professional can and cannot do

Can protect professionals in the face of legal accusations

Is required for membership with professional associations and for licensure, where applicable

Each association has their own code of ethical standards agreed upon by that group of professionals

Canadian Professional Counsellors Association (CPCA)

Association of Cooperative Counselling Therapists (ACCT)

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Treatment models as organizers

There are dozens of treatment approaches. Their primary contribution to successful helping is they provide a framework to organize the process of therapy

Successful helping requires several ingredients, each important and interactive and dynamic in therapy.

The Problem Management Framework is one way of organizing the process for therapy.

The Problem Management Framework is an intuitive model embedded in every other framework.

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Therapy is a decision-rich process

Clients make decisions - coming to therapy, choosing issues to discuss, choosing options, choosing goals, etc. They have their own style of decision-making.

Helpers make decisions - choosing approach, choosing issues to highlight, choosing interventions and responses, etc.

Steps to making a rational decision:

Problem identification & information gathering

Analysis

Making a choice

Follow through

Most decisions are rational, indirect as well as adaptive

Two decision-making styles: fast (intuitive) and slow (logical)

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Beliefs, Values, Norms & Moral Principles

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Beliefs, Values, Norms & Moral Principles

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Therapy must be value-driven and ethical to serve society as well as the individual

The beliefs, values, norms, ethics, and morality of clients and therapists are embedded in helping

What do you value?

How have social norms influenced you?

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What is the importance of feedback?

Monitor progress towards life-enhancing client outcomes ("What does progress look like?")

Monitor the degree to which therapy sessions are contributing to these outcomes ("How are we doing?")

Could use brief surveys

Giving feedback to the client can be a form of encouragement and an invitation to self-challenge

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At the core of your relationship with your client is the ability to communicate effectively with one another

You do not have control over the communication skills the client brings to the session (although you can help them develop the skills within therapy), but you can foster your own skills

Attending to the client

Engaging in unbiased listening

Working at understanding what clients are saying about themselves

Responding to clients with understanding

Helping clients explore their concerns more fully

Helping them stay focused

Helping them develop new perspectives on their problem situations and unused opportunities

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A successful outcome of counselling requires that clients go away able to manage their problems in living more effectively and to develop opportunities on their own

Sharing some form of the problem-management and opportunity-development process with them during sessions is essential in order for this to occur

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Goal 1: Life-Enhancing Outcomes

Goal 2: Learning Self-Help

Goal 3: Prevention Mentality

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How could you invite your client to self-challenge?

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How could you invite your client to self-challenge?

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In class discussion: what would you do/say?

"I'm wondering if we could try....."

"What do you think you could do to face that head on?"

"If nothing changes then where do you see this ending up?"

"What kind of options can we find here together?"

"I would invite you to try one of the options we have discussed on your own, and then we can discuss it in our next session."

"What would you be comfortable with here?"

"If I were to present you with this scenario, how do you think you might perceive it?"

"Earlier you said x, how would you [use that skill]/[apply that] in this situation?"

"What do you think would be helpful to direct you toward your desired outcome?"

"Do you recognize any behaviour patterns that have helped move you toward that goal?"

"If X doesn't work, what other options do you see?"

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"Fools rush in"
Blind spot #1: not stopping to think

"Often wrong, but never in doubt?"
Blind spot #2: what you don't know can hurt you

"If it were any closer, it would bite you!"
Blind spot #3: not noticing

"My own worst enemy"
Blind spot #4: not seeing yourself

"Don't give a cat calendar to a dog lover!"
Blind spot #5: my-side bias

"Thinking inside of the box"
Blind spot #6: trapped by categories

"Thinking by the seat of your pants"
Blind spot #7: jumping to conclusions

"Why it's so hard to find the proof in the pudding"
Blind spot #8: fuzzy evidence

"The usual suspects" why we miss the real culprit
Blind spot #9: missing hidden causes

"He can't see the forest for the trees"
Blind spots #10: missing the big picture

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Sternberg on Why Smart People Do "Stupid" Things

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Sternberg on Why Smart People Do "Stupid" Things

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The egocentrism fallacy

They think it's all about them. In planning their actions, they take into account their own interests, but no one else's

The omniscience fallacy

They may indeed know a lot about something. However, they start to think they know everything about everything.

The omnipotence fallacy

They think that they are all-powerful - that they can do whatever they want

The invulnerability fallacy

They think that they can get away with whatever they do - that they will not be caught, or that even if they are, they will be able to get themselves out of any fix.

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Being liked and loved

"I must always be loved and approved of by the significant people in my life"

Being competent

"I must always, in all situations, demonstrate competence, and I must be both talented and competent in some important area of life"

Having one's own way

"I must have my own way, and my plans must always work out"

Being a victim

"Other people and outside forces are responsible for any misery I experience. No one should ever take advantage of me."

Avoiding

"It is easier to avoid facing life's difficulties than to develop self-discipline; making demands of myself should not be necessary."

Passivity

"I can be happy by avoiding, by being passive, by being uncommitted, and by just enjoying myself."

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Self-defeating mindsets

Mindsets - more or less permanent states of mind; assumptions, attitudes, beliefs, values, biases perceptions of self/others/the world, etc.

Mindsets, whether productive or problematic, tend to drive behaviour

Your role will be to invite clients to transform self-limiting mindsets into self-enhancing and liberating new mindsets, all with the purpose of your clients practicing new behaviours, leading to desired outcomes.

Self-limiting internal behaviour

Not all thinking is just thinking. Some forms of thinking are actually behaviours. They are things we can choose to do or not do.

For some clients, developing new perspectives and changing their internal behaviour can be enormously helpful.

Self-defeating expressions of feelings and emotions

Managing our emotions and the ways we express them is part of social-emotional intelligence

Some of our emotions are bottled up to the degree that we are not aware of them, some are accessible to us but only inside, and others are quite visible.

You can help your clients to face up to needless denial and bottling up of emotions, like refusing to acknowledge the one was hurt; letting emotions run riot internally while not expressing them externally; and self-defeating forms of emotional expression, like flying off the handle.

Dysfunctional external behaviour

External behaviour refers to both things we do and things we do not do (e.g. confronting someone or avoiding the confrontation; both of which have consequences)

Your job will be to help your clients change their behaviours so that they learn to cope with their problems better or develop opportunities they otherwise would not have developed.

Distorted understanding of the world

Clients' failure to see reality correctly can keep them mired in problem situations and prevent them from identifying and developing opportunities (e.g. their assessment of their own capacity, which could be exaggerated or undervalued)

Discrepancies between thinking and acting

What clients think or feel versus what they say

What they say versus what they do

Their views of themselves versus the views others have of them

What they are versus what they claim they want to be

Their stated goals versus what they actually accomplish

Their expressed values versus their actual behaviour

Unused strengths and resources

Some resources are client based (e.g. unused talents and abilities) and some are external (e.g. failure to identify and use social support in managing problems or developing opportunities)

Even self-defeating behaviours can be a source of strength.

e.g. if a client employed considerable logic to explain away a circumstance, you can commend them on their ability to use their logic while inviting them to apply it now to achieve a different goal: to see the world as it is.

Predictable dishonesties of everyday life

"The 'predictable dishonesties of life' refers to the distortions, evasions, games, tricks, excuse-making, and smoke screens that keep clients (and ourselves) mired in their problem situations. All of us have ways of defending ourselves from ourselves, from others, and from the world. We all have our little dishonesties." [p. 197]

If taking responsibility for something is too unpleasant, we can blame others. But that can damage your relationship with those others perpetuate an unhealthy coping strategy.

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Help clients challenge themselves to

Change ways of thinking, expressing emotions, reacting, and acting that keeps clients mired in problem situations and prevent them from identifying and developing opportunities

Become partners with the client in helping them challenge themselves to:

Find opportunities in their problems

Discover unused strengths and resources, both internal and external

Invest these resources in the problems and opportunities of their lives

Commit themselves to the actions needed to make it all happen

In summary, the goals of the challenge are:

To change patterns keeping clients mired in problem situations and prevent them from identifying and developing opportunities

To partner with the client in helping them challenge themselves

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All helping is a mixture of support and challenge

Challenging without being supportive will result in an unpleasant confrontation, alienating your client

Being supportive without challenge can end up empty and counterproductive

Find the right mixture between support and challenge is essential for a change to take place

Good counsellors also help their clients test reality by challenging them and their assumptions

Certain patterns of congruency and discrepancy between client and counsellor facilitate change. There is a significant body of research suggesting that congruency between counsellor and client enhances the therapeutic relationship, whereas discrepancy between the two facilitates change (Trevino, 1996, p. 203)

Claiborn (1982, p. 446) concluded that the presentation of discrepant points of view contributes to positive outcomes by changing "the way the client construes problems and considers solutions." (cited by Trevino, 1996, p. 203)

"We must say difficult things to clients in plain nonjudgmental language." (Finn, 2005)

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Help clients

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Clients may have varying degrees of "blindness" to issues in their lives. Challenging these can help the client move to new perspectives.

Simple unawareness - Things clients are simply not aware of

Failure to think things through - After exploring problems and opportunities, searching for possibilities, or formulating plans of action in an incomplete and haphazard way, we go on to base decisions on our flawed reason

Self-deception - There are things clients would rather not know because if they

Choosing to stay in the dark -

Knowing, but not caring and failing to see consequences -

Important skills for helping clients challenge their blind spots and move to new perspectives:

Advanced empathy

Information sharing

Helper self-disclosure

Making assumptions and giving recommendations

Confrontation

Encouragement

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1. Avoid the "MUM effect"

At first, you might find it difficult to invite your clients to challenge themselves

You might want to keep silent, or "mum" about what you might see as undesirable messages to your clients

If you do, you will be less than effective as a therapist

It may help you to remember that your role is not to hold clients accountable but rather invite clients to hold themselves accountable.

2. Recognize your excuses for not inviting clients to challenge themselves

"I am just not used to challenging others. My interpersonal style has had a lot of the live-and-let-live in it. I have misgivings about intruding into other people's lives"

"If I challenge others, I open myself to being challenged. I may be hurt, or I may find out things about myself that I would rather not know."

"I am afraid I will hurt others, damage them in some way or another. I have seen others hurt by heavy-handed confrontations."

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Guidelines for Effective Invitations to Self-Challenge

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Guidelines for Effective Invitations to Self-Challenge

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1. Keep the goals of the client self-challenge in mind:

Always be clear about the reasons why you are inviting your client to self-challenge

It should be to help clients develop the kinds of alternative perspective, internal behaviour, and external actions needed to achieve the three goals of helping (life-enhancing outcomes, learning self-help, and developing a prevention mentality).

2. Don't force clients to make decisions, but do provide "choice structure"

Allow your client to see that they can choose other ways of thinking or behaving

Therapeutic dialogue between you and your client allows for the emergence of such conversations and for the client to have an insight and make a different choice.

When you invite your client to self-challenge, you are also supporting them in their exploration of different perspectives, thus providing "choice structure."

3. Be tentative but not apologetic in your approach

If you are overly direct in your challenges, they might come across as confrontations or accusations, putting clients in a defensive posture.

You want your clients to respond to you-not react.

On the other hand, you need to take care not to sound apologetic because that can prompt your client to dismiss what you are saying.

It is a fine balancing act to deliver your point in a way that can be heard by the client, nudging them to reflect on themselves rather than react to you.

4. Help clients make their self-challenges clear and specific

A vague invitation to self-challenge will leave your client lost

A clear and specific invitation to self-challenge should rejuvenate the dialogue and move your client forward.

Instead of saying the generic, "you need to pull yourself together," you may say, "You didn't have control over what happened to you, but you do have control over how you respond to it. What do you think about your response to being laid off thus far?"

5. Invite clients to challenge unused strengths rather than weaknesses

When people dwell too much on their shortcomings, they tend to belittle their achievements and withhold rewards from themselves even when they engage in life-enhancing behaviour.

Challenging strengths means helping clients explore the assets and resources they have but fail to use.

Even those who went through adverse life experiences can see those as sources of strengths.

When refocusing your client on the unused strengths rather than weaknesses, take care not to minimize the suffering the client has experienced.

6. Help clients build on their success

Often, clients will minimize their achievements. That stance allows them to view themselves as less than capable.

If you see the discrepancy, see if it is appropriate to invite your client to challenge that assumption.

The goal is for them to shift their perspectives, allowing themselves to appreciate and celebrate their successes, building on them one at a time, instead of dwelling on difficulties and shortcomings.

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Invitations to self-challenge should be made:

Within a strong therapeutic alliance

With empathy

With therapeutic goals in mind

By providing "structured choice"

Tentatively but not apologetically

Clear and specific

Invite clients to challenge unused strengths rather than weaknesses

Help clients build on their successes

1. Develop a solid relationship on good rapport and understanding
2. Be open to invitations to challenge from others - how to you respond to being challenged?
3. Work on your own life - what's left unchallenged?
- Mitchell & Berenson

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Following WWII, counselling psychology evolved, offering guidance to “the person as a person”, shifting away from a problem-based approach to a person-based approach.

Advances in developmental psychology, learning theory, psychiatry and sociology transformed Vocational Guidance into Career Development.

Counselling emerged as its own discipline and was dominated by Carl Rogers’ client-centered counselling.

Counselling can be defined as a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals.

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Aimed to guide young people in the process of making career decisions.

Pioneered by Frank Parsons:

He suggested to consider 3 factors when choosing a vocation:
1. knowledge of work,
2. knowledge of self, and
3. matching of these through “true reasoning.”

Following his influence, the Superintendent of Boston Schools designated 117 teachers as vocational counsellors, and other districts soon followed suit.

Early Vocational Guidance was based on simple logic and lacked a philosophical or psychological foundation.

During WWI, the psychometrics movement developed.

Vocational Guidance adopted psychometrics and trait factor psychology, which granted it more legitimacy.

An overreliance on testing had the unintended result of creating labels as opposed to increasing self-determination.

Today, we view it as rather authoritarian.

Maintained popularity until the end of WWII.

The Great Depression, population increases, increased educational opportunities and women in the workforce created demands this model could not answer adequately.

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No mention of counselling in formal literature until 1931. In the US, it began as guidance.

Guidance was developed in the early 1900s out of concern for improving the lives of those adversely affected by the industrial revolution.

Also influenced by the social welfare reform movement, spread of public education, and changes in population makeup including an influx of new immigrants

Primary audience was schoolchildren

Jesse B. Davis pioneered the institutionalization of guidance in schools

Focused on understanding one’s own character, moral consciousness, and interpersonal relations

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“Counselling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.” - (20/20: A Vision for the Future of Counseling, 2010)

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Other Important Figures in Psychotherapy

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Other Important Figures in Psychotherapy

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Various theories of human functioning and therapy models have emerged over the 20th century, giving today’s counsellors a well-developed and heterogeneous toolkit.

Behavioural Therapies & Theory

Were established in the 1960s and 70s with developments including modelling behaviour, social skills coaching, and self-help strategies

In the late 1970s, research cemented behaviour therapy as an effective treatment for many anxiety-based behaviour problems but showed limited application to problems driven by internal, unobservable processes

1. John Bowlby

Developed Attachment Theory, demonstrating through direct observation the effects of separation from the mother on small children.

Described secure and insecure attachment strategies and how each creates an ongoing pattern of attachment throughout a person's life.

Today, it is a central element to many psychotherapeutic theories and practices, and recent scientific breakthroughs are providing new information that supports and develops Bowlby's ideas

2. Watson

Developed Behavioural Theory in 1913 and defined psychology as "purely objective"

3. Pavlov

Developed the concept of Classical Conditioning in 1903

4. Skinner

Developed the concept of Operant Conditioning in 1938

5. Eysenck

Was among the first to use the term "Behaviour Therapy" and to apply learning theory and conditioning techniques to therapy

6. Wolpe

Developed "Systematic Desensitization" as a treatment for phobias in 1958

Cognitive Therapies & Theories

1. Ellis

Developed Rational Therapy in 1955, including the ABC Model:

This therapy was renamed "Rational Emotive Behaviour Therapy" in 1993 to recognize its behavioural and emotional aspects

2. Beck

Developed his theory of Cognitive Therapy in the 1960s, which revolved around cognitive schemas

3. Rogers

Championed this branch of therapies with his Person-Centered Therapy:

1. the therapeutic relationship is a central component of this therapy

2. empathic understanding, unconditional positive regard, and congruence were identified as essential qualities for the therapist to possess; this has been integrated into many other therapies

Humanistic - Existential Therapies

Grew out of ideas from existential philosophers such as Kierkegaard, Friedrich Nietzsche, Martin Heidegger, Martin Buber, Jean-Paul Sartre and others

In 1946, Viktor Frankl developed Logotherapy, a type of Existential Therapy focused on the search for meaning (aka the here-and-now) and owning one's free will

Humanistic - Gestalt Therapies

Fritz & Laura Perls

Developed Gestalt Therapy in the 40s and 50s

Goals of Gestalt are

raising the client's awareness

enlarging the client's choice

helping the client to make full contact with themselves and their environment

The role of the therapist is that of a facilitator, emphasizing the client's self-support rather than their reliance on the therapist

Integration

As early as 1936, there was interest in integrating therapeutic models

Theoretical integration - merging two or more models

Common factors approach - identifying factors most commonly associated with positive outcomes across models

Technical eclecticism - an atheoretical approach wherein the best therapeutic technique is selected based on the presenting problems

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As a neurologist, Freud aimed to apply a medical model of his theories of psychological distress and its treatment

Initially developed "the talking cure" which involved hypnosis and the patient talking about their symptoms and then linking them to feelings, events, and repressed trauma memories

Later replaced hypnosis with free association wherein the patient talked about whatever came to their mind without censoring or seeking logical connections

Developed key concepts including the unconscious mind, defenses (i.e.. repression, resistance) and drives

Developed the analytic technique, which included the exploration of dreams and slips of the tongue (aka Freudian slips) as ways to access the unconscious mind and the therapist's interpretation of the material offered by the client

Developed the concepts of projection and transference, which are still used in psychotherapy today

Several students of Freud went on to make contributions to psychotherapy:

Carl Jung - medically trained, developed Analytic Psychology, which was concerned with personality type and structure

Alfred Adler - medical doctor whose theory of human functioning centred around social relationships and innate growth orientation

Sandor Ferenczi - medical doctor who proposed the therapist should be active, authentic, warm, and an equal partner to the client in therapy. Gave great significance to the therapist's internal responses to the client (countertransference)

Otto Rank - theorized that the relationship between child and mother, including the birth experience and separation from the mother were central to child's psychological and emotional development

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Prevailing view for many years was that mental illness was caused by spiritual distress or evil spirits

Mentally ill individuals were contained, tortured, put to death, or displayed for entertainment

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How do you want clients to feel when they are in your office?

What do you want clients to focus on when they are in your office?

The following qualities of a therapist's office increased the perceived quality of care and comfort that potential clients expected to receive (Devlin & Nasar, 2012):

Softness - many comfortable surfaces and textures

Personalization - display of personal mementos, effects, and certificates, etc

Orderliness - neat and tidy vs clutter

Location

Perceived safety & privacy

Size & Setup

Seating & Furniture

Technology

Sensory issues - sound, lighting, scents

Art & Colour

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1. Act in the best interest of the client

2. Plan and apply interventions that are likely to have positive outcomes

3. Refer clients to other support systems when your services are no longer meeting their needs

4. Avoid dual/contradictory relationships

5. Provide clients with information about practice policies

6. Respect and appreciate client diversity

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Ethics is a system of moral principles that guide behaviour.

General Ethical Principles:

1. Nonmaleficence and beneficence - doing no harm and promoting client well-being

2. Autonomy - supporting clients toward making their own wise decisions and respecting client diversity and agency

3. Justice - acting fairly

4. Fidelity - fulfilling commitments to clients and to the profession

5. Confidentiality - maintain whenever possible and use thought and care in circumstances where you must break confidentiality; inform clients upfront of the circumstances under which you cannot maintain confidentiality

6. Professional Responsibility - practice within your scope of competence and present your credentials accurately; commit to lifelong learning, development and improvement of competence and skill; maintain professional relationships and use collaboration/consultation well

7. Evaluation, Assessment & Interpretation - use interventions that are within your scope of competence and appropriate for the client's needs, for the betterment of the client

Following a code of ethics:

Lends strength and credibility to the profession

Guides professional decision making

Gives clients information about what a professional can and cannot do

Can protect professionals in the face of legal accusations

Is required for membership with professional associations and for licensure, where applicable

Each association has their own code of ethical standards agreed upon by that group of professionals

Canadian Professional Counsellors Association (CPCA)

Association of Cooperative Counselling Therapists (ACCT)

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Problem situations and unused opportunities:

self-doubt

unreasonable fears

stress that accompanies serious illness

addiction

failing relationships

loss of employment

confusion in adapting to a new culture

catastrophic loss

incarceration

abuse

personal crisis

loneliness

victimization

racism/systemic oppression

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1. Motivation

Client readiness and the ability to engage meaningfully

Cooperation

Self-disclosure

Confronting problems

Effort to change

Low levels of defensiveness

Tools to move through anxiety/discomfort

Belief that treatment is necessary and important

Self-referred vs referred by other

1. Positive but realistic expectations for treatment

Client must have hope/optimism about their involvement in therapy

Must have a clear understanding of the therapeutic process

Promoted through client education and engagement early on

2. Full participation in treatment

Those who effectively engage in therapy early on are more likely to have positive outcomes

Share their concerns freely, collaborate with the therapist, take steps to improve their lives, recognize their role in creating their problems, identify specific problems/issues, believe they have the power to improve their situation, maintain positive expectations of change

3. Intelligence

4. Education

5. Socioeconomic level

6. Initial symptoms of depression or anxiety

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A - ge
D - isability (aquired)
D - isability (developmental)
R - eligion/Spirituality
E - thnicity
S - ocioeconomic status
S - exual orientation
I - ndigenous heritage
N - ation of origin
G - ender/sex

The therapist must:

Develop awareness of how demographics affect the way clients experience problems and view therapy.

Demonstrate cultural competence and humility; must work within the client's cultural context.

Be aware of their own biases and strive to overcome them

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Capitalizing on Client Characteristics for Successful Outcomes

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Capitalizing on Client Characteristics for Successful Outcomes

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10 Key Ingredients of Successful Helping

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10 Key Ingredients of Successful Helping

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1. Focus primarily on the client and the contextual factors of the client's life

2. Define success in terms of outcomes with life-enhancing impact for the client

3. Describe what an effective therapist looks like

4. Develop and working alliance with the client

5. Acquire and use the communication skills at the heart of the therapeutic dialogue

6. Integrate the basic principles related to cognition, behaviour, and emotions

7. Use feedback to improve the effectiveness of the helping sessions and client's change efforts

8. Come to grips with the role that beliefs, values, norms, and moral principles play in the helping process

9. Help the clients review poor decisions and execute life-enhancing decisions

10. Adopt a treatment model aligned with the universal problem-management process

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Therapeutic Presence: Tune In to Clients and Listen Carefully

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Therapeutic Presence: Tune In to Clients and Listen Carefully

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Chapter 4 Learning Objectives (p. 97)
1. Describe the communication skills needed in helping.

2. Make dialogue second nature to interactions with clients.

3. Recognize ways counsellors can demonstrate empathic presence with clients.

4. Formulate ways to make active listening the foundation of understanding clients’ issues.

5. Identify the key ingredients of successful therapy.

6. Identify all forms of distorted listening.

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Commit Yourself to the Helping Relationship and the Values that Drive It

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Commit Yourself to the Helping Relationship and the Values that Drive It

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Chapter 3 of The Skilled Helper Learning Objectives
1. Explain what makes helping relationships work.

2. Identify the key values that drive the working alliance.

3. Recognize respect as the foundation value.

4. Recognize empathy as the primary orientation value.

As Ian McEwan says of a character in his 1990 novel The Innocent, “Now that he could name the fog he had been moving through, he was at last visible to himself.”

5. Recognize diversity as a sense-of-the world value.

6. Formulate an action-oriented, outcome-focused value.
7. Produce a plan to influence clients to embrace self-responsibility.

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E - Eye gaze or Eye contact

M - Muscles of facial expression

P - Posture

A - Affect

T - Tone of voice

H - Hearing the whole person

Y - Your response

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The power of empathy: Helen Riess at TEDxMiddlebury

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Self Responsibility as an Empowerment-Focused Value

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Self Responsibility as an Empowerment-Focused Value

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The goal is to help your clients:

discover, develop, and use the untapped power within themselves

use their resources to get things done/make changes

Empowerment-based norms:

Start with the premise that clients can change if they choose

Do not see clients as victims

Do not see clients as overly fragile

Are not fooled by appearances

Means coaching and consulting with clients

Focus on learning instead of "helping"

Are aware of cultural differences

The Helping Relationship through the Lens of Self-Responsibility

Assumes the client has the power to do what is right for self and others

The opposite of empowerment is dependency or oppression

Helping is a two-way social-influence process

Influences clients without robbing them of agency

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Foundational Skills of the Helping Profession

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Foundational Skills of the Helping Profession

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From the start of intake, a good helper is building the therapeutic alliance:

Tell the client the purpose of the session: to get to know them.

Share that you will be asking some questions about various aspects of their life and the concerns that brought them to counselling.

Guide the client to provide information about their presenting problems, background, and current life context

Give the client the opportunity to ask questions and clarify as needed.

The first session or two will depend on the client, your role as a counsellor and the context within which you will meet:

formal - structured information-gathering

semi-formal - some information-gathering and some get-to-know-you conversation

informal - get-to-know-you conversation

If the client is in crisis, a crisis assessment should be conducted instead, and a safety plan created.

Purpose of an Intake Interview:

1. Gather information from the client:

History/background

Current situation/life context

Client characteristics

Presenting concerns

2. Share information with the client

Counselling process and approach

Consent to counselling

Confidentiality and limits to confidentiality

3. Agree on goals, a plan of action or direction of counselling

Content of the Intake Interview Might Include:

Demographic and identifying information including age, relationship status, and living situation

Presenting problems, including reasons for seeking help now, symptoms, onset and duration of difficulties, the impact of concerns on the person's lifestyle, and previous efforts to obtain help

Prior and additional emotional difficulties (including persistence across contexts)

Current life situation, including important relationships, occupational and educational activities, social and leisure activities, stressors and sources of gratification

Ethic, cultural, religious and socioeconomic information

Family background, including information on the composition of family of origin and current family relationships, parenting styles, role models and messages, family values, strengths and difficulties

Personal and developmental history (health, work, sex and relationships, previous counselling, substance use, personal goals in life that may be hampered by the presenting problems)

Career and educational history

Medical history, including significant past and current illnesses, medical treatments, and medications

Types of additional information collected:

Description of client's presentation (how they are dressed, grooming, posture, affect, warmth, motivation)

Summary and recommendations (initial acknowledgement of links between presenting problem and other information, to what extent your services are a fit, estimated number of sessions needed)

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• Their skills, strengths, and resources.

• Their general emotional states.

• Their hopes, fears, and expectations regarding therapy.

• Their degree of openness to and readiness for change.

• Their willingness to work on changing..

• Whatever reluctance or resistance they feel.

• The entire range of their relationships together with all the associated ups and downs, especially the relationships related to their current problem situations.

• Their level of interpersonal communication skills.

• Their blind spots.

• External factors that stand in the way of progress.

• External factors that support constructive change

Clients need to ask themselves these questions (per Egan):

What does progress look like?

What progress am I making in terms of getting to the heart of the problem situation?

To what degree do I understand what the resolution of the problem situation should look like?

What are my goals?

How can I clarify these goals?

What actions must I take to achieve these goals?

How do I start moving in the right direction?

What obstacles am I running into and how am I dealing with them?

What do I need to do to persist in achieving the life-enhancing outcomes I say I want?

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Embedded in therapy

Embedded in people - a "human universal," familiar and logical to people across cultures

Poses 4 questions for clients:

1. What is going on?

2. What does a better future look like?

3. How do I get there?

4. How do I make it all happen?

According to the text, the approach to helping that works best is the one that is embedded within all successful approaches. Egan calls this the standard problem-solving framework. He identifies four sets of questions for clients to ask themselves (and for the helper to keep in mind) to achieve positive outcomes:

1. What’s going on? “What are the problems, issues, concerns, or undeveloped opportunities I should be working on?” This involves helping clients spell out her or his current picture.

2. What does a better future look like? “What do I want my life to look like? What changes would help manage my problem situation and develop unused opportunities? What goals do I need to pursue to manage my problem situation?” This involves helping clients paint their preferred picture.

3. How do I get there? “What do I need to do to make the preferred picture a reality? What plan will get me where I want to go? What actions will get me started on the right path?” The plan outlines the actions clients need to take to create a better future. This is the way forward.

4. How do I make it all happen? “How do I turn planning and goal setting into the kind of action that leads to the solutions, results, outcomes, or accomplishments that have the impact I’m looking for? How do I get going and persevere until I manage my problems and develop my unused opportunities?”

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An effective therapist, per Egan:

1. Has a solid set of interpersonal skills and through them expresses acceptance, warmth, and empathy.

2. Acts in such a way as to build trust with clients. “This person understands me. I believe this person can help me.”

3. Does his or her part to develop a collaborative working alliance with clients and come to an agreement with them on the goals of helping.

4. Understands the client’s condition and can provide a plausible explanation for the source of the client’s distress.

5. Understands both the client and the client’s problem situation in every relevant context—cultural, social, economic, political, and so forth.

6. Has a flexible helping approach or treatment plan and communicates this approach clearly to the client.

7. Is believable, persuasive, and convincing without robbing the client of his or her autonomy or dignity.

8. Collaborates with clients in monitoring their progress and their views of the helping process.

9. Establishes a formal or informal feedback system.

10. Makes adjustments to the therapeutic process based on an evolving under-standing of the client’s problem situation, formal or informal feedback, and signs of client reluctance or resistance.

11. Helps clients, despite their difficulties, to develop a realistic sense of possibility, hope, and optimism.

12. Does not avoid difficult issues related to the client’s problems or to the client-helper relationship, but handles them tactfully.

13. Understands self, and injects self into the therapeutic dialogue only to the degree that this helps and does not distract the client.

14. Knows the best research related to the client: the client’s personality, the client’s problems, the social context, and possible treatments for the client.

15. Is committed to professional self-improvement. Understands the best the helping industry has to offer and makes it available to the client.

16. Has a solid grasp of the key ingredients of successful therapy and, through collaboration with the client, knows how to tailor and orchestrate them at the service of client outcomes.

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Essential Conditions of Therapeutic Alliance

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Essential Conditions of Therapeutic Alliance

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EMPATHY:
- is the clinician's ability to see the world through the client's eyes and to communicate that understanding so that the client feels heard and validated
- helps clients feel that the therapist can relate to their experiences and be with them emotionally
- is strongly associated with positive change in clients and may be an even better predictor of outcomes than treatment interventions
- accounts for 9% of the variance in treatment outcomes (Elliot, Bohart, Watson, & Greenberg, 2011)

UNCONDITIONAL POSITIVE REGARD:
- is transmitted through emotional warmth, appropriate reassurance, the communication of confidence and interest in the client, and the use of therapeutic interventions that empower the client
- gives clients the message that they matter and that the clinician is nonjudgmental and "privileges the client's experience" (Norcross, 2010, p.117) by recognizing that the client's experience always trumps the therapist's expertise.
- exhibits warmth and caring which in turn increases the likelihood of a positive outcome than using aggression or confrontation

CONGRUENCE:
- means being genuine with a client and contributing to the establishment of a positive therapeutic relationship
- gives clients clear, accurate, unambiguous, honest, yet sensitive messages
- means not merely verbalizing concern but embodying it
- demonstrates the clinician's belief in what they are saying, the feedback they are giving by clarifying and showing clients that their message matches their internal state.

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What Makes the Helping Relationship Work?

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What Makes the Helping Relationship Work?

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The relationship as a means to an end

Don't overstress the relationship. The goal is to help clients manage problems better.

The relationship as a working alliance

Collaboration between client and helper based on their agreement on the goals and tasks of counselling

Keep the client's points of view and preferences centre stage

What kind of relationship does the client want?

What do I need to do to help the client become a collaborating partner in the helping process?

Research found clients appreciate even "seemingly small, strengths-fostering behaviours such as making encouraging statements, making positive comments about the client, and greeting the client with a smile."

The Relationship as a Forum for Relearning

The relationship itself is often a forum or a vehicle for social-emotional relearning.

Effective helpers model attitudes and behaviours that help clients challenge and change their own attitudes and behaviour

Protected by the safety of the helping relationship, clients can experiment with different behaviours during the sessions themselves

Clients can transfer what they are learning to other social settings

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Definition: "The alliance refers to the quality and strength of the collaborative relationship between client and therapist." (Norcross, 2011, p. 120)

If you do not have a collaborative relationship with your client, no matter how skilled you are in other areas, the outcome will suffer. Collaboration is active, mutual, and therapist-dependent.

Guidelines for Fostering Alliance:

Support the client's decision to seek treatment by discussing the importance of taking a first step and the courage that is involved in seeking help

Allow alliances to emerge naturally

Track evolving needs/wants of the client by continually seeking feedback from your client, and addressing strains or rifts in the relationship

Focus on resources and help clients identify their strengths

Don't be surprised at differing views of the relationship

Recognize ups and downs are common (cycles of repair & rupture)

Client change tends to occur early in the treatment process

Client's subjective experience of meaningful change is critical

Three ways to get off to a good start:

1. Develop positive expectations

2. Help clients understand the helping process

3. Emphasize life-enhancing outcomes

The helping relationship must:

Be established relatively quickly

Focus on client-enhancing outcomes

Be a two-way relationship, heavily relying on dialogue

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Perceived self-efficacy refers to belief in one's capabilities to organize and execute the courses of action required to manage prospective situations.

Belief in one's efficacy influences how they think, feel, act, and motivate themselves.

Action-Oriented, Outcome-Focus hinges on:

1. Outcome expectations - "if I do X, things will change"

2. Belief in self-efficacy - "I have what it takes to do that" or "I am capable of X."

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Recognize Diversity as a Sense-of-the-World Value

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Recognize Diversity as a Sense-of-the-World Value

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Diversity competence refers to:

the knowledge and the skills needed to relate, communicate effectively, and work with people who have their own set of diversities

awareness of your own personal culture and how you might come across to people who differ from you culturally

awareness of the personal cultural biases you may have toward individuals and groups other than your own

working to understand the values, beliefs, and worldviews of groups and individuals with whom you work

awareness of how sociopolitical influences such as poverty, oppression, stereotyping, stigmatization, discrimination, prejudice, and marginalization might have affected the groups and individuals with whom you are working.

recognizing that any sort of diversity - age, level of education, sexual orientation, gender, disability - can become targets of discrimination

getting to know the basics of family structure and gender roles in the groups with whom you work

developing an understanding of how people in different cultures understand and deal with illness, including mental illness, and how they typically feel about help-seeking behaviour

acknowledging that people in the same culture have widely different beliefs and experiences because of their personal culture (see:  intersectionalism). Culture does not mean same-ness; cultures are not a monolith

accessing your own level of cross-cultural and personal cultural competence and striving to continue improving in all of the areas discussed above

developing and practicing "cultural humility" (recognizing and correcting mistakes as it relates to culture)

recognizing your cultural limitations, which include making mistakes

never assume or infer a person's cultural affiliation or orientation from knowledge of any group to which they are believed to belong

learning about your client from your client's point of view without making any assumptions about them and their background or personal culture

realizing that mainstream Western psychological theory, methods of inquiry, diagnostic categories, assessment procedures, and professional practices might not fit other cultures or might need some adaptation. Be aware that some of these factors might not even fit people from Western cultures that well because of within-culture diversity and other diversity factors beyond culture.

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Empathy as the Primary Orientation Value

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Empathy as the Primary Orientation Value

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Empathy at its best is relationship oriented. It is a two-way street.

Empathic accuracy depends on how both parties to a conversation communicate

Focusing on your relationship with the client rather than the client as an individual will foster your ability to hear them and then respond with empathic accuracy

Empathy is a radical commitment to work at understanding:
1. Each client from their point of view, together with the feelings surrounding this point of view and to communicate this understanding, when helpful.
2. Individuals in and through the context of their lives. The social settings in which they have developed and currently "live and move and have their being" provide routes to understanding.
3. The dissonance between the client's point of view and reality (**who defines reality?)

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A. Avoid behaviours that show disrespect

Do no harm

Do not rush to judgement

B. Engage in behaviours that show respect

Become competent and committed

Be genuine

Make it clear that you are "for" the client

Assume the client's goodwill

Keep the client's agenda in focus

Get off to a good start:

1. Develop positive expectations

2. Help clients understand the helping process (share expectations)

3. Emphasize life-enhancing outcomes (the client’s subjective experience of meaningful change is critical)

Keep the Client’s Point of View and Preferences Centre Stage

What kind of relationship does the client want/expect? (doctor/friend/expert/partner-style)

What do I need to help the client become a collaborating partner in the healing process?

Research supports seemingly small, strengths-fostering behaviours such as encouraging statements, positive comments, and greeting clients with a smile

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Empathic Responding: Work at Mutual Understanding

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Empathic Responding: Work at Mutual Understanding

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Chapter 5 of the Skilled Helper Learning Objectives
1. Explain the importance of responding skills in developing relationships with clients.

2. List the three dimensions of all responding skills.

1. Perceptiveness

2. Know-how or Competence

3. Assertiveness

3. Synthesize ways counsellors can communicate empathy in therapy.

The basic formula is “You feel….because….”

4. Use empathy wisely to achieve therapeutic goals: give yourself time to think, use short responses, and gear your response to the client but remain authentic.

5. Recognize the shadow side of responding.

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Active Listening as Foundation of Understanding:

Tuning in serves the purpose of understanding your client and is a part of active listening

Active listening reflects the fact that listening is a goal-oriented task that requires:

Intent

Focus

Effort

Forms of Poor Listening:

1. Non-listening - listening without being engaged, tuned out.

2. Partial listening - listening to only some of what is said, missing the main points

3. Audio-recorder listening - listening at a surface level only, able to repeat what is said but missing the underlying message

4. Rehearsing - focusing on what you will say next rather than fully listening to the client

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Non-Verbal Behaviours Help:

Regulate conversations

Communicate emotions

Modify or nuance verbal messages

Provide important messages about the helping relationship

Give insights into self-perceptions

Provide clues when clients or counselors are not saying what they are thinking

Non-Verbal Channels of Communication:

Bodily behaviour - posture, body movements, gestures

Eye behaviour - eye contact, staring, eye movement

Facial expressions - smiles, frowns, raised eyebrows, twisted lips

Voice-related behaviour - tone, pitch, volume, intensity, inflection, spacing of words, emphases, pauses, silences, fluency

Physiological response - pace of breath, blushing, paleness, pupil dilation, perspiration

Physical characteristics - fitness, height, weight, complexion

Space - at what distance a person chooses to be during conversation

General appearance - personal grooming and attire

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SOLER Approach

S: Face the client Squarely

O: Adopt an Open posture

L: Remember that it is possible at times to Lean toward the other person

E: Maintain good Eye contact

R: Try to be relatively Relaxed, or natural in these behaviours

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Demonstrate Empathic Presence by Visibly Tuning In

Intensity of presence

Expression of empathy

Positioned to listen carefully

Attention manifested in both physical and psychological ways

Self Check for Visibly Tuning In:

What are my attitudes towards this client?

How would I rate the quality of my presence to this client?

To what degree does my nonberbal behavior indicate a willingness to work with the client?

What attitudes am I expressing in my nonverbal behaviour?

What attitudes am I expressing in my verbal behaviour?

To what degree does the client experience me as effectively present and working with them?

To what degree does my nonverbal behaviour reinforce my internal attitudes?

In what ways am I distracted from giving my full attention to this client?

What am I doing to handle these distractions? How might I be more effectively present with this person?

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Four required elements for true dialogue:

1. Turn Taking - Monologues breed isolation. Dialogue demands engagement.

2. Connecting - helper and client need to engage each other if their working alliance is to be productive. They need to actively listen to one another and respond in terms of what they think the other person is saying

3. Mutual influencing - being open to being influenced by what the other person has to say; “openness to the other”

4. Co-creating outcomes - good dialogue leads to outcomes that benefit both parties

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1. Filtered listening

2. Evaluative listening

3. Stereotype-based listening

4. Fact-centered rather than person-centered

5. Sympathetic listening

6. Interrupting that does not promote dialogue

7. Falling for myths about nonverbal behaviour

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The Helper’s Internal Conversation

To be an effective helper, you need to listen not only to the client but also to yourself, paying attention to your “internal conversation”

Internal conversation includes your nonverbal behaviour, your feelings and your emotions.

The internal conversation may be about yourself, your client or the relationship

It goes on all the time. An effective helper uses it as a tool for helping.

It can help you identify what you can do to further assist the client and also what is hindering your ability to assist them.

Take care not to become preoccupied - listen to yourself on a “second channel.”

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Nonverbal behaviour can modify verbal communication by

1. Confirming or repeating what is being said (e.g. a nod of the head, tone of voice)

2. Denying or confusing what is being said (e.g. saying yes while not sounding enthusiastic)

3. Strengthening or emphasizing what is being said (e.g. gestures or tone of voice)

4. Adding intensity to what is being said (e.g. exclamations, glances, tone of voice, etc.)

5. Controlling or regulating what is being said (e.g. a glance might silence the other from speaking)

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When we are with our clients, we are listening for:

1. Experiences - what happened to them

2. Thoughts - the way they think and the actual thoughts that occur to them

Points of view, beliefs, values, attitudes, convictions

Intentions, proposals, plans

Decisions

3. Behaviours, both external and internal - what they do or don’t do

4. Affect - feelings, emotions, and moods they have as a result of their experiences, thoughts and behaviours.

5. Strengths, opportunities, and resources to amplify

6. Hope, optimism, self-efficacy, problem-solving, internal locus of control, creativity, wisdom, courage, positive emotions, self-esteem, love, emotional intelligence, forgiveness, humour, gratitude, faith, morality, coping skills, and a sense of well-being.

7. Nonverbal messages and modifiers

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To help your clients achieve life-enhancing outcomes.

To assist with this task, while listening, you:

1. Organize what you are hearing in terms of problem management and opportunity development, and

2. Organize your view of your client’s personality

1. Personality can be described as the complex organization of thoughts, emotions, and behaviours that give direction and pattern to the person’s life.

2. These thoughts, emotions and behaviours occur in response to internal and external experiences, or “activating events”

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Being with and understanding the other requires:

Attending to

Observing

Listening to your client so you can understand them as fully as possible

Empathic listening leads to empathic understanding

“It means entering the private perceptual world of the other and becoming thoroughly at home in it. It involves being sensitive, moment to moment, to the changing felt meanings which flow in this other person, to the fear or rage or tenderness or confusion or whatever that he or she is experiencing. It means temporarily living in the other’s life, moving about in it delicately without making judgements.” - Carl Rogers' definition of empathic listening

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Use empathy throughout the helping process

At the beginning of the process, empathy builds trust

Further into the process, empathy helps you challenge your clients and help them challenge themselves while looking for opportunities to change their lives and commit to a plan of action.

Use empathic responses as a mild social-influence process

Your responses to your client at times will be guided by your sense of what should be talked about, not just what you see as the client’s core message

By doing that, you exert a mild social influence on the dialogue and thus on your client (e.g. by refocusing your client’s self-loathing as a desire to be a better human being)

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Responding to Core Client Messages

Identify and respond to what you believe are the core messages

Pay particular attention to one or two messages out of many the client may communicate

Continuously ask yourself, “What is the key? What is most important here?”

Check out the accuracy with your client; ask for clarification

You may have to respond to experiences or action or feelings rather than all three at once

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Give yourself time to think

1. Responding with accurate empathy requires thoughtfulness. You may be tempted to jump in too quickly with an empathic response when the client pauses.

“Too quickly” means that you do not give yourself enough time to reflect on what the client has just said so you can identify the core message being communicated.

Competent helpers often pause and allow themselves to consider what the client is saying before responding.

Use short responses

1. The therapeutic process requires a dialogue between the counsellor and client. That does not mean that you and your client take an equal amount of time to speak. (

Ideally, your responses are relatively frequent but lean and trim.)

2. In trying to be accurate, you may find yourself offering long-winded responses, especially if you let your client speak at length before responding.

Answering the question, “what is the core of what this person is saying to me?” can help you make your responses short, concrete, and accurate.)

Gear your response to the client but remain yourself

1. If a client speaks animatedly about something they are excited about and you reply accurately but in a flat, dull voice, your response is not fully empathic

2. This does not mean that you should mimic your clients or go overboard or not be your authentic self

3. It means that part of being with the client is sharing in a reasonable way in their emotional tone

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Responding Accurately to Client's Feelings, Emotions and Moods

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Responding Accurately to Client's Feelings, Emotions and Moods

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When using the empathic understanding of “you feel…because…,” it’s important that you use the correct family of emotions and the right intensity of the emotion.

The four main families of emotions can be grouped under the following headings: sad, mad, bad, glad

Any of these emotions can vary from low to high in intensity

Distinguish between expressed and discussed feelings

Expressed feelings are the feelings felt by the client during the session

Discussed feelings are feelings the client felt at the time of the event they are describing

Your client may have felt terrified of taking an action when they took it (discussed feeling) but sitting in front of you, they may be feeling elated that they did it (expressed feeling).

Read and respond to feelings and behaviour embedded in client’s nonverbal behaviour.

Often clients are unable to communicate their feelings, emotions, and moods with words

You might be able to infer their emotional state from their non-verbal communication

They may appear sad, anxious, apathetic, or worried. You can reflect that back to them to move the conversations forward.

Be sensitive in naming emotions

Some clients may be hesitant to talk about their emotions. It might be too threatening for them to get in touch with their emotions, or it might be culturally unfamiliar for them to do so.

You might need to begin with responding to their experiences rather than feelings. The goal, however, will be to bring the client’s feelings into focus.

Use variety in responding to client’s feelings and emotions. You can respond with:

Single words

Different kinds of phrases

What is implied in behavioural statements

What is implied in the client’s experiences