Mark E. Young-Learning the Art of Helping_ Building Blocks and Techniques-Pearson (2016)

Learning the art of heLping Building Blocks and Techniques Sixth Edition Mark E. Young University of Central Florida 330 Hudson Street, NY, NY 10013 Vice President and Publisher: Media Project Manager: Lauren Carlson Kevin M. Davis Full-Service Project Management: Editorial Assistant: Ann McAlpine Megha Bhardwaj/Joy Deori, Executive Field Marketing Manager: iEnergizer Aptara® LTD Krista Clark Composition: iEnergizer Aptara® LTD Senior Product Marketing Manager: Printer/Binder: RR Donnelley/ Christopher Barry Harrisonburg North Program Manager: Janelle Rogers Cover Printer: RR Donnelley/Harrisonburg North Project Manager: Pamela D. Bennett Text Font: ITC Garamond Std Operations Specialist: Deidra Smith Cover Photo: Offset by Shutterstock/ Cavan Images Copyright © 2017, 2013, 2009 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Printed in the United States of America. 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Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc. or its affiliates, authors, licensees or distributors. Library of Congress Cataloging-in-Publication Data Names: Young, Mark E., author. Title: Learning the art of helping : building blocks and techniques / Mark E. Young, University of Central Florida. Description: Sixth edition. | Boston : Pearson, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2016012245| ISBN 9780134165783 (alk. paper) | ISBN 0134165780 (alk. paper) Subjects: LCSH: Counseling. | Psychotherapy. Classification: LCC BF636.6 .Y68 2017 | DDC 158.3—dc23 LC record available at https://lccn.loc.gov/2016012245 Print ISBN 10: 0-13-416578-0 ISBN 13: 978-0-13-416578-3 10 9 8 7 6 5 4 3 2 1 Print with MyEducation Lab with eText: ISBN 10: 0-13-447449-X ISBN 13: 978-0-13-447449-6 To SKSJM ABOUT THE AUTHOR Mark E. Young is Professor at the University of Central Florida. He received his bachelor’s degree from Miami University, his master’s from Wright State University, and his doctorate from Ohio University. He has trained helpers for more than 25 years and worked as a therapist in community mental health, private practice, college counseling centers, and corrections for more than 15 years. Since 2003 he has been affiliated with the Marriage and Family Research Institute teaching relationship skills to low-income couples. His professional writing has focused mainly on therapeutic methods and techniques, wellness, and couples. If you have comments or suggestions on what you have read, please send an e-mail to [email protected]. iv PREFACE HOW IS THIS BOOK DIFFERENT FROM OTHER BOOKS ABOUT HELPING SKILLS? This book is unique in five ways. First, it is based on lessons learned through years of practice and supervision. I have tried to infuse what I learned from my clients, my stu- dents, and my teachers about the practical aspects of helping. For example, we will talk about what a therapeutic office environment should look like and how to appropriately terminate a client. My work with students has helped me understand the common prob- lems in learning the art of helping and how to overcome them. Second, the most important innovation of this book is that it involves you person- ally in your learning. Throughout the book you are asked to “Stop and Reflect,” to con- sider thorny issues and challenges that you will face. If you wish, you can journal using Journal Starters or do outside homework to deepen your interaction with the material. In addition, you will have the opportunity to practice on your own by watching videos of helpers and clients and then identify the best helping responses. Every chapter contains Application Exercises in which you can follow the steps of a particular technique and get feedback on your answers. Third, this book emphasizes that the relationship between helper and client is the most powerful ingredient for success. The relationship (Vitamin R) potentiates all the basic techniques that you will learn. If you and the client are on the same wavelength, progress is possible. When the relationship fails, the helping process falters. In this book, I talk about how to develop a therapeutic relationship and how to repair ruptures that threaten it. Fourth, I have tried to incorporate the latest research on effective treatments. Stay- ing close to the research can be called “evidence-based practice.” At the same time, we must recognize that there is such a thing as clinical wisdom or “practice-based evidence.” Not every method, technique, or client problem has been researched or even discovered. Thus the helper-in-training needs to learn from his or her clients about what is working for that specific person. I suggest that in every session, the helper should elicit feedback from the client about the relationship and progress toward goals. Finally, this is a book with an integrative perspective. That means that I have drawn from the techniques of many different theories rather than presenting a purely person-centered or cognitive behavioral approach. At first this may sound like chaos. How can we possibly learn to arrange treatment by blending so many competing theo- ries? In this text, we do not blend theories but instead take a common factors approach to organizing the techniques using the REPLAN method. Common factors are those therapeutic effects that underlie the various theories. REPLAN is an acronym that describes each of the healing factors. R stands for establishing and maintaining a thera- peutic Relationship, E is Enhancing efficacy and self-esteem, P means Practicing new behaviors, L is Lowering and raising emotional arousal, A is Activating expectations, hope, and motivation, and N is providing New learning experiences. Every theory emphasizes one or more of these common factors and even advanced therapeutic techniques tend to fall into one of these categories. We have found that categorizing the techniques in this way provides a rational basis for deciding what kind of help the client v vi Preface needs. Is it important to raise self-esteem or practice new behaviors? This forms the skel- eton of our treatment plan and is guided by the goals that are collaboratively formed between helper and client. This approach can incorporate both time-honored methods and cutting-edge techniques. WHAT IS NEW IN THE SIXTH EDITION? • The Sixth Edition of Learning the Art of Helping has additional coverage of cultural issues. Throughout the book are new Culture Check sections that highlight issues of culture in research and in personal experiences as they relate to helping skills. • In addition, Chapter 12 focuses specifically on learning to help those who are cul- turally different from you. • For the first time, we have identified helping skills you should develop when you work with children. • We address the issue of gender differences and how they can challenge the helping relationship. • The book now includes two new self-assessment tools to help you evaluate recorded sessions or transcripts. They are the Helper Competency Scale, which assesses the basic skills, and the Depth Scale, which looks at the depth of helper responses. • In addition to the end of chapter activities, such as homework, activities, exercises, self-assessments, and journal starters, we now identify specific points of practice where you can watch a video of the skill you are learning or complete written exer- cises and receive feedback on your answers. You can now access these ancillary materials at the same time you are reading about them. ACKNOWLEDGMENTS In my own journey, there have been many who have taught and inspired me to be a better person and a better helper. I must acknowledge my teachers Rajinder Singh, J. Melvin Wit- mer, Harry Dewire, and James Pinnell, my first supervisor, who took me as a raw recruit in a mental health clinic, sacrificing his time and talent to teach me as an apprentice. We shared a zeal and passion for the profession, and his wisdom infuses every chapter of this book. I must also mention those who have encouraged me in my writing, Sam Gladding, Gerald Corey, Jeffrey Kottler, Adam Blatner, James Framo, John Norcross, and Jerome Frank. I appreciate the feedback from my colleagues at Ohio State University, Darcy and Paul Granello, and Daniel Gutierrez at the University of North Carolina at Charlotte. Tracy Hutchinson deserves special mention for reading every chapter and giving feedback at every step. I also recognize the helpful comments of those who reviewed various drafts of the manuscript including Hannah Acquaye and Shainna Ali. In addition, the following reviewers supplied insightful feedback for updating this edition: Valerie G. Balog, University of North Carolina at Charlotte; Daniel Bishop, Concordia University Chicago; Natalie Arce Indelicato, University of North Florida; Kristin Perrone McGovern, Ball State University; David A. Scott, Clemson University; and Heather Trepal, University of Texas at San Antonio. I would like to thank my editor, Kevin Davis, who has believed in this book since its first edition. Finally, I recognize the contribution of my wife, Jora, who remains my most demanding critic and my staunchest supporter. and Termination 276 Chapter 12 Skills for Helping Someone Who Is Different 297 Glossary 315 References 323 Index 349 vii . BRIEF CONTENTS Chapter 1 Helping as a Personal Journey 1 Chapter 2 The Therapeutic Relationship 31 Chapter 3 Invitational Skills 60 Chapter 4 Reflecting Skills: Paraphrasing 85 Chapter 5 Reflecting Skills: Reflecting Feelings 101 Chapter 6 Advanced Reflecting Skills: Reflecting Meaning and Summarizing 121 Chapter 7 Challenging Skills 147 Chapter 8 Assessment and Goal Setting 175 Chapter 9 Change Techniques. Part I 208 Chapter 10 Change Techniques. Part II 243 Chapter 11 Evaluation. Reflection. CONTENTS Chapter 1 HELPING AS A PERSONAL JOURNEY 1 The Demands of the Journey 1 Becoming a Reflective Practitioner 2 Using Reflection to Help You Overcome Challenging Helping Situations and Enhance Your Learning 3 Using Reflection to Help Clients with Backgrounds Different from Your Own 3 Using Reflection to Accommodate New Information about Yourself 4 Learning to Reflect through Exercises in This Book 6 What is Helping? 6 Psychological Helping 8 Interviewing 8 What Are Counseling and Psychotherapy? 10 Coaching 11 Challenges You Will Face in Learning the Art of Helping 11 The Challenge of Development 12 Taking Responsibility for Your Own Learning 12 Finding a Mentor 14 Finding the Perfect Technique 14 In Limbo 14 Accepting Feedback and Being Perfect 15 Following Ethical Guidelines 15 Individual Differences 17 Who Can Be an Effective Helper? 17 What Can You Bring to a Client? 19 The Nuts and Bolts of Helping 21 Learning Basic Skills and Common Therapeutic Factors 21 Therapeutic Building Blocks 22 Change Techniques 24 The Importance of the Building Blocks 24 The Stages of the Helping Process: A Road Map 24 Summary 26 Exercises 27 Group Exercises 27 Group Discussions 28 viii . Contents ix Written Exercises 28 Self-Assessment 29 Homework 29 Journal Starters 30 Chapter 2 THE THERAPEUTIC RELATIONSHIP 31 The Importance of the Therapeutic Relationship in Creating Change 33 What Is a Helping Relationship? Is a Professional Helping Relationship the Same as a Friendship? 34 The Unique Characteristics of a Therapeutic Relationship 36 What Clients Want in a Helping Relationship 38 How Can a Helper Create a Therapeutic Relationship? 38 Relationship Enhancers 39 Other Factors That Help or Strain the Therapeutic Relationship 45 Facilitative Office Environment 45 Distractions 46 Appearing Credible and Taking a Nonhierarchical Stance 46 Therapeutic Faux Pas 47 Transference and Countertransference 50 Summary 56 Exercises 57 Group Exercises 57 Small Group Discussions 57 Homework 58 Journal Starters 59 Chapter 3 INVITATIONAL SKILLS 60 Listening to the Client’s Story 61 Nonverbal Communication between Helper and Client 64 Regulation 64 Intimacy 65 Persuasion 65 Nonverbal Skills in the Helping Relationship 65 Eye Contact 66 Body Position 66 Attentive Silence 67 Voice Tone 67 . x Contents Facial Expressions and Gestures 68 Physical Distance 68 Touching and Warmth 69 Opening Skills: How to Invite 71 Saying Hello: How to Start the First Session 72 How to Start the Next Session 72 Encouragers 73 Questions 74 Summary 79 Exercises 80 Group Exercises 80 Small Group Discussions 82 Written Exercises 83 Self-Assessment 84 Homework 84 Journal Starters 84 Chapter 4 REFLECTING SKILLS: PARAPHRASING 85 Reasons for Reflecting 86 Reflecting Content and Thoughts. Reflecting Feelings. and Reflecting Meaning 86 The Skill of Paraphrasing: Reflecting Content and Thoughts 89 How to Paraphrase 89 Paraphrasing: What It Is and What It Isn’t 90 When to Paraphrase and the Nonjudgmental Listening Cycle 91 Common Problems in Paraphrasing 94 Simply Reciting the Facts 94 Difficulty Listening to the Story because of “Noise” 94 Worrying about What to Say Next 95 Being Judgmental and Taking the Client’s Side 95 Being Judgmental of the Client 96 Turning a Paraphrase into a Question 96 Summary 97 Exercises 97 Group Exercises 97 Small Group Discussions 98 Written Exercises 99 . Contents xi Self-Assessment 99 Homework 99 Journal Starters 100 Chapter 5 REFLECTING SKILLS: REFLECTING FEELINGS 101 The Importance of Understanding Emotions 101 The Skill of Reflecting Feelings 102 The Benefits of Reflecting Feelings 102 Why It Is Difficult to Reflect Feelings 103 How to Reflect Feelings 104 Step 1: Identifying the Feeling or Feelings 104 Step 2: Putting the Emotion into Words 104 Common Problems in Reflecting Feelings and Their Antidotes 110 Asking the Client. Uncovering the Next Layer 122 Why Reflect Meaning? 124 Challenging the Client to Go Deeper: The Inner Circle . “How Did You Feel?” or “How Did That Make You Feel?” 112 Waiting Too Long to Reflect 112 Making Your Reflection a Question 112 Combining a Reflection and a Question: The Error of the Compound Response 113 Focusing on Other People 113 Interrupting Too Soon and Letting the Client Talk Too Long 114 Confusing the Words Feel and Think 115 Missing the Mark: Overshooting and Undershooting 115 Letting Your Reflecting Statements Go On Too Long 116 Summary 117 Exercises 117 Group Exercises 117 Written Exercises 119 Self-Assessment 120 Homework 120 Journal Starters 120 Chapter 6 ADVANCED REFLECTING SKILLS: REFLECTING MEANING AND SUMMARIZING 121 Meaning. xii Contents Strategy 126 Worldview: Meanings Are Personal 129 How to Uncover Meaning in the Story 130 Reflecting Meaning 130 Using Open Questions to Uncover Meaning 133 Summarizing 134 Focusing Summaries 135 Signal Summaries 135 Thematic Summaries 136 Planning Summaries 136 The Nonjudgmental Listening Cycle Ends with Summarizing 137 What Happens after the Nonjudgmental Listening Cycle? 138 A Questioning Cycle Typically Found Early in Training 138 Summary 140 Exercises 141 Group Exercises 141 Small Group Discussions 142 Written Exercises 143 Self-Assessment 145 Homework 145 Journal Starters 146 Chapter 7 CHALLENGING SKILLS 147 When Should We Use the Challenging Skills? 149 Giving Feedback 150 Why Is Feedback Important? 150 How to Give Feedback 151 Confrontation 154 What Is a Discrepancy? 154 Why Should Discrepancies Be Confronted? 154 Cognitive Dissonance and Confrontation: Why Confrontation Works 155 Types of Discrepancies and Some Examples 156 How to Confront 158 Steps to Confrontation 159 Common Problems in Confrontation and Their Antidotes 161 Final Cautions about Confrontation 162 . Affective Assessment 184 B. Developmental Issues 185 2. Family History 186 3. Physical Challenges and Strengths 186 Categorizing Clients and Their Problems 188 Organizing the Flood of Information: Making a Diagnosis 188 Goal-Setting Skills 188 Where Do I Go from Here? Set Goals! 188 Why Must We Set Goals? 190 When to Set Goals 191 What Are the Characteristics of Constructive Goals? 192 Goals Should Be Simple and Specific 192 . Contents xiii Other Ways of Challenging 163 Relationship Immediacy 163 Teaching the Client Self-Confrontation 164 Challenging Irrational Beliefs 165 Humor as Challenge 166 Summary 167 Exercises 168 Group Exercises 168 Small Group Discussions 169 Written Exercises 170 Self-Assessment 170 Homework 174 Journal Starters 174 Chapter 8 ASSESSMENT AND GOAL SETTING 175 Why Assessment? 176 Assessment Is a Critical Part of Helping 177 Reasons to Spend Time in the Assessment Stage 178 Two Informal Methods of Assessment That Every Helper Uses: Observation and Questioning 181 Observation 181 Questioning 183 Conducting an Intake Interview: What to Assess? 184 A. Cognitive Assessment 184 1. Behavioral Assessment 184 C. Cultural and Religious/Spiritual Background 186 4. PART I 208 What Are Change Techniques? 209 REPLAN and the Common Therapeutic Factors 210 Understanding the Factors or Major Components of the REPLAN Model 210 How the REPLAN System Helps You Plan Treatment 211 Using the Common Therapeutic Factors 212 Steps in Treatment Planning Using the REPLAN Model 212 Enhancing Efficacy and Self-Esteem 214 Sources of Low Self-Esteem 216 Silencing the Internal Critic: The Technique of Countering 218 Practicing New Behaviors 221 Role-Playing 223 Giving Homework Assignments as Practice 226 Lowering and Raising Emotional Arousal 230 Reducing Negative Emotions 230 .xiv Contents Goals Should Be Stated Positively 194 Goals Should Be Important to the Client 195 Goals Should Be Collaboration between Helper and Client 195 Goals Should Be Realistic 196 Resources for Identifying and Clarifying Goals 197 The Technique of Using Questions to Identify a Goal 198 Questions That Help Make the Goal More Specific 198 Questions That Help Turn a Problem into a Goal 198 Questions to Determine a Goal’s Importance 199 Questions to Enhance Collaboration on Goal Setting 199 Questions That Help Confirm That the Goal Is Realistic 199 The Technique of Boiling Down the Problem 201 Summary 203 Exercises 204 Group Exercises 204 Small Group Discussions 205 Written Exercises 206 Self-Assessment 206 Homework 206 Journal Starters 207 Chapter 9 CHANGE TECHNIQUES. Contents xv Reducing Anxiety and Stress 231 Raising Emotional Arousal and Facilitating Expression 234 Creating Positive Emotions 236 Summary 237 Exercises 238 Group Exercises 238 Small Group Discussions 240 Self-Assessment 241 Homework 241 Journal Starters 242 Chapter 10 CHANGE TECHNIQUES. REFLECTION. Hope. and Motivation 244 The Demoralization Hypothesis 244 Motivation and Readiness 245 Increasing Expectations and Fostering Hope 246 Providing New Learning Experiences 256 Definitions of New Learning Experiences 256 What Client Problems Are Helped through New Learning? 257 Common Methods for Providing New Learning Experiences 257 Summary 272 Exercises 272 Group Exercises 272 Small Group Discussions 274 Written Exercises 274 Self-Assessment 275 Homework 275 Journal Starters 275 Chapter 11 EVALUATION. AND TERMINATION 276 Evaluating the Effectiveness of Helping 277 Basic Outcome Evaluation Methods 279 Use Progress Notes to Track Improvement on Goals 279 Use a Global Measure to Detect Overall Improvement 279 Consistently Assess the Client’s View of Progress and the Therapeutic Relationship 280 Use a Specific Measure 281 Use Subjective Scaling and Self-Report to Measure . PART II 243 Activating Client Expectations. xvi Contents Improvement 281 Use Another Person to Monitor Change 282 Use Client Satisfaction Scales 282 Use Goal-Attainment Measures 282 Termination 283 How to Prevent Premature Termination 283 How to Tell Whether Termination Is Needed 285 How to Prepare a Client for Termination 286 Dealing with Loss at Termination 286 The Helper’s Reaction to Termination 287 How to Maintain Therapeutic Gains and Prevent Relapse Following Termination 287 Follow-Up 288 Booster Sessions 288 Engaging Paraprofessionals 288 Self-Help Groups 288 Continue Self-Monitoring Activities 288 Role-Playing for Relapse Prevention 289 Letter Writing 289 Summary 289 Exercises 289 Group Exercises 289 Small Group Discussions 290 Written Exercises 290 Self-Assessment 291 Homework 291 Journal Starters 296 Chapter 12 SKILLS FOR HELPING SOMEONE WHO IS DIFFERENT 297 Differences Make a Difference 297 Mismatch between Client and Helper 298 How Can You Become Culturally Competent? 298 What Is Culture. and What Should We Do about It? 299 Skills for Helping Someone Who Is Culturally Different 300 The Skill of Cultural Study and Cultural Immersion 300 A Tutorial Stance: The Skill of Understanding the Client’s Culture by Listening 301 . Contents xvii Tapping Cultural Support Systems 301 Achieving Credibility and Trust 301 Culturally Adapting Treatment: Tailoring Your Approach to the Client 302 Acknowledging Differences by Broaching 303 Skills for Dealing with Gender Issues 303 Challenges Caused by Differences in Gender 303 Skills for Addressing Gender Issues 304 When the Difference Is Gender 305 Skills for Helping a Child 306 Identifying Helping Skills for Working with Children 307 Using Basic Skills as a Guideline for Working with Children 311 The Case for Play Therapy 311 Summary 312 Exercises 312 Group Exercises 312 Small Group Discussions 312 Self-Assessment 313 Homework 313 Journal Starters 313 Glossary 315 References 323 Index 349 . . Summary Exercises • Group Exercises THE DEMANDS OF THE JOURNEY • Group Discussions • Written Exercises Learning to be a professional helper is a journey that takes years.1 Identify ways of reflecting that you can begin implementing to • Learning Basic Skills and Common deepen your learning of helping skills.2 Recognize that there are personal challenges in learning helping • Change Techniques skills such as recognizing the time factor needed to master skills • The Importance of the Building Blocks and dealing with ethical dilemmas as you train with fellow learners. • Self-Assessment Besides gaining a basic fund of knowledge about people and • Homework their strengths and challenges. you will be able to: The Nuts and Bolts of Helping 1.3 Identify the therapeutic factors. and the stages of the helping relationship. the building blocks. CHAPTER 1 Helping as a Personal Journey The Demands of the Journey Becoming a Reflective Practitioner • Using Reflection to Help You Overcome Challenging Helping Situations and Enhance Your Learning • Using Reflection to Help Clients with Backgrounds Different from Your Own • Using Reflection to Accommodate New Information about Yourself • Learning to Reflect through Exercises in This Book What Is Helping? • Psychological Helping • Interviewing • What Are Counseling and Psychotherapy? • Coaching Challenges You Will Face in Learning the Art of Helping • The Challenge of Development • Taking Responsibility for Your Own Learning • Finding a Mentor • Finding the Perfect Technique • In Limbo • Accepting Feedback and Being Perfect • Following Ethical Guidelines • Individual Differences LEARNING OUTCOMES Who Can Be an Effective Helper? • What Can You Bring to a Client? By the end of this chapter. one must be constantly learning • Journal Starters 1 . Therapeutic Factors • Therapeutic Building Blocks 1. The Stages of the Helping Process: A Road Map 1. Being a reflective practitioner means that you make a com- mitment to personal awareness of your automatic reactions and prejudices by taking time to think back on these reactions and perhaps to record them in a journal or discuss them with a supervisor or colleague. all helpers become frustrated at times when clients fail to reach the goals we expect of them. “interior” journey because you must be committed to understanding yourself as well as your clients. In this book you will learn the essential helping skills. watching and then reflecting on video seg- ments. BECOMING A REFLECTIVE PRACTITIONER Because of the challenges caused by our personal reactions and unique client character- istics. Reflection trains one to be open to contemplation. will react to different learning situations based on your history and favored learning . we teach one method of dealing with the dilemma of understanding the client and monitoring the self. 2000. You may find that your teachers ask you to use reflective methods in class and on your own. and feelings of attraction. and to be inquisitive in one’s lifestyle as well as in one’s work. or even reflecting teams (Griffith & Frieden. 2007). but it is not enough to be skilled. at every turn. he is disgusted by her body and realizes his reaction is extreme. Bastow. It makes him think about the rejection he received for being Jewish and white during his childhood in segregated Washington. repulsion. But helping is also a personal.2 Chapter 1 • Helping as a Personal Journey and updating knowledge just as a physician needs to know about new treatments and new diseases. He thinks that his repulsion is perhaps a historical attempt to have someone to reject as he was rejected. we believe that helpers need a method of integrating new learning and coping with moments of indecision and doubt. Irvin Yalom. & Ratkowski. DC. 2002. you will experience attraction and repulsion because of your personal needs and prejudices based on your cultural conditioning. This journey is difficult because it requires that we simultaneously try to focus on the client while keeping a close watch on our own tendencies to judge. the reflective practitioner consciously reviews what has happened and decides on a plan of action. Becoming aware of our prejudiced responses to others is part of the journey of the professional helper. in his book Love’s Executioner (1989. Just as every client will respond to the same technique or skill in a different way. These reactions can be roadblocks on our journey if they interfere with the ability to form a vibrant client/helper relationship or when we see the client as a reflection of ourselves rather than as a unique human being. For example. journal writing. Magnuson & Norem. This is an approach called the reflective practitioner. Willow. conducting small groups to react to case studies. You will experience self-doubt when your clients encounter complex and unfamiliar problems. describes his treatment of an obese woman who is depressed. In this book. pp. to become resourceful. or to force our viewpoint on others. you face self-doubt. All of these reactions flood into his mind before the client ever even opens her mouth. personal prejudices. as a stu- dent. and frustration. It makes him wonder why he cannot accept fatness even though he was able to easily counsel people who were criminals when he worked in a prison. you. From the moment he meets her. Jeffrey Kottler (2010) con- siders reflection to be not only a necessary characteristic of an effective helper but also a form of training. the teacher might use such techniques as Socratic questioning (asking leading questions). to boost our egos. Moreover. 94–95). In other words. to consider alterna- tive plans of action. there are times. and some do best when they can have hands-on experi- ence and then talk about the theory. you will respond differently to different assign- ments throughout your program of study based on your individual preferences. rather than to merely remember and give back just what you have heard or read. But sometimes this seems to make the client even madder. reflection can help you meld old and new information. In short.” I have found that the process of reflection allows me to better accommo- date new information rather than rejecting it out of hand. In fact. but now my rule of thumb was in jeop- ardy because it did not seem to be limiting her progress or the group. I found support for this rule in the fact that when clients received both forms of treatment. It asks you to chew everything thoroughly before you swallow it. I would insist on the client dropping out of indi- vidual counseling while she attended my group. For example. The process of reflection can help at such times when tried-and-true methods are not working. sav- ing their most personal issues for their individual sessions. Still. Using Reflection to Help Clients with Backgrounds Different from Your Own An important and frequent challenge occurs when you encounter people who are com- pletely different from you in one or several ways: culture or ethnicity. a client may be hostile and uncooperative. she was applying the insights of individual counseling to her interpersonal world! I went to my supervisor with my dilemma. When I was first learning group counseling. and she felt that individual counseling was a vital support in her life. I received a new client for my group who had undergone a number of very traumatic events and was still being seen individually by another therapist. socioeconomics. At times like these. Let me give an example from my own experience. As I began to practice group counseling. I read in several text- books that clients should never receive both group and individual therapy at the same time. You can record what is said and then write your reaction and rebuttals in the margins. Chapter 1 • Helping as a Personal Journey 3 styles. you will be confronted with many challenging experiences both in the classroom and when you actu- ally meet your clients. they did not contribute to the group. She seemed to be profiting from both forms of treatment. others need to write down what they are learning. and she helped me put my old rule and my new experience together. Using Reflection to Help You Overcome Challenging Helping Situations and Enhance Your Learning If you are engaged in a course of study to become a professional helper. especially when the client is in need of a great deal of support or has been traumatized. I constructed a revised rule: “Most of the time. Some students learn best by listening and then reflecting. With her help. You can come to class with questions and concerns based on the previous week’s lesson. the method of the reflective practitioner challenges you to be more than a recep- tacle of knowledge. when both modalities might be beneficial. clients will not benefit from both forms of treatment. Normally. reflection can help you even when a teacher’s method does not suit your learning style. You will undoubtedly experi- ence similar moments as you study the skills of helping. . You may be shocked when you discover that the methods you have always used to help your friends are not recom- mended in a therapeutic relationship. Your training may tell you to encourage clients to articulate their concerns more fully. Thus. She performed beautifully in group. One day. however. including exer- cises to help you become accustomed to the reflective process. rationalizing your mistakes. being a reflective practitioner also means having the courage to ask for feedback from others and then to reflect on how you can work more effectively in a particularly difficult situation (Kinsella. ASK FOR SUPERVISION Supervision is the practice of a helper and a supervisor sitting down to review the helper’s problems and successes with his or her clients. So. rather than making excuses or blaming others. 2010. preferences.4 Chapter 1 • Helping as a Personal Journey education. or blaming the client for a lack of progress. It allows you to carefully consider the feedback you are getting from supervisors. others will comment on your interpersonal style (the typical way you interact with others). He or she learns from difficult clients. you might be shocked by or you might disapprove of a particular family dynamic. discounting the giver of feedback. including asking for supervision. helping requires helpers to become aware of their own personalities. religion/spirituality. and even your gestures and pos- ture. and personal reactions. and supervisors. 1987). In the course of your training. That is why we think of helpers as expanders rather than as “shrinks. your words. and keeping a personal journal. and unexpected suc- cesses (Gordon. race. impotent. 1983. This approach abandons the view of supervision as a dependent relationship and guidance as the main purpose of the meeting. The following are some ways that you can be proactive in reflecting on your prac- tice. 2004). failure of a technique. Everyone in the helping field needs periodic supervision whether he or she is a student or an experienced practitioner. take time to think back on what you know and what you have learned and compare it with your new experience. Supervision’s real value is that it is a time set aside for . values. In supervi- sion. unpleasant interactions. you will be better able to separate your personal prejudices about what seems normal and perhaps look at the situ- ation from an alternate viewpoint. Lawrence LeShan (1996) reported that his own mentor still sought supervision for herself. You will frequently become defensive. The ability to see another perspective is enhanced when you have the opportunity to reflect with teachers. Because of your own upbringing. teachers. and family rules and relationships. and even your clients. becoming a client yourself. allow yourself to register surprise and all the other emotions as you encounter these novel situ- ations. even when she was in her 80s. developing a support group of fellow learners. If you undertake the challenge of becoming a reflective practitioner. In addition. fellow students. ethical issues. you will reflect on possible courses of action. Professional helpers are required to be under supervision while they are students and during their post-degree internships. indicating that the reflective process is necessary at all stages of the journey. For example.” Using Reflection to Accommodate New Information about Yourself Perhaps more than any other profession. you will encounter family situations where people openly express their thoughts and feelings and others where they rarely if ever reveal their inner lives to each other. Through reflecting. Later. or incompetent. Growth means that we consciously stretch and are able to see multiple viewpoints. and feelings. Reflection can help you inte- grate new discoveries that you make about yourself. Yet the reflective practitioner is one who examines and reflects on critical incidents and strong personal feelings in the course of supervision. Schön. These are natural reflexes to the threat of feeling uncertain. fellow students. this book pro- vides a number of opportunities to personally respond to the material. Many universities offer free services to students.. The examples that follow were submitted by helpers working in the field. Some helpers even use journals as a therapeutic technique and a way of assessing the client’s feelings. students are part of a cohort or group that goes through every class together. As a student. try out various solutions. KEEP A PERSONAL JOURNAL One of the most popular methods for reflecting is to keep a personal journal. but it must be in a setting where you have the chance to face real problems. My Day Journal. More than half of therapists become clients after their advanced training and about 90% consider it to be very beneficial (Norcross. Many therapists in private practice are members of such groups. Sax.g. OTHER METHODS FOR REFLECTING Reflection does not have to be a separate activity. It can be incorporated into your daily life as a student or practitioner. 2004. and studies together. If you are not part of a cohort. They write their reflections to clients in letters. relationships. DEVELOP A SUPPORT GROUP OF FELLOW LEARNERS Another golden opportunity for reflecting on your new learning is to develop a supportive group of co-learners with whom you can discuss your personal reactions to the material. and make mistakes. Gordon. Chapter 1 • Helping as a Personal Journey 5 you to listen to yourself as you explain your situation to someone else. There is a boom in blogging and online Internet journals. and dreams (Stone. and Journie. You should be aware that some schools restrict their counseling centers to people who are in critical need. In some training programs. Personal journaling is also available on your smartphone using applications such as Day One. A number of writers (e. 1998). Schön (1987) indicates that having a “master teacher” is important. Make use of this valuable opportunity to reflect on your work. synchronously or asynchronously . or client and helper journal together and compare notes. 2006) have compiled lists of opportunities for reflection. 1990). shares information. They found that reflecting can take place: • When writing case notes • During group supervision • During individual discussion with a supervisor • In personal therapy • While journal writing • During meditation • As a part of course assignments such as papers • While listening to recorded sessions • When talking informally to fellow practitioners • When unexpectedly thinking about a client • In online groups. The best learning environment involves reflection in action. and this can be a way for you to experience what it is like to sit in the other chair. BECOME A CLIENT Another way of building a reflective component into your learning plan is to enter a counseling relationship as a client. you may have the opportunity to ask supervisors and faculty members to look at your videos and discuss cases with you. Momento. you can still develop a supportive group that meets regularly. The apparent moral is that we need to prevent people from falling in rather than just treating the victims. Helping only requires a person desiring help (a client). psychotherapy. or through advocacy. If you do not find the stimulus question to be relevant. rather than on merely helping an individual client. So. we have included “Stop and Reflect” sections that ask you to consider your reaction to real cases or situations. a school administrator who takes time to listen to a crying first grader can utilize helping skills. In Table 1. and a conducive setting (Hackney & Cormier. someone willing and able to give help (a helper). 2005). and briefly describes the role of the helper. In every chapter. Being a skilled reflective practitioner is a benefit in each field and in each helping relationship. and someone still needs to pull them out. A teacher’s aide in a sixth-grade classroom can take a nonjudgmental stance when a child talks about why homework is late. The problem is that there will always be people falling in the river. A foster parent can learn to listen to the child and to the biological parents. we identify some of the major ways that we can help another per- son. psychologically. whether we have a therapeutic relationship or not. One of the current controversies is how much emphasis should be placed on advocacy. design your own or. financially. whether physically. record your reaction to your practice sessions each week. Consider the anecdote about a group of people pulling accident victims from the river without sending anyone upstream to see why people were end- ing up in the river in the first place.6 Chapter 1 • Helping as a Personal Journey Learning to Reflect through Exercises in This Book As you read this book. Instead. we take the stance that although all helpers should have . These questions are meant to kindle your thinking. Efforts to make our social systems more responsive and just will not entirely replace the need to help individual clients.1. or seeking to change unfair social and political systems. Next we look at helping and the different emphases of counseling. and coaching in helping clients. These sections have no right or wrong answers. spiritually.1 A Reflection Plan WHAT IS HELPING? Helping is a broad term that encompasses all the activities we use to assist another person. confiden- tial relationship. instead. interviewing. MyCounselingLab Application Exercise 1. Finally. The table provides examples and cautions. You will also have opportunities to receive feedback from your fellow students and to reflect on your own progress when you practice new skills. You can learn helping skills and use them whether you are on the way to becoming a professional or you simply want to help those with whom you live and work. For example. Helping does not require a contract or a professional. Marital partners can help each other deal with disappoint- ments and frustrations. we will offer several opportunities to develop this reflective habit. we have included suggested journal questions at the end of each chapter. they ask for personal reactions and hopefully stimulate your thinking. They can make your learning more interactive if you take the time to respond as authentically as you can. but do not feel that answering these questions is your only journal- ing option. personal growth the helper must thoughts. Chapter 1 • Helping as a Personal Journey 7 TABLE 1. educators are sociopolitical or concern to if advocating for a Most clients are not recommending level the Veterans specific client. effectively. and of training and the client needs to behaviors supervision. Financially Giving money to Not all Giving money to Donor the Red Cross organizations a person on the make the best use street can assuage of donated funds. read their client’s or oversimplify aware of their scriptures. treatment Psychologically Counseling or This kind of Clients can become Professional This book is psychotherapy helping requires dependent on the Helper about helping to aid client a commitment to relationship. looking for this kind additional training Administration of help. to consider or temple. and psychologically. this aspect of a utilize spiritual person’s life and beliefs to aid help or refer. in changing. and a long period stay alert to when feelings. . their own personal than address them. Advocating Calling Social This kind of help The client may Client This is a normal at agency or Security to is only useful be helped in one Advocate part of every school level understand if clients then situation but not helper’s daily application learn more about empowered to work. your conscience but Be sure your may not actually be donations are used helping. go it alone. or biases. procedures and how to work the deal with future explaining them system themselves. helping client get on Medicaid Spiritually Encouraging Helpers must Client may be Spiritual Helpers are client to pray or be aware of seeking to avoid Advisor becoming more meditate.1 Ways of Helping Ways of Help That Is Not Role of the Helping Example Cautions Helping Helper Comment Physically Joining Habitat None Doing things Laborer for Humanity to for people that build houses they can do for themselves makes them dependent. go to background and problems rather responsibility church. situations. mosque. service. for helpers in this about gaps in area. to the client Advocating Writing letters You must have Professional helping Activist More at the of complaint client’s permission requires a client. not trying to improve the situation of the interviewee. and Coaching. Despite these differences. this can be confusing. but both avenues are equally important. different settings and different contracts between helper and client mean that this kind of helping can be defined in a variety of ways (see Figure 1.1 Different Emphases among Psychotherapy. psychotherapy. To the newcomer. counseling. couple. Both assessment methods can utilize simple and direct questions or use a fill-in-the- blank approach. Growth. interviewing is a conversation between an interviewer and an interviewee. There are published structured interviews for a variety of psychological con- ditions and problems. they must also have the skills to help the individual.1). A strong dose of encouragement. Interviewing. Counseling. FIGURE 1. The area overlapped by all four circles depicts this shared base. includ- ing interviewing. the interviewer gathers and records information about the interviewee. The following sections will clarify some of the most common terms. Interviewing is part of the assessment process that we dis- cuss in more detail later. or children.8 Chapter 1 • Helping as a Personal Journey advocacy skills. Some helpers are better at working with agencies and institutions. hurdles. Interviews can be structured with a series of predetermined ques- tions or unstructured with the helper fitting questions in during the flow of the session. If you utilize an intake or history form during the first session with a client and fill in all the spaces. . during an interview. as is giving a client a paper-and-pencil test. and some helpers are better with families. couples. or family member. and coaching. Information may be oriented. group. In essence.1. you are conducting an interview. interviewing is one method of assessment. But it is important to talk about the relationship between Psychotherapy More emphasis on Counseling pathology and More emphasis accurate diagnosis. there are many common theoretical underpinnings as well as common skills. from eating disorders to depression. Interviewing According to the simplest definition. Psychological Helping Although helping in the psychological realm is the term we use in the last row of Table 1. Thus. During the conversation. used to help another person rather than Coaching the client. on the therapeutic relationship and overcoming Interviewing normal More emphasis on developmental gaining information. the inter- viewer is eliciting data. or ability to think in a “live” setting. whether substance abuse is involved. and from the client himself to determine the extent of his problem. as part of the assess- ment process. or entrance into special training programs. couples most frequently complain about the following concerns: their inability to communicate. Second. some companies use a stress interview (a type of situational interview) to determine which of their employees can operate best under pressure. So I frequently stopped their argument about finances to insert a question about these other areas. I wanted to make sure that I covered each of these areas and that I was not missing something important. A helper must go back and forth between helping and interviewing in almost every session because clients bring up new . This case demonstrates several important issues. a short test we give to all our clients during the first session. in-laws. children. so that you can begin to distinguish their separate but complementary roles. Many people think that this kind of interview is unethical. and interviewing is experienced as an intrusion. interviewing. Whenever we inter- view someone. even their finances. He had marked several of the questions that indicate substance abuse problems. to assess some skill. I needed to know whether financial problems were the only issues. can make your helping more effective because it is a way of making sure you are going in the right direction and treating the right problems. from his spouse. I immediately took time to ask the husband several questions about his drinking and looked back at the OQ-45. and finances. Clients want to tell you their version of the story. sex. Employers interview applicants for jobs. they both wanted to talk about their anger and frustration related to financial difficulties. I had other items on my agenda. It seemed clear that they blamed each other for these problems. By the end of the session it was clear that his drinking was a serious problem that needed treatment before we could solve any other concerns. For example. It is also essential to know whether there has been violence in the relationship. During the first ses- sion. In the middle of the session. Chapter 1 • Helping as a Personal Journey 9 assessment and helping early on. interviewing and counseling are rarely separate pro- cesses. I was recently seeing a couple for counseling. and each wanted to unload. we want to watch the person’s reaction to the interview because we can learn about how he or she responds to people. In my experience. poise. or to confirm a diagnosis. Although I felt that it was important that they be allowed to express some of these feelings. I used the data from the test. the interview is primarily for the benefit of the organization. the wife revealed that she was concerned about her husband’s drinking. interviewing can be disruptive of the relationship. For example. but the point is that an interview can provide an opportunity to observe the reaction of a student or employee in a contrived situation similar to actual situations that he or she may encounter. The interviewee is “grilled” and even treated disrespectfully to gauge his or her reaction. In clinical settings. This is called a situational interview. Helpers interview to determine the appropriateness of services for an individual. Finally. First. many counseling centers hire intake interviewers who talk with clients and then assign them to the appropriate counselor or refer them to another service or treatment facility. For example. or whether either party suffers from a mental disorder. helping and interviewing frequently occur during the same therapeutic session. An interview may also be used to test the interviewee’s skills. promotions. The purpose of an interview may be to help an interviewee or to make a decision about that person. but in business settings. These interviews are designed to ultimately benefit the client. 10 Chapter 1 • Helping as a Personal Journey issues as the relationship deepens. which is the bible of mental disorders (American Psychiatric Association. psychotherapy was used to describe the process of helping clients who were troubled by mental disorders. In summary. Between 1920 and 1950. psy- chologists. . however. and behavior for which there are specific diagnostic criteria. Interviewing is an art whose medium is the relationship. The basic helping skills you learn in this text will help you create this climate of openness. Historically. clinical social workers. marriage and family therapists. Mental disorders are defined as severe disturbances of mood. these are the only problems that most health insurance companies recognize as reimbursable. For each disorder. and acceptance needed for an effective interview. the words counseling and psychotherapy are now used interchangeably. motivate. it is not merely a mechanical process of filling in the spaces. In the literature and in practice. In most states. and panic disor- der. In the assessment chapter. Sessions with a counselor or psychotherapist take place on a regularly scheduled basis. and psychiatrists can all practice counseling and psychotherapy in private practice when they have a license. there is a list of criteria that the client must meet to possess the diagnosis. This atmosphere increases the quantity and quality of information obtained. 2013). Examples include major depressive disorder. creating confusion for professionals and clients. and treatment planning have been integral aspects of psychotherapy. such as individuals certified in treating substance abuse or with a background in human services. they also try to empower clients to address persistent problems in living and make changes that will lead to overall improvement rather than temporary relief. counselors. usually weekly. Even today. It is up to the helper to repair the relationship when clients feel disrupted and to explain the reasons for the interview so the clients under- stand your need to get the whole picture. not all of which are designed to directly help the interviewee. arouse. Counselors and other psychotherapists use specific techniques to persuade. you will have an opportunity to utilize your helping relationship skills and also learn to interview for key data. A therapeutic relationship will last several months or even several years. schizophrenia. Although counselors and psychotherapists may help clients deal with emergencies. What Are Counseling and Psychotherapy? Counseling and psychotherapy are professional helping services provided by trained individuals who have contracts with their clients to assist them in attaining their goals. diagnosis. and encourage their clients and to thoroughly assess their issues and backgrounds. thought. A skilled inter- viewer knows how to quickly develop a working relationship with an interviewee in order to obtain the most relevant information for the decision-making process. the processes of assessment. different professional groups have tended to prefer one or the other. The criteria for more than 300 mental disorders are outlined in the Diagnos- tic and Statistical Manual of Mental Disorders (DSM). can usually practice within an organization under supervision. Other individuals without these licenses. The inter- viewer creates a climate where the interviewee will feel like talking and asks relevant questions to gain vital information. warmth. inform. interviewing is utilized in a variety of settings. From the beginning. and last about 1 hour. marital issues. non-competitiveness with team members and enthusiasm” (p. Later in this book. What may be different is that the definition of a coach frequently includes a very encouraging cheer- leader sort of attitude and the focus on specific achievable goals that the client wants to pursue (Biswas-Diener. ability to size up people. and the transition to college or work—what we might call “normal problems. Chapter 1 • Helping as a Personal Journey 11 Counseling was developed in the early 1960s as psychotherapy for “normal peo- ple. But coach- ing is mostly counseling by another name. 451). and engage in treatment planning. and diagnosis. Coaching practices are springing up because coaching is not yet regulated by licensing boards and state legislatures. Both will refer to the contractual and profes- sional relationship between a trained helper and a client. personality tests and other assessment activities were minimized. diplomacy and tact. deal with potential stumbling blocks and improve their performance. patient. In this section. By the same token. and identifying areas of growth rather than dys- function was emphasized. professionals such as psychologists and marriage and fam- ily therapists who prefer the term psychotherapy or therapy also help clients with difficul- ties such as adolescent adjustment. they will be used interchangeably in this book. CHALLENGES YOU WILL FACE IN LEARNING THE ART OF HELPING A major feature of this book is that I have included input from students about specific hurdles they have faced on the road to becoming a helper. along with words such as treat- ment. For that reason. Here is a definition provided by Cummings and Worley (2009): “Coaching is a development process whereby an individual meets on a regular basis to clarify goals. . Although these values are still common among counselors today. self-confidence. the distinctions between counseling and psychotherapy have blurred. Coaching allows individuals without therapeutic degrees to practice professional help- ing. Coaching Coaching is a new term on the mental health scene. we look at the normal challenges that you will probably face in your training. Now. Modern coun- selors routinely use assessment tools. 2009). DuBrin (2005) identifies the following elements of an effective coach: “empathy.” Medical terminology was shunned by counselors. It is an intervention that is highly personal and generally involves a one-on-one relationship between coach and client” (p. Under what circumstances is this kind of enthusiasm helpful or potentially detrimental? Determine for yourself whether you think coaching is a new approach or merely a mar- keting strategy. active listening. concern for the welfare of oth- ers. learn diagnostic methods. patience toward people. counseling includes helping people with mental disorders as well as those experiencing normal developmental problems. About 90% of this definition overlaps with counseling and psychotherapy. Counseling was focused more on the counselor/client relation- ship as the medium for change rather than on the tools and techniques. and because there is a market for a helper who is not therapeutic but mostly supportive. ix).” Although some may still feel there are good reasons to make distinctions between the terms counseling and psychotherapy. rather than as a diagnostic label. Counselors believed in seeing each individual as a unique person. and “coaching” sounds a lot more pleasant than counseling or therapy. we will talk about this issue more. You will be learning supervision skills as you do so. To receive the maximum . Another implication is that people enter this training with varying levels of expertise.2. especially in the skilled trades.12 Chapter 1 • Helping as a Personal Journey The Challenge of Development An immediate challenge. In Table 1. If you are a beginner. despite what state legislatures allow. One cannot master the art of helping in one semester or even 2 years of formal training. ask your instruc- tor for more challenging assignments. A journeyman still needs ongoing contact with an expert or master counselor. Taking Responsibility for Your Own Learning In other course work. is a feeling that you should be effective right away. You have probably heard of master plumbers or master electricians. with your instructor’s permission. Take comfort in the small victories when your instructor or fellow students notice your progress—even if it is hard for you to see. If you already have some helping experience. Recognizing and normalizing where you are at this moment—whether journeyman or beginner—can help you focus on the next step ahead and alleviate some of this feeling that you should swiftly ascend to a higher level of helping. You may also discover that your experience allows you to make connections not available to you the first time you learned these skills. A significant number are already journeymen when they register for basic helping skills training (McLennan. It is difficult to accept that considerable time and training is necessary. Encourage them to reflect on their learning. you may have found that memorizing the text and attending class were sufficient for success. and feeling effective may elude you for quite some time. In essence. a new helper is probably not permitted to handle all of the day-to-day decisions independent of supervision until after 2 years of education and 2 more years of supervised experience. you will see this concept applied to the development of expertise in helping (Young. Hoffman and his colleagues use traditional “guild” terminology from the trades to divide expertise into seven stages. Also. the more experienced students eventually feel that the course has been extremely valuable. you may feel that your time is being wasted going back over the basic skills. Invariably. I have frequently taught basic skills to students who have been working as helpers for several years. there are many stages ahead of you on the journey. 1998). we sometimes expect to have some measure of competence quickly. it may be the only time when you are able to reflect during the day. If you feel that this course is repetitious. as you encounter the seemingly endless flood of information and skills that you will need to learn. find ways to help other members of your training group by giving them detailed feedback. it maps the journey from entry level to master level. helping skills training requires that you perform skills in front of other people in practice situations. They report that it was benefi- cial to reexamine their basic positions on important questions such as “Under what circum- stances should I give advice?” and they feel that they may have not been as thoughtful as needed about treatment alternatives when working in a system that prescribes the way that clients are helped. Supervision (a reflective process) is a vital part of the journey because when you are a working professional. 1994). One implication of this developmental concept is that. you may find that on-the- job training has not been systematic and that this course can help fill in the gaps. The concept of levels of expertise is a commonsense approach that has been around for centuries. Although becoming a master of the helping arts is a lifelong journey. If you are in this situation. Unlike traditional classes. and who can quickly and effectively deal with normal professional situations. someone beginning the first class in basic helping skills but not yet accepted into a program of study. & Klein. E. Some helpers stay at the journeyman stage for life. in which the teacher pours from the jug of knowledge into the student’s mug. or getting special help from the instructor. apprenticeship lasts from 1 to 12 years. If the class moves ahead. Chapter 1 • Helping as a Personal Journey 13 TABLE 1. For example. Expert An expert is an exceptional journeyman who is highly esteemed by his or her peers. A journeyman works on orders from his or her supervisor. you may need to continue to work on that skill by practicing with fellow students. Source: Young. it can be a detriment in learning helping skills because it may keep you from volunteering to practice in class and receiving the feedback that will help you grow. you may appear to be ahead of or behind your classmates as you learn a particular skill in this book. Shadboldt. journée. 31(3). The apprentice is fully immersed in professional helping and works as an assistant. M. rather than seeing the process of learning as a “mug and jug” phenomenon. You must take responsibility for educating yourself and request the training that you need. benefit from practice sessions. this is because the master is thought of as “the expert” in a particular area within the field. In addition. (1998). A master is one whose judgments and practices become standards for others to follow. Frequently. You must . and so on. Reprinted with permission of Love Publishing. There is a strong tendency to compare oneself with others and to view training as a com- petition. the expert is one who can handle “tough cases” and may have some particular area of expertise based on considerable experience with a certain type of problem—for example. Expert status is by no means inevitable. 2. reading. The novice is a new trainee who is on probation. Initiate A person who has been selected for a program and has begun introductory training—a new student in his or her first semester. Students in practicum and internship experiences are apprentices. Burton. Master A master is one of a select group of experts who are qualified to teach others. 1995) Naivette One who knows nothing about the practice of counseling or psychotherapy—a layperson. Apprentice A student still undergoing instruction but who is beyond the introductory level. domestic violence. Novice The word novice means one who is new. whose diagnostic and therapeutic skills are exceptionally accurate. crisis intervention. Journeyman The term journeyman comes from the French word for day. Skills-based training for counselors: Microskills or mega-skills? Counseling and Human Development. This term was coined by Hoffman to identify a person who is completely naive to the trade. One way to identify a master is that he or she is regarded as an expert by other experts. This period of training may last for many years. even beyond the 2 to 3 years postgraduate experience required by the supervisor or the licensing state. In the trades. substance abuse.2 “Guild” Terminology for Helper Development (Based on Hoffman. A journeyman is one who can do a day’s work unsupervised. you must open yourself up to feedback and suggestions. watching videos of your performance. for example. Although that may be a good strategy in some classes. but you may not necessarily be helping the client. and you will need these skills to really be effective.” Even your attempts to regain your old self seem awkward and artificial. How few are the times when someone really stops to listen wholly and solely. that you will find the perfect technique that will work for every client. it is true that one learns to have more faith and confidence in one’s own judgment and abilities (Skovholt & Ronnestad. you may be learning. however. however. There is nothing wrong with learning all you can. Although you may be able to keep your skill level hidden for a little while. Finding the Perfect Technique Beginning helpers are extremely anxious to learn specific techniques and interventions. “He acts like being with that person is the most important thing in the world.” “empathy. It is a challenge. In Limbo As you begin the process of learning to help. the founder of multimodal therapy.” Although I had read about “eye contact. It is unlikely. As you consciously learn the helping process. especially in the beginning. You may find that the new techniques and interventions feel artificial or “not like me” at first. Canipe & Brockett. In your training. If you abandon the therapeutic relationship in favor of an exciting technique. and you must seek them out. eventually you will be alone with a client.” and “unconditional positive regard. They gather techniques and tricks of the trade at workshops. “I used to know what to do when a friend was upset. this may mean that you face embarrassment if you are honest about what you do not know or cannot do. When you feel anxious or ineffective. it may be difficult to be natural. As we will discuss later. . Teachers and supervisors are vital guides through- out the journey. we talked about the value of a master therapist for reflecting or supervision. As time goes on. cautions us that training can sometimes undermine our native talents (1990). how powerful such attention can be. 1992).” when I saw the quality of his presence. it is normal to experience a desire to learn every method available and assume a sort of “cookbook” approach to helping. for the first time. I no longer know what to say. but even then. Although beginning helpers are often naturally therapeutic. you may find that you abandon your natural helping style.14 Chapter 1 • Helping as a Personal Journey move from teacher-directed learning to self-directed learning (Caffarella. Do not be sur- prised to hear yourself say. they typically find that they must temporarily set aside their old ways of helping. Finding a Mentor Earlier. I remember saying to myself. to find experienced helpers who have the time to act as mentors or who will allow you to observe. Now that I’ve begun to study helping. Once I watched one of my own teachers in a session with a client. 2003). techniques account for only a portion of being successful in helping. 1993. Arnold Lazarus. One of the best ways to learn the helping skills is to watch effective models and to receive feedback from teachers even if they are only a few steps beyond you. He tells the story of his friend. But learning from models is not restricted to only those in the highest altitudes of therapeutic expertise. a dentist. supervision and mentoring are essential for self-assessment and reflection. I grasped. hoping that one of them will be the magic pill that cures all clients. On the other hand. ethical dilemmas are just as likely to arise in your training group. you will find a way to integrate the old “therapeutic friend” with the new “therapeutic helper. The following are some guidelines you may wish to adopt as a group during your class. or beliefs. But the story is there to remind us that we have much to lose. Although there may not seem to be any serious harm in doing so. personal warmth. religions. do no harm. however. as you give up old hab- its and learn new skills. and it is as if someone says. students accept feedback but feel discouraged about being “wrong. and updated versions are available online. “There are a number of different paths. humiliation. families. forming these boundaries will set up an atmosphere of trust and allow for more freedom for all participants. they attempt to justify their actions rather than listening to critiques and suggestions. In many cases. it is easier not to react personally because you feel confident in your basic skills. it will be necessary to talk with your instructor about how to handle these conflicts. . However. Early on. The challenge of the Hippocratic oath to all practitioners of the healing arts is primum non nocere—first. This means that you should not tell your best friend. Lazarus felt that the result was a rather phony person who resorted to jargon instead of listening. emotionally arousing techniques. Chapter 1 • Helping as a Personal Journey 15 who was a natural listener and was very therapeutic with his patients. Perhaps Lazarus’s friend was going through a stage characterized by overzealousness and insecurity. we may fail to recognize that clients in a helping relationship can also be harmed by inappropriate advice.” When faced with feedback. These standards can be found in recent publications. Hopefully. Although many of the issues described in these guidelines will not surface in your train- ing group. you should still be prepared. Make sure everyone is in agreement to abide by the ethical guidelines. rules are inadequate to deal with every problem that arises. or your spouse. our training will be something to overcome rather than to rely on. so that everyone is in agreement. If we abandon our genuineness. Ethical guidelines and codes largely deal with the work environment. and all the other qualities that make people feel we are listening and caring. and subtle messages of contempt when we do not under- stand their cultures. Which one is better?” Following Ethical Guidelines We are all familiar with errors in medical treatment. But the dentist went back to school to become a therapist. Ethical guidelines have been proposed by virtually every professional organization in the helping professions. Guideline 1: Do not reveal what other training group members say about themselves during role-playing and practice sessions. you should discuss these thoroughly.” Accepting Feedback and Being Perfect Your willingness to accept feedback will be another indicator of developmental change. your father. It may be your first experience in keeping professional secrets. similar to the seal of the confessional taken by Catholic priests. As you gain confidence and see how different responses take clients in different directions. Try thinking of it as a sacred trust. Ethical guidelines help us avoid harm to clients by asking us to adhere to some general rules. Optimally. I am sure you have heard of an “empathy sandwich. reading about a technique or seeing it demonstrated at a workshop is not sufficient training. are you really competent and knowledgeable enough to give advice? Could your advice be dan- gerous to a person’s relationships or his or her academic or professional life? Could it undermine the client’s self-confidence? These concerns suggest that you might wish to resist giving advice during this part of your training and develop some alternative skills. you may find that giving advice. Learning to be sensitive to the cul- tural and religious differences and honoring the unique experiences of clients help us to avoid the trap of subtly communicating that a person’s values and worldview are unacceptable. life experiences. Even if you are relatively sure that the probability of violence is low. In couples communication. Similarly. your judgments may be based on inadequate knowledge. A few years ago. In fact. Give only specific and constructive feedback. Using an unfamiliar and potentially harmful method should only be attempted with the guidance and permission of your teacher or supervisor.16 Chapter 1 • Helping as a Personal Journey Guideline 2: Avoid giving advice. it may have an equally powerful negative effect when misap- plied. Avoid making value judgments on a person’s lifestyle. Give feedback only when asked and package it in a way that the other person can accept. Guideline 5: Stay mainly with the techniques described in the book or those taught by your instructor. Guideline 4: Be careful with feedback to clients and to fellow students. and even be aware of these issues in our esteemed colleagues (cf. it is vital that you discuss any suggestion of violence with someone in authority. Guideline 3: Do not impose your values on others. Give feedback on areas where the person wants more information. We give feedback not to show how clever we are but to provide something useful to the client. Granello & Granello. or philoso- phy of life. Generally speaking. Giving vague or very nega- tive feedback can be damaging. This is a practical suggestion as well as an ethical guideline. Practicing new techniques is only ethical when you are under supervision. 2007). one of the most prolific writers and most innovative thinkers in cognitive therapy. It makes us realize that we have the obligation to be sensitive and to receive training in suicide assessment and prevention. From the ethical perspective. Guideline 6: Notify your instructor or supervisor at once if a member of your training group or a client is contemplating suicide or is considering harming others. Michael Mahoney. simple positive feedback will be the most helpful here because one negative statement is heard five times louder than a compliment. may reflect your own limited experiences.” It means giving the bad news in between two positive statements. this kind of sandwich is not a bad idea for training situations. specific. From the practical standpoint. A powerful technique can cut both ways. can damage the relationship and slow client progress. especially early on. . or may communicate con- tempt or lack of acceptance of the other person. committed suicide. Gottman (2000) has found that it takes five positive statements to counteract one negative statement in a couple’s conversation. Similar to giving advice. Knowing more about these may help you because many of these qualities can be acquired. 2015. • Female students raised in traditional families may have difficulty trusting in an internal authority (their own thoughts. or having children). and conclusions. or are going through a particularly stressful life stage (for example. various writers have looked at specific traits that lead to effective helping. consider how the following indi- vidual differences may have an impact: • Minority students may have fewer same-race peer interactions (less support) and fewer minority role models (Cheatham & Berg-Cross. Marx. Are you similar to the professionals you know? What must you know. The writings of 15 different authors described 55 characteristics. attitudes. Corey. getting married or divorced. MyCounselingLab Application Exercise 1. 1981. and beliefs of effective helpers. 1987). Students facing outside stressors may also have difficulty maintaining the flexible schedule that is required (Gaff & Gaff. 2008. & Callanan. • Hypermasculine upbringing may cause male trainees to be “fixers. Corey. 1971. & Purkey. Gladding. feelings. 2006). • Some male students may not be as attuned to relationships and feelings as their fe- male counterparts. and what abilities must you possess going in? Although there is no single personality configu- ration that defines the perfect helper. 1992). it is a personal journey. leaving home. 1981. They have also looked at the beliefs and attitudes most condu- cive to learning and working in the profession. are one of the first in your family to attain higher education. Development is not a competition with your classmates.” seeking solu- tions quickly. Sometimes you may feel that you are taking two steps forward and one step back. nor is it necessarily a linear process. Allow yourself time to develop and move at your own pace. Quimby & O’Brien. 1990). I have tried to consolidate these into five key elements (Combs. WHO CAN BE AN EFFECTIVE HELPER? Questioning whether you are really cut out for a job is to be expected when you enter a new field. Specifically. In this section. you may face additional challenges in the process of becoming a helper. Avila.2 Following Ethical Guidelines in Your Training Individual Differences If you are a member of a minority group. Such considerations should serve to illustrate that development is not the same for each person. A student’s progress in learning the art of helping cannot be confined to a timetable (Barrow. before understanding the client. They may fail to recognize and accept feelings of fear and helplessness in themselves and may therefore have difficulty recognizing them in others. rather than to discourage those with special situations. . Chapter 1 • Helping as a Personal Journey 17 Learning to talk about suicide and violence with your fellow students and your instructor is good training for your later work when you must learn to disclose to supervisors or other authorities. have a disability. Bernard. the effective helper has good self-esteem and is a secure and mentally healthy person.” This fifth characteristic of an effective helper has two facets: First. Similarly. they are lifelong learners. nor should it be a way to experience power over others or to feel superior to those with more serious problems. The addicted client needs to be well beyond the thrall of his or her addic- tion before becoming a counselor. the helper’s job requires risk taking and action. L. Helping requires one to devise innovative ideas with different clients in differ- ent situations. 1967). Does this mean that if you have a serious mental disorder you should not be a professional helper? I think the answer is yes. The effective helper has a stable and fulfilling personal life with close family and friends to provide support as a buffer to the stress of helping. cultures. First and foremost. he or she must be able to look with a detached eye at human destruction and see where the healing can be started. 1989. Effective helpers appreciate their strengths but know their limitations. He or she wants to help others and believes that people have the desire to change. The helper must be able to communicate his or her nonjudgmental attitude as well as warmth and caring. most writers agree that the effective helper has good self-care skills. They are able to examine themselves critically. time management.18 Chapter 1 • Helping as a Personal Journey Kottler. human motivation. the helper must be able to listen unflinchingly to stories of great pain. the effective helper is both creative and intellectually competent. an effective helper has a positive. Patterson & Eisenberg. They have the courage to look at themselves under a microscope and can separate helping the client from boosting the ego of the helper. the founder of psychodrama. Although the process of recovery may intrigue the recovering alcoholic or addict. and moral dilemmas. A helper must be able to deal flexibly with ambivalence. relaxation. and personal self-renewal. accepting view of other peo- ple. Creativity and flexibility are equally important. Spurling & Dryden. Yet before entering the field of professional helping. unfinished busi- ness. his unexpected response was “courage. leisure. He or she has to allow clients to work through difficult situations without moving them to premature decisions. too. Individuals who believe that they can control every circumstance and that there is a procedure and a solution for every crisis have a difficult . Second. It is easy to become emotionally “bankrupt” and “burned out” if one does not develop techniques for stress management. 2010. and human development and understands how to create change. Like a physician who sets a broken arm. was once asked what the most necessary quality was for a group leader. When J. recovery is not the only creden- tial one needs. Learning to be a helper because of a personal mental disorder is not the correct motivation. a Renais- sance person who appreciates both the science and the art of helping. Those who remain vital in the pro- fession have an “insatiable curiosity” to learn and grow in their skills and knowledge (Spurling & Dryden. every person should not only evaluate his or her own personal mental health and stamina but also get a second opinion from a professional. clients who have been helped want to return the favor. Truax & Carkhuff. Fre- quently. He or she accepts people who are different from himself or herself and is not judg- mental about other people’s lifestyles. Second. 1987. Fourth. 1983. Many who are attracted to this profession want to help others. They make reflection and personal growth part of their lifestyle. values. The effective helper has specialized knowledge of human relationships. 1989). but soon find that doing so can be depleting. and religions. individuals who have received help themselves may be attracted to the field that helped them so much. Moreno. Third. McConnaughy. without the security offered by other sciences. Helpers should not be clones. As you consider the characteristics of effective helpers that we have identified. effective helpers must have the courage to help in situations of uncertainty. They are not necessarily inborn. First. Much depends on knowing our own abilities and finding an environ- ment where they can be put to good use. Chapter 1 • Helping as a Personal Journey 19 time as helpers. What extracurricular activities might help you to grow? . She was practi- cal and concrete and liked people who were “down-to-earth. there are no psychological tests that accurately predict a person’s tendency to be violent. There is room for many types of individuals. Second. She has excellent judgment and is indis- pensable to her school because she knows how to take quick action and exudes calm and poise in times of confusion. each of whom brings significant strengths and unique limitations.” She wanted to solve prob- lems and make a difference in the lives of children. train- ing. a graduate student. Answer the accompanying questions as truthfully as possible. remember two things. She seemed to roll her eyes when the discussion became too intellectual. each person brings unique characteristics to the helping pro- fession and. However. Which of these qualities do you presently possess and which do you want to improve? For those skills you need to develop. think for a moment about what you might do to challenge yourself. Her particular strength is that she knows how to manage crises. It seemed to me that sometimes she tended to be too quick to come to closure with adult clients when they became stuck or were indecisive. Do not look at the characteristics of effective helpers in order to identify those you do not have. Maria’s case illustrates that each of us brings strengths to the helping role. the challenge is to find a place where these gifts will help others. got under my skin sometimes because she had little patience for long theoretical discussions and did not like studying anything that did not have immediate application. Build on your own strengths and add new skills as you go along. She instantly grasps what has to be done and takes bold and concrete steps to accomplish it. Maria now works effectively as a school counselor. For example. because your answers may point out areas you may wish to address later in your training. The example of a former student may help to illustrate this. STOP AND REFLECT Helper Characteristics The characteristics of effective helpers identified by the experts are listed in brief form in the follow- ing statements. many of the characteristics can be developed. Sometimes she pushed them to make decisions and seemed insensitive to their turmoil. Because human behavior is relatively unpredictable. What Can You Bring to a Client? Although the preceding list identifies some basic characteristics of effective helpers. Helpers’ decisions must be based on experience. there is no one set of personal qualities that defines the ideal helping professional. as in Maria’s case. and even intuition. Maria. How true is this for you? How can you grow? Stable and Mentally Healthy You have good self-esteem and are basically a secure. but friends and family can give you feedback on your coping ability. How true is this for you? How can you grow? Courageous You have enough courage to examine your own personal problems and to seek help and guidance for yourself when you need it. You can appreciate both a scientific and an artistic approach to learning about helping. mentally healthy person. You know your limits and are able to set boundaries to protect yourself from burnout. You are willing to admit that you need to change and grow. and family customs that differ from your own. for the most part. to deal with the cruelties that other people inflict on each other without being so disturbed that it disrupts your own life or your ability to help.20 Chapter 1 • Helping as a Personal Journey Positive View of Humankind You believe that most people are basically good and are striving for self-improvement. religions. You are not rigid or inflexible in your attitudes. (You may not be able to make a completely unbiased self-assessment. You are able. You are not bothered by many prejudices about people. How true is this for you? How can you grow? .) How true is this for you? How can you grow? Good Self-Care Skills You do not become overly involved with those you are helping. How true is this for you? How can you grow? Creative You are a creative person in some aspect of your life. You enjoy people and believe that people can change. cultures. How true is this for you? How can you grow? Intelligent and Psychologically Minded You are an intellectually curious person who is interested in the psychological world of other people. 1991): 1. 1981) showed how different theories rely on these factors for their effectiveness. Because it is so central to what helpers do. Corsini & Wedding. By learning to create a climate of openness and listening. the old skills find their way back in a more therapeutic way as you discover that the nuts and bolts of helping must precede more elaborate interventions. Karson & Fox. It will seem awkward at first to use other skills instead of the ones that are most comforta- ble. we make a rationale to include techniques in this category that lower emotional arousal and create positive emotions such as relaxation training and meditation. The question is. Chapter 1 • Helping as a Personal Journey 21 THE NUTS AND BOLTS OF HELPING In this section. These skills mostly originated as techniques embedded in theories of counseling and psychotherapy. you will have the foundation to develop more advanced skills and to implement the other therapeutic factors. they are actually drawing on similar meth- ods. The therapeutic building blocks or basic skills that you will learn are mainly aimed at helping you maximize this therapeutic factor. from cognitive behavioral to psychodrama (Corsini.” that make up the more complicated techniques that you will be learning. & Hubble. Although help- ers seem to be utilizing different techniques. Learning Basic Skills and Common Therapeutic Factors Basic helping skills are normally taught as small units that we call basic skills or building blocks. “Are these different theories calling forth unique healing qualities or are there common things that all helpers do that work?” Common therapeutic factors are thought to be the basic healing properties that underlie all effective counseling theories and techniques (Duncan. 2005). This makes learning easier. Frank described six common therapeutic factors that seem to cut across theoretical persuasions (Frank & Frank. we will examine it in more detail in the next chapter. Miller. or “mega-skills” (Young. you will be introduced to the basic skills. Raising emotional arousal and promoting emotional expression (Later.) 6. Stu- dents have trouble seeing the big picture because they learn first one piece and then another. Wampold. Your first challenge may be to incorporate new learning without abandoning your natural therapeutic abilities. It is estimated that there are between 100 and 500 different theoreti- cal orientations. Individual skills often seem so elementary that students may be confused about why they are important. 2008. Maintaining a strong helper/client relationship 2. Increasing the client’s motivation and expectations of help 3. Enhancing the client’s sense of mastery or self-efficacy 4. Parloff. One of the best-researched and most potent common factors is the therapeutic helper/client rela- tionship. Herink. 2009. . 2001. but I have found that as time goes on. Providing opportunities to practice new behaviors Most therapies utilize these therapeutic factors to produce change and they are probably even more important than theory-specific techniques (Lambert. 1998). or “building blocks. Providing new learning experiences 5. One conceptual framework that may help to put these small pieces into the big- ger puzzle is understanding that these fundamentals are effective because they evoke common therapeutic factors. 2010). 1979). but it also creates problems. The lifetime work of Jerome Frank (1971. 1980. These are the most fundamental components of the helping interview. When elements are combined. The therapeutic building blocks represent the foundational interven- tions used to create change. Reflecting skills Paraphrasing Reflecting feelings 3. Invitational skills (two sub-categrories.3).3 The Building Block Skills Skill Category Therapeutic Building Block 1. but they can also be combined into more complex tech- niques. Goal-setting skills Using questions to identify a goal Boiling down the problem . They represent the combined wisdom of many theorists and helpers over time. Although this may seem to be an overwhelming number. These building blocks are like the elements of the periodic table we all learned in high school chemistry (I apologize if this brings back traumatic memories). The therapeutic building blocks are divided into five categories (see Table 1. In this book. Each category represents an important helping activity as follows: TABLE 1. they form more complex substances. 11 of the building blocks are quite simple (we call them invitational skills) and very easy to master.22 Chapter 1 • Helping as a Personal Journey Therapeutic Building Blocks Therapeutic building blocks is the phrase we use to describe the basic helping skills. such as oxygen and hydrogen coming together to make water. Advanced reflecting skills Reflecting meaning Summarizing 4. such as asking open-ended questions or maintaining eye contact. nonverbal and opening skills) Nonverbal skills Appropriate eye contact Body position Attentive silence Voice tone Gestures and facial expressions Physical distance Touching Opening skills Encouragers Door openers Minimal encouragers Questions Open questions Closed questions 2. Challenging skills Giving feedback Confrontation 5. we identify 19 therapeutic building blocks. and long-term goals. others. These skills encompass all the subtle verbal and nonverbal messages that helpers send to encourage a client to open up without applying pressure. challenging skills push clients to recognize discrepancies in their statements. Recognizing and reflect- ing the gist of the client’s story and underlying emotions is something you will practice throughout your training. You may think that paying attention is only polite. which involves shaping a client’s vague or unrealistic goals into specific and achievable targets. For example. a client who says that he wishes to stop smoking but does not follow any of the suggestions made by the helper might be challenged about the discrepancy between words and behavior. Giving feedback and confrontation are the fundamental chal- lenging skills. These skills take some time to develop. For example. . Understanding the unique meanings that people assign to events and helping them identify their beliefs about themselves. The second key helping skill in this area is to “boil down” the problem. losing a job may also be seen as a sign of failure or evidence of incompetence. Advanced reflecting skills are hunches that helpers make and repeat to their clients to see whether they understand the unique impact of their cli- ents’ problems beyond the basic facts and feelings. Depending on the person. they disclose more deeply and the important issues begin to surface. When clients feel understood. Reflections are condensed versions of the facts and emotions the client has con- veyed. begin to narrow the focus. They include reflecting meaning and summarizing. CHALLENGING SKILLS (TWO SKILLS—CHAPTER 7) Whereas invitational skills. reflecting skills. imagine how you would feel if the helper constantly checked her watch or looked out the window. Challenging skills identify incongruities in a client’s story and may give information on client strengths and weaknesses. These building block skills of using questions to identify a goal and boiling down the problem are needed to help clients develop short. and reflecting skills let them know that you have heard their sto- ries. and the world are advanced skills that move clients to deeper self-understanding. Eye contact and attentive body posture are two of the invitational behaviors you will learn and practice. ADVANCED REFLECTING SKILLS (TWO SKILLS—CHAPTER 6) Advanced reflecting skills help a client move even deeper than the reflecting skills do. but it is also a skill. For example. Goal-setting skills. the loss of a job is not just the change in economic status and feelings of loss. not a social encounter. GOAL-SETTING SKILLS (TWO SKILLS—CHAPTER 8) Up to this point. however. The helper shares these “snapshots” of the client’s story to let the client know that he or she is being understood both in terms of content and at the affective (emo- tional) level. REFLECTING SKILLS (TWO SKILLS—CHAPTERS 4 AND 5) Invitational skills invite clients to tell their stories. and advanced reflecting skills encourage deeper self-examination. Chapter 1 • Helping as a Personal Journey 23 INVITATIONAL SKILLS (ELEVEN SKILLS—CHAPTER 3) Invitational skills are the basic means by which the helper invites the client into a therapeutic relationship. Advanced reflecting skills help clients explore. the aim has been to encourage the client to disclose in as much depth and breadth as possible. The first key goal-setting skill is using ques- tions to identify a goal. but they may also remind clients that the helping relationship is a work project. Challenging skills can strain the relation- ship. gratitude. 1978. . In Chapter 9. deep muscle relaxation. Just as in basketball or baseball. brainstorming. Your training in the helping skills will be very similar. How- ever. 1975. We call these change techniques because they are interventions designed to help the client achieve a goal that has been identified using goal-setting skills. every helper needs to practice the fundamentals. The diagram shows five helper tasks that occur more or less sequentially from the first session to the last. when fundamentals are mastered. something is required of each person if the process is to move forward. THE STAGES OF THE HELPING PROCESS: A ROAD MAP The advantage to mastering the building block skills is that they help in the development of a therapeutic relationship. The art of helping begins when the therapeutic building blocks have become second nature. this book also introduces you to some more advanced techniques in Chapters 9 and 10. The road map proposes a two-lane road with helper and client side-by-side. In a moving scene. . An example of this prin- ciple is shown in the 2010 film. meditation. & Jones. a commonly misused change technique. giving information. Through repeti- tion. when combined in a combat situation. he rebels and angrily confronts his teacher for having wasted his time. At each stage of the road. the teacher shows him how each of the seemingly unrelated tasks is a fundamental move in the art of Kung Fu. they form an impenetrable defense. or plays. They begin making fun of their own tendencies to say “Mm-hmm . The Importance of the Building Blocks We have said that one of the problems confronting most beginning helpers is that they learn elementary skills in isolation and cannot see how the skills fit into a grand scheme. 1986).2 presents the stages of the helping process over time. many of which will seem awkward and repetitive. . Ivey & Mathews. A therapeutic relationship is one that allows the client to solve the problems for which he or she has sought help. encourage- ment. you will learn two cognitive therapy techniques: countering and thought stopping. . Without solid fundamentals. they form more elaborate and elegant techniques. they are linked into more complex movements. .” They secretly yearn to do what famous therapists do in training films: have a tremendous impact on cli- ents. Figure 1. and they will take on a naturalness that you can- not feel at first. we address giving advice. This five-part structure is based on the work of several different writers (Dimond & Havens. Dimond. giving homework. as well as the use of change questions. At one point. In sports. .” and “What I hear you saying is. The road map of the helping process shows the typical progression of activities of helper and client through the process.24 Chapter 1 • Helping as a Personal Journey Change Techniques Beyond the therapeutic building blocks. his teacher tells him over and over again to pick up his coat and hang it on the rack. When the student begins to study karate. the plays are less effective. Then the helper can learn and practice change techniques like those in Chapters 9 and 10. The Karate Kid. They do not understand how flashy theory-based techniques such as Gestalt’s “empty chair” relate to the baby steps they are learning in class. You will also learn and practice role-playing. In Chapter 10. and some techniques for stim- ulating emotional arousal and expression. and reframing. You will learn basic helping moves. Havens. The stu- dent wants to be Bruce Lee. when they are properly learned and put in the appropriate sequence. the movements become second nature. assessment. Establishing and maintaining the relationship is crucial to the other stages of the road. the client recipro- cates: opening up and disclosing more fully. For example. and the helper must take time to collect needed information. the helper collects information and the client pro- vides it through answers to questions or data from intake forms or tests. The third stage in the helping process is goal setting. the helper uses invitational and reflecting skills to build a trusting relationship. Many helpers might spend an entire session collecting back- ground data. In the second stage. If trust is established.2 Road Map of the Helping Process For example. Normally. a strong therapeutic relationship allows a client to disclose more easily in the assessment stage. and some might spend a session or two conducting more in-depth evaluations using tests. In this book. In goal setting. Most helpers find that it takes a session or two in the beginning just for building the therapeutic relationship and allowing time for the client to open up. . at the first stage. assessment actually occurs throughout the helping process when a new problem emerges. although we have not included them in the therapeutic building blocks. tend to sidetrack us from our central purpose. your course of study will include an entire course on assessment. The helper must use his or her expertise to shape these goals into clear statements and accept only those goals that will lead to real improvement in the client’s life. assess- ment skills are covered in Chapter 8. relationship building. the client par- ticipates by thinking about and agreeing to the goals that are mutually determined. although important. The reason for not saying more about assessment in this book is that these skills. Chapter 1 • Helping as a Personal Journey 25 START Relationship Building HERE Assessment Goal Setting Intervention and Action Evaluation and Reflection STOP FIGURE 1. which is to learn the fundamentals of a helping relationship. However. FWFSZPOF
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Helping. Using a whiteboard or flip chart. the interviewee. In this exercise. In the second part of the on helping the interviewee feel comfortable and re- exercise. including the adage of the mountain climber: Don’t look at the self-acceptance. but right now appreciate can practice the helping arts. other facing toward the back of the room. This unstructured interview ends encouraged to stop their partner and ask for specific after the interviewer’s 20th question. remember where you are. As you begin. the instructor draws a figure Unstructured Interview of four connected geometrical shapes. vantages and disadvantages of one-way communica- vantages of each style? In the unstructured interview. rear-facing students again look away from the laxed and on following up on the interviewee’s an- board and the instructor draws a different figure of swers rather than opening up a new topic. When they have completed as “Can you tell me a little bit about your family?” It the drawing. One out to others. their two drawings. To begin. asks these questions of another person these two kinds of communication options. we made the statement that developing an Communication atmosphere that allows the client to feel comfortable The purpose of this exercise is to become aware of two and relaxed enhances interviewing. but this time they are questions are asked. each front-facing student explains the figure to In the second part of the exercise. one member of the group. such completed the drawing. The rear-facing students the group will need to keep track of how many open still may not look at the board. you and your friend talk on the phone about a computer problem you are having. information. the group discusses the two contrasting inter. draw what they hear their partner describing. For example. and the ability to reach summit. the rear-facing students cannot see viewer should focus on making the interviewee feel the figure and are not allowed to speak until they have comfortable and asking nonspecific questions. ing to each other’s communication. Exercises GROUP EXERCISES list? What did you get that was new or unexpected in the unstructured situation? Exercise 1: Dividing into Groups and Constructing Questions Exercise 2: One-way versus Two-way Earlier. keep your attention on your next step. For example. What was the effect of each interview style on more accurate? Conduct a class discussion on the ad- the interviewees? What are the advantages and disad. Each group communication is when your boss sends you an e-mail develops a list of 20 questions it would like to ask or you get a letter from the credit card company. there is not just one kind of person who day you’ll get to the top. two new individuals his or her rear-facing partner. An example of one-way students divide into groups of four or five. Two- someone about his or her life if the group members way communication means both people are respond- wanted to get important information or know the per. and Structured Interview at each step you tell her what you are doing and she When the list is compiled. “Is the triangle twice as big as the square? Is the rectangle inside the circle?” When Discussion and Analysis the drawing is complete. Which took longer? Which one is views. son better. This time. The interviewee should students find a partner and then sit back to back with answer honestly but may pass on any question if it is one sitting facing the front of the classroom and the too personal. they may stop and show it to their part- should be more informal and the emphasis should be ner and look at the board. helps you solve the problem. the interviewer does not use the list. Did this affect communication? . The rear-facing students from the group participate in an interview. cooperation. Think about the noise that was going on in the did you obtain the answers to all the questions on the classroom. This exercise explores an interviewer. basic communication forms. each set of partners compares Finally. in the group. Someone in about the same complexity. Instead the inter- Of course. tion. Chapter 1 • Helping as a Personal Journey 27 identified characteristics of effective helpers. and in the first phase. rather than stating the problem. or learning to sew). Exercise 1: Stages of the Road Map With my chosen problem. Goal setting: Discussion 4: Your Reaction to New Learning Imagine yourself without the problem. they suggest that we all have greater b.28 Chapter 1 • Helping as a Personal Journey GROUP DISCUSSIONS It can be a small problem you are now facing or an issue from the past that you can pretend is an issue to- Your instructor may pose these questions to the whole day. Intervention and action: any particular thoughts that you had during that time? What kind of approach by a helper would you Discuss them with classmates and see whether you object to? Is there anything that immediately can relate your previous experience to what you might comes to mind that you might want the helper encounter as you learn helping skills. Relationship building: Sometimes job interviews are comfortable. your cultural and religious background. Do you think these What important issues would a helper have to energizers are helpful? Is this kind of encouragement find out about you. What Experiences would you be doing.” transform it into a future sce- go through as you were gaining expertise? Was your nario. Write in a journal to express my feelings . discuss the following: You probably How would you feel about spending the first ses- were encouraged to study helping by friends or family sion answering questions about your problem? members. let us examine the five stages shown in Figure 1. just leave it blank. What do you think are the natural helping How might you respond to the helper’s request qualities that you possess and that you do not want to that you complete tests or inventories? lose during your training? c. or would you prefer a more interview? Which jobs really require people to react businesslike atmosphere? quickly under stress? Discuss some job interviews that How much would you like the helper to say you have participated in. and some- times they are stressful. I would most like to: To get a better idea of the sequence of the helping pro- Listen to advice about how to solve my problem cess. “I bite the computer. thinking. Think about a problem that you are experiencing. Frequently. How important would it be for a helper to be vantages to making someone uncomfortable in a job warm and inviting. Do you think there are ad. If the problem you have WRITTEN EXERCISES selected does not really fit with a particular tech- nique. your goals. or feeling that you are not experiencing now? Think of a time when you learned a new skill (for Can you turn your problem into a goal? For ex- example.” spurts? Were you self-critical at first? If so. and your history before he or she Discussion 3: Your Present Strengths could help you? In a small group. what ef- fect did your negative thinking have? Can you identify d.2. your environ- enough to make people achieve lasting change? ment. What stages did you my fingernails. Assessment: potential than we are aware of. to do? React to each of the interventions below as to whether you would want the helper to use this specific technique. learning a new program on ample. Jot down your answers to the following questions class or ask you to break into smaller groups to reflect. want in a helper? tion. such as “I would like to have attractive improvement gradual or were there sudden growth nails that I would not be ashamed of in public. Discussion 1: Interviewing a. playing tennis. What conclusions can you about himself or herself? draw about interviewing? How long do you think it would take before you trusted a helper enough to disclose something Discussion 2: Energizing extremely personal? There are a number of high-energy spokespeople What sort of personal characteristics would you who run infomercials and talk about human motiva. about each stage of the helping process and the helper who might be assisting you. your family. 8. career in a helping profession. with themselves. been working for only a few years (say. and keep a conversation 1. When do you feel least confident in your job? 4. feeling.) 2. Think 1 2 3 4 5 6 7 8 9 10 about what you are good at when it comes to dealing with other people. Talk to people about serious and painful subjects Make an appointment with a professional who has without being overwhelmed. Role-play my problem 1 2 3 4 5 6 7 8 9 10 Enter group therapy and hear the reactions of Not at all confident Very confident others 5. Talk about myself. Bring a family member with me to a session Complete an assignment to say no to others 1 2 3 4 5 6 7 8 9 10 more often Not at all confident Very confident Hear a story by the helper about how he or she 6. Does another helper supervise you? If so. (Be sure to add a couple of ques- Not at all confident Very confident tions of particular interest to you. Describe any other skill that you have that you might be able to transfer to the helping Efficacy and Self-Esteem If you are considering a relationship. If you want to extend that activity. HOMEWORK How do you rate yourself on the following skills? I am confident that I can: Homework 1: Meet a Professional 1. Allow other people to cry or express negative Keep a record of specific behaviors emotions. Other (anything here that you think would help) 1 2 3 4 5 6 7 8 9 10 e. scribed below. Do you benefit from conferences? . it Not at all confident Very confident is important to remember your old strengths and find a way to incorporate them with your new helping skills. To what theoretical orientation do you subscribe? 1 2 3 4 5 6 7 8 9 10 5. and acting ideas. you probably possess some important interpersonal skills already. What kinds of professional reading do you do? Not at all confident Very confident 6. 9. my deeper feelings. make small talk. what do going. Thinking about the therapists you have known or observed. Chat. Compare his or her answers with yours. Chapter 1 • Helping as a Personal Journey 29 Just have someone to listen (no advice) 4. look 1 2 3 4 5 6 7 8 9 10 at these qualities of effective helpers and ask someone who knows you to rate you on a 1–10 scale for each Not at all confident Very confident characteristic. Challenge people when they are not being honest tion in this chapter as a self-assessment activity as de. and my How would you be thinking. when you had accomplished it? 1 2 3 4 5 6 7 8 9 10 SELF-ASSESSMENT Not at all confident Very confident Use the “Stop and Reflect: Helper Characteristics” sec. you value about these sessions? 1 2 3 4 5 6 7 8 9 10 2. While you are learning new skills. Help people figure out answers to their problems. 1–5). Ask him 1 2 3 4 5 6 7 8 9 10 or her the following questions and react briefly in writ- ing to each answer. Make people think by posing challenging ques- handled a similar problem tions. what qualities do they possess that you Not at all confident Very confident admire? 3. Make people feel comfortable. Evaluation and reflection: How would you know that you had definitely Not at all confident Very confident completed your goal? 7. 3. Some- short. 1. What did you do and say that You can use a computer. to help but you were not as successful. your instructor may ask you to complete journal entries several times during the semester. Reflect on a time when you think that you really and thought about. ability to help? Because this class invites so much personal growth. Reviewing times in my life when I have not been as er hand. Be- ing in a page or two. Other questions . it should be reread 2.30 Chapter 1 • Helping as a Personal Journey 7. not only in a journal but also with your classmates. continue writing. cause these are warm-ups. did you find ways to help The following are two stimulus sentences you others? Has helping been a regular part of your work can use to provide a warm-up for your journaling. you are definitely gaining knowledge and skills. if you can. Include jobs you held in organi- you are asked to share some of your journal or not. . your lectures. helped someone. starters or create your own. Bring your reflections different about the two situations? . Feel free to modify these journal your experiences on your journey. even if you feel that you have departed from the original JOURNAL STARTERS stimulus sentences. What was cles. you will be able best deal with setbacks in my basic skills training? to see your own development and think about future What feelings do I have as I start this process? goals. allows you to reflect on your own attitudes successful as I wanted to be. and so on. wheth- particular topic that might overwhelm others? Whether er paid or volunteer. not in a helping capacity. ap- zations in high school or college if your work history is proach it with complete honesty and edit it later. Even if your job was to keep private before they hand in their assignment. 8. on the oth. List your jobs and. Did you notice any big “jumps” or stages in your to class or share them privately with your instructor. seemed to have been especially helpful? Contrast or develop a three-ring binder to construct a journal this. or is it a new development? Summarize your learn- Each chapter contains several of these starters. poems. After writing for a while. purchase a blank book. life. reflect on what you are learning in class and focus on the Consider creating a personal journal that chronicles challenges you face. The journal. with another time when you tried that allows you to add other information such as arti. pictures. under each. A journal is not just a record. . By helped me to overcome the problem? How can I looking back over your work later on. write significant times I suggest that students write everything down learnings you gained about working with other peo- and then remove or black out those portions they want ple. Through this book. how did I react? What about helping and to react personally to the ideas. and other courses. both clients and co-workers. Is it possible to share too much about a Review your résumé or your past work history. Try to be as honest Homework 2: Review Your Work History as you can. discussing briefly why helpers and researchers place so much emphasis on the therapeutic relationship. you will learn about 31 . Finally. you will be able to: 2. CHAPTER 2 The Therapeutic Relationship The Importance of the Therapeutic Relationship in Creating Change • What Is a Helping Relationship? Is a Professional Helping Relationship the Same as a Friendship? • The Unique Characteristics of a Therapeutic Relationship • What Clients Want in a Helping Relationship How Can a Helper Create a Therapeutic Relationship? • Relationship Enhancers • Self-Disclosure and the Therapeutic Relationship Other Factors That Help or Strain the Therapeutic Relationship • Facilitative Office Environment • Distractions • Appearing Credible and Taking a Nonhierarchical Stance • Therapeutic Faux Pas • Transference and Countertransference Summary Exercises • Group Exercises • Small Group Discussions • Homework LEARNING OUTCOMES • Journal Starters By the end of this chapter. This chapter digs a little bit deeper into the mystery of the interaction between client and helper. 2.1 Understand the unique characteristics of a therapeutic relationship.2 Identify ways to create a working alliance with a client. 2. you will learn how you can build such a relationship with another person.3 Identify factors that help or strain the budding relationship. Here. I took three knives. . Jim told me one day that he thought I had become too dependent on the relationship and that we needed to reduce our sessions to once per month. I continued to see Jim over the next few months. Before addressing these important issues. At other times. I was so diso- riented by powerful feelings that I could hardly concentrate. As time went on. I felt like the rug had been pulled out from under my life. He was older than me by 25 years and had gray hair. I became stronger and was able to handle my problems much better. and as we went through the buffet line. Jim was a minister who also had a degree in counseling. Jim remained calm and at the end offered some hope. ushering me into his crowded office. I came to a session and found that there was a mix-up in communication and only a half hour of my session remained. he commented. shook my hand warmly with both of his. Once. After 4 or 5 months. it made me mad that he was not available when I called. and I wanted someone who could understand that side of me. I met a friend for lunch. Jim said. though. I was anxious. and I had heard that he had been happily married for many years to another therapist in the area. It took 6 months or so before I was able to really get back on solid ground and feel a sense of confidence. let us take a look at a real client’s recollection of her relationship with a counselor in her own words: I came to counseling because my husband was having an affair. I had always been the kind of person others leaned on. I was able to hold on for a few weeks while things sorted themselves out. I was bursting with sadness and anger. and I was devastated over the impending breakup of my marriage. First. I was frustrated that when I needed to talk to him. After that session. and I sensed that all my problems were no burden to him. He listened to me for the next half hour as though nothing else in the world was more important. For some irrational reason. Jim fit perfectly my ideas of what a helper should be. but he seemed to make me feel that there was all the time in the world. Later. That night I dreamt that I was sitting in Jim’s waiting room and everybody else was allowed to go in except me. “I don’t think it is time to give up on this yet. so I called to make an appoint- ment. I was upset because I really needed to talk to someone. Then. Knowing Jim was there was a great comfort sometimes. Even though it wasn’t his fault. Although I am not a Christian. My expectations were high. and four napkins. I had one of the most powerful experiences of my life. I was like a zombie at work. Part of me saw Jim’s reducing our sessions as a form of confidence in me. I am very spiritually oriented. I don’t want to give the impression that I am a weak person. three forks. This was the first time I had ever been so needy. It made me realize that I could rely on that to help me through this crisis. I also felt sick to my stomach when I realized how dependent I had become on my therapist.” Having that light at the end of the tunnel made a lot of difference. depressed. he asked me the question. I agreed that things were better and silently assented to this new arrange- ment. When we talked about it in the session. I had also heard that he studied with some famous teachers. Jim got up to greet me at the door. At our first meeting. I feel that I owe Jim a debt that I can never adequately repay. In many ways. But I also felt suddenly adrift. and I was desperate. Although I cried through much of the first session. it was still 3 or 4 days until our session. I heard that Jim was the best therapist in the area. I felt unimportant.” This really helped me become aware of how discarded and unwanted I felt in my relationship with my husband. “What holds you together?” I then talked about my spiritual beliefs.32 Chapter 2 • The Therapeutic Relationship mistakes that can be made that strain or weaken the helping relationship and the knotty problems of transference and countertransference. and having trouble eating and sleeping. three spoons. I had talked to a few friends about the situation. “I guess it was hard for you to face another rejection. The therapeutic relationship is crucial in all modalities of helping including group work. Tiet. Belkin. and sometimes the relationship does not even gel despite the best efforts of the helper. do not like the helper. 1999. 2011). helpers have indicated that achieving client goals is much more likely in a good relationship. In the next section. if the helper does not instill confidence and communicate warmth and acceptance in the first few sessions. You might com- plain. In addition. These are the “mega-skills” (Young. which shows the six therapeutic factors. but I recognize his caring and his undivided attention as one of the things that pulled me through. 2002). that relationship sometimes is a mirror that reflects our ongoing relationships outside of therapy. The helper/client relationship is also an important factor in understanding why clients drop out in the first few sessions. & Vermeiren. 1980. and it also reveals that strong emotions can be evoked when the relationship is strained or terminated. I don’t idealize him any longer. Chapter 2 • The Therapeutic Relationship 33 He helped me survive during the lowest period of my life. but also must be created immediately to prevent attrition. Clients drop out because they feel uncomfortable with the helper. 2007). On the flip side. So the power of the therapeutic relationship not only is vital to creating improvement. 1950. you would “vote with your feet” by not returning. working with children and ado- lescents. The central importance of the relationship in the helping process is portrayed in Figure 2. Fiedler. Ilgen. Wampold. Therapists and researchers have long recognized the importance of a strong working alliance in potentiating change (Bachelor & Horvath. The quality of the relationship is truly a common therapeutic factor among all theoretical approaches (Duncan. there are a number of things you can do to make a helping relationship work. 2010). Horvath & Greenberg. Think about how you might feel if you were to go to a physician and. but more likely. Katzow & Safran. In fact. or decide that the helper is not capable of helping. As in any profes- sional relationship. or common factors that are thought to underlie more specific therapeutic techniques . the physician showed no warmth or concern and did not seem to listen. 1998).1. the quality of the therapeutic relationship appears to be more predictive of success than the theoretical approach of the helper (Nuttall. Still. we look at the reasons why we place so much emphasis on establishing and maintaining such a relationship. & Hubble. AliciA B. and he or she will give up on the helper or even give up on seeking professional help altogether. 2011). 2002. & Finney. 2014. Jong. THE IMPORTANCE OF THE THERAPEUTIC RELATIONSHIP IN CREATING CHANGE There is strong research support for the contention that the relationship is a key factor in client success (Horvath & Bedi. Alicia’s story illustrates the power that a therapeutic relationship can have to sustain us in difficult times. the client’s fragile hopes may be dashed. although he or she appeared to have a lot of technical skill. Not all helping relationships are so intense. and working with couples and families (cf. Miller. Lambert (1986) indi- cates that utilizing effective techniques accounts for some of the success in helping but that the therapeutic relationship accounts for about twice as much as technique (Norcross. a poor therapeutic relationship or a rupture can lead to dropout (de Haan. From behaviorists Kanfer and Goldstein (1986) to Carl Rogers (1957). 1994). 2006). Geluk. Boon. Norcross. and motivation. discussed in the preceding chapter—requires the presence of a strong. and Emotional Motivation Arousal FIGURE 2. It is also true that each stage on the road map of the helping process—relationship building.1). goal setting. Later on in the text. however. and Raising Hope. a difference between a friendship and a professional helping relationship.34 Chapter 2 • The Therapeutic Relationship Enhancing Efficacy and Self-Esteem Providing New Practicing Learning New Experiences Maintaining a Behaviors Strong Helper/Client Relationship Activating Client Lowering Expectations. a caring attitude. assessment. each is built on a distinct contract. . and emotional support. It asks the helper to think about what the client needs in relationship to each of these factors. “R” stands for the relationship located at the center of the diagram to emphasize that the other factors depend. “L” for lowering and raising emotional arousal. to a large extent. intervention and action. There is.1 Six Common Therapeutic Factors (see Laska. The REPLAN system is a treatment planning method based on these six factors. Gurman. and “N” for providing new learning experiences. cooperative relationship between helper and client in order to accomplish the treatment goals (see Figure 2. and evaluation and reflection. What Is a Helping Relationship? Is a Professional Helping Relationship the Same as a Friendship? As you learn the art of helping. 2014). hope. The other factors are “E” for enhancing efficacy and self-esteem. enhancing your relationships and aiding those you care about. “P” for practicing new behaviors. we will look at specific techniques under each of these general headings. “A” for activating client expectations. on the power of the client/helper relationship for their effective- ness. These factors are all things that helpers do regardless of their therapeutic allegiance. you will be able to provide friends with a listening ear. & Wampold. REPLAN is a mnemonic device that helps you to remember the therapeutic factors when you are setting goals for a client. you have a con- tract to help the client make specific changes in his or her life. and disregard for whether the client ultimately likes him or her. they may not. that you have a toothache. As you become a professional helper. clients may assume that everything that they say to their counselor is confidential. Although the analogy does not hold completely. who may find this behavior intrusive and phony. you might find your- self treating a client as a friend. what are the specific qualities that the therapeutic relationship should have to maximize the client’s progress? . helping can sometimes be a painful process and it is best accomplished in a more professional environment where a particular block of time is set aside. You might be tempted to use elaborate techniques on your friends when all they are asking for is support. felt that this is a vital aspect of the helping relationship yet it is often ignored. It is easy to find ourselves being sociable and sympathetic. Berne believed that problems in relationships frequently occur because the parties have made assumptions but not outlined their expectations of each other. Chapter 2 • The Therapeutic Relationship 35 For example. There are several instances where counselors must release information—for exam- ple. is to do a good job. The helper’s concern. rather than thinking about how to help the client. and to provide support. She may suggest that you take some aspirin and that you make an appoint- ment with a dentist as soon as possible. in a friendship. Thus. When that happens. the founder of transactional analysis. your family. you might not be able to “hold his feet to the fire” when it is required. who is a dentist. It is like- wise easy to act like a therapist with our friends. enjoy each other’s company. On the other hand. or discuss the weather. Consider this analogy: You mention to your friend. to prevent harm to others. Eric Berne (1961). However. it is the client’s issues that are discussed and the client’s welfare that is paramount. Before leaving this topic. What makes this difficult is that we have learned our natural helping skills in the context of our friendships and family relationships. in the professional helping relationship. For example. ethics trump the therapeutic relationship whereas in friendships. In exchange. Remember that with friends you have no agreement or contract for change. When you are in trouble. or your favorite hobby. she proba- bly won’t pull out her dental equipment and start drilling in the living room. the professional helper is committed to hours of listening. not to make a new friend. but it is not. in a professional helping relationship. instead you have an opportunity to care. Moreover. In addition. a professional helper is required to identify and articulate issues not normally broached in a friendship. Although we have said that these two relationships are different. such as painful childhood memories and issues that evoke guilt and shame. the helper receives compensation for services rendered. One reason for drawing the distinction between a professional helping relation- ship and a friendship is that it is easy to make mistakes in both settings when you begin learning helping skills. Despite her professional capabilities. as a professional. you will recognize how important it is to identify the contract early in the relation- ship so that people you meet on an airplane and clients you see in your office know whether you are acting as a friend or a professional helper. let us take a moment to emphasize the importance of a contract in relationships. Some counselors outline the parameters of the helping rela- tionship in a handout that they discuss with their clients. you can talk to me and vice versa. confidentiality. responsibility for the outcome. Clients must know what they are agreeing to and must participate in the changes that they are about to make. not to maintain the relationship over the long term. the assumption is that we are there for each other. to show concern. However. he or she begins to discuss deeper and deeper issues. 2009. 2005). Crises are exceptions to . Help from a professional is usually not a gift but involves a fee-for-services relationship. There is an agreement about compensation for the helper: Although some help- ers may be volunteers or interns. Hilsenroth. and the client respects the help- er’s expertise. allowing honest disclosure by the client and feedback from the helper. & Handler. stronger therapeutic alliances are linked with better outcomes (symptom improvement) (Dinger. a real alliance may not be possible. The relationship not only is about support but also requires honest feed- back: At times. Even if the client invites it. Does the therapeutic relationship have to be one where client and helper have mutual fondness and a kind of chemistry? Perhaps not. It is a one-way street where the helper is the giver. This might strain the relationship but ultimately reassures the client that the helper is being honest. or feelings shared with a neighbor. But what are the characteristics of this special relationship? How will you know whether you are providing these aspects to a client? Here are the elements of a therapeutic relationship: There is a mutual liking—or at least respect: A therapeutic relationship has at its base respect. The purpose of the relationship is the resolution of the client’s issues: Com- pared with other relationships. Even the volunteer may benefit by listing the work experience on his or her résumé. Without this. helpers try to devote regularly scheduled times to clients. Falkenström. Sachsse. but at least the helper conveys respect for the client’s autonomy. There is an understanding that the relationship is confined to the sessions and does not overlap into the participants’ personal lives: As a general rule. most receive credit or money for each client hour. & Holmqvist. the helper/client dyad is unbalanced in favor of the client. As the client experiences this safety. 2011). Granström. & Symonds. At the beginning of the relationship. 2014. Ackerman. the helping relationship requires the helper to give the client feed- back or nonjudgmental information about the client’s behavior. Just as a friend might become your ally in quitting smoking or maintaining an exercise program. Strassle. The helper discloses his or her life only if it is very likely to aid the client. More important.36 Chapter 2 • The Therapeutic Relationship The Unique Characteristics of a Therapeutic Relationship Thus far. 2002. The helper’s own issues are dealt with in his or her personal life outside the therapeutic hour. Strack. There is a sense of teamwork as both helper and client work toward a mutually agreed-upon goal: The client can draw strength from the fact that the helper is there to provide support for change in the mutually decided direction. we have emphasized that professional helping relies on a contractual relation- ship involving a trained helper and a client wanting help. Horvath & Bedi. they report greater progress on therapy goals (Clemence. Del Re. the helper does not ask for or receive support from the client. & Schauenberg. Flückiger. When the helper and the client have confidence in that relationship. the client feels the helper’s presence as a constant nudge to grow. There is a contract specifying what will be disclosed to others outside of the relationship: Unlike a friendship at work. the client begins to realize that secrets will not circulate. confidences with a family member. helper and client discuss compensation. Horvath. Safety and trust are established. do you look for someone who is similar to you? Does this search for similarity mean that it is harder to make contact with someone who is quite different? How could one’s preference for similar people be a handicap in a helping profession? . Of course. You will certainly find other points in the book where your own ideas are challenged. such as this one. is from your home state. In what other situations do you think that a professional helper might have an advantage? • Have you noticed that in group situations you become interested when someone mentions something you agree with or when you have similar backgrounds? This “similar-to-me effect” has a powerful influence on our connections with people. referral may be called for. or reminds you of yourself at a younger age. The relationship can also be ended by either party at any time. the helper termi- nates the relationship when sufficient progress has been made or if the client is not making progress at all. In those cases.1 Overscheduled STOP AND REFLECT Learning the art of helping is a personal journey that asks you to examine your own ideas and reflect about what you are reading. When you look for friends. not appreciated. or that some- how changed the friendship? What effect did this have on you? • Some people think that our mobile. Try to use the “Stop and Reflect” sections. Start by considering the following questions about friendship and helping. you are well on your way to becoming a reflective practitioner. Chapter 2 • The Therapeutic Relationship 37 the rule. stressful society has led to a lack of community and has separated us from our extended family. Sometimes the relationship is ended by referral to another helper when special expertise is required such as sex therapy or substance abuse treatment. Most helpers give out a 24-hour crisis hotline number rather than their home phone number. If you can begin this habit now. especially if the therapeutic relationship is not developing. and frequently insurance companies limit their payments to a certain time frame. Sometimes agencies specify how many sessions a client may be seen. If friendships and family relationships were closer. to jot down your thoughts and reactions. • Have you ever given a friend help that was not well received. and then share them with another classmate or small group. but nearly all helpers have a system for dealing with emergent problems. In a job interview. the relationship can be terminated at any time: A unique aspect of the helping relationship is that once the client has reached the identified goals. the helping relationship is put on hold until some future help is needed. it is unethical to abandon a client who needs help. do you think that professional helping would be needed? • What would you do if a friend told you that he or she were contemplating suicide? Think about your answer and then discuss it with the class. MyCounselingLab Video Exercise 2. Generally. As a contractual relationship. They do not interact socially with clients when it can be avoided so that objectivity is not strained by other considerations. Discuss your answers with a small group. Learn to pause at those moments and contrast the two positions. you may be more apt to hire someone who is a member of the same sorority. The helper taught me a technique. 11. Davis. The helper greeted me. 9. 6. The helper went beyond a business relationship and made extra efforts to help. The helper showed good listening behaviors: remembering what was said and paraphrasing. I liked some personal characteristics of the helper (well groomed. Thus. The helper came highly recommended. The helper normalized the feelings I was having. I had a positive first impression. Using the relationship as a nonjudgmental space where they could open up to a supportive person 3. They mentioned: 1. The helper’s office environment helped to enhance the relationship (including rel- evant books). such as making a list of goals. 4. including pointing out strengths. similar back- ground). & Williams. The helper facilitating new thoughts and actions HOW CAN A HELPER CREATE A THERAPEUTIC RELATIONSHIP? So far. 15. 8. When clients were asked about incidents that helped establish a solid relationship with the helper. and said goodbye. Lilliengren & Werbart. The helper explained how therapy would work. 3. Labeling and expressing feelings 2. 7. Finding new ways of relating to people because of their experience in the therapeu- tic relationship 5. 2003. Clients in two other studies (Ackerman & Hilsenroth. The helper self-disclosed that he or she had had a similar experience. introduced himself or herself. But how can a helper create this special experience? Before looking at these suggestions. The helper validated my feelings and gave me support. 12. they men- tioned the following helper behaviors: 1. 2005) were asked to identify the most helpful things they experienced in the helping pro- cess. 14. 5. 10. 13. 2005). The helper used humor.38 Chapter 2 • The Therapeutic Relationship What Clients Want in a Helping Relationship A client’s judgment about the strength of the therapeutic bond is a better predictor of cli- ent progress than the helper’s (Bedi. The helper encouraged me by making comments. The helper was open to my criticism about the structure of the sessions or what he or she said. such as eye contact and leaning forward. 17. we have examined the therapeutic relationship from the perspective of a client and identified its crucial role in creating change. 2. The helper showed good nonverbals. The helper emphasized that it was my choice and that I knew myself best. 16. Having therapists ask questions and summarize to help them find patterns in their lives 6. remember that you probably already . it is critical to know what clients can tell us that weakens or strengthens the relationship. The helper was honest and frank. Becoming more aware of themselves through self-exploration 4. more important. empa- thy involves the ability to convey your accurate perceptions to the other person. and persuasibility. the presence of liking. As Alicia pointed out. and the significance of another person’s story. which means “feeling oneself into” another person’s experience. He listened to me for the next half hour as though nothing else in the world was more important. being fully present is often a potent relationship enhancer. there is the possibility of change. 1986). more than anything else. Empathy means that you grasp the facts. There is a vast literature on the importance of empathy. They include some nonverbal skills such as posture. it is important to recognize that creating a therapeutic relationship consists of a set of skills that takes time to learn (Wachtel. Empathy training has been found to be an essential in good leadership and parenting (Gordon. In most human interactions. “You are important and I want to help. On the other hand. “Then. Thus. p. I had one of the most powerful experiences of my life. Although much of it focuses on the helping relationship. You may have found that people naturally seek you out for help. respect. She was describing a kind of intense. Nonverbal behaviors such as posture will be dis- cussed in a later. It says. the very small helper behaviors called relationship enhancers cannot be ignored because they lead ulti- mately to the kind of safe and open relationship that gives the client the courage to change. 2011). Stephen Covey. PRESENCE Do you recall what the client Alicia B.” EMPATHY The word empathy is related to the German word Einfühlung. the people we are talking to are checking their phones. It is important to recognize your own natural abilities and not discount them as you eliminate some behaviors and try out new ones. Because the focus in this part of the chapter is on creating and enhancing the therapeutic relationship. More often. and self-disclosure) in a little more detail. If we like. there is a free flow of information—no holding back—and that person’s suggestions hold more weight. empathy has proved to be a vital aspect of other interper- sonal situations. and persuasibility. or driving the car. 1987. and trust. openness. this kind of presence is rare. Naturally. when there is communication. empathy. and self-disclosure. Here is how Carl Rogers described it: “I think if the therapist feels ‘I want to be as present to this person as possible. These helper behaviors lead to the emotional qualities or relationship components of lik- ing. respect. Furthermore. in The 7 Habits of Highly Effective People . the feelings. Relationship Enhancers Frederick Kanfer and Arnold Goldstein (1986) identified key relationship enhancers. and trust has relationship consequences of communication. intentional listening with full attention. Chapter 2 • The Therapeutic Relationship 39 know some of the ways to make a relationship work. I want to really listen to what is going on. Presence implies total absorption and is quite similar to the concept of flow (Csikszentmihalyi. and trust someone. the relationship enhancers create a favorable emo- tional climate for helping. In other words. 1990). openness. washing the dishes. as well as presence. said about her therapist in the case that opened this chapter? She said.” Calling this listening is only part of what Alicia was trying to convey. respect. I want to be real in this relationship’ then these are suitable goals for the therapist” (Baldwin. or helper behaviors that improve the quality of the therapeutic relationship. we look at three relationship enhancers (presence. empathy. more in-depth discussion. 47). “That’s it! That’s how I feel!” If we further analyze this statement. Empathy and Differences. Konrath. If the helper hears the story only superficially or appears judgmental. it could be said that a client experiences empathy when the helper communicates that he or she understands the facts. Campbell. There is growing evidence that human beings are bio- logically attuned to others. all by itself. 2009). 2009) and relationship advantages of empathy (de Waal. Empathy means taking a “tutorial stance” rather than an authoritarian position when we are confronted with a person’s life experi- ence that clashes with our own. which are brain cells that fire when we see another person performing an action (Decety & Ickes. In his book Social Intelligence. and the special mean- ings of the client’s story. gender. by Daniel Goleman (2006a). Face- book and reality television and talent shows are filled with examples of exaggerated self-perceptions.40 Chapter 2 • The Therapeutic Relationship (1990). Of course. Daniel Goleman explains how developing our social IQ is vital to interpersonal functioning in our intimate relationships (Goleman. the emotions. A spate of other books. recommends seeking “first to understand then to be understood” as one of the ingredients of personal job success regardless of your profession. Note how your facial muscles cringe when you see someone about to fall. the client does not experience the helper’s empathy. seeking to understand the client—recognizing that the helper must learn from the client what it is like to be that person. helps. The book Emotional Intelligence. Empathy occurs when the client feels and may even say. and solid friendships. bolstered by these findings in neuroscience. Racism and prejudices about various cultural groups can be seen as a form of nar- cissism or self-absorption. Foster. 2006b). Neuroscience and Empathy. have focused on the business (Patanaik. & Bushman. even if he or she is accurate about the facts. The problem is that being overly concerned with one’s own success and needs prevents us from focusing with empathy on the concerns of others. suggests training in emotional aware- ness as the long-term cure for this condition in our society. Recent news events have focused on alienated adults and teenagers who seem to lack any recognition of the feelings and needs of others. There has been a lot of talk about the discovery of mirror neu- rons. Goleman also points out that one of the prime benefits of empathy—besides perspective taking—is that it soothes the other person’s emotional arousal. Empathy does not occur in this situation if the helper has not communicated understanding to the client. empathy can have a positive spillover into other areas of a person’s life. Goleman’s research shows that awareness of one’s own emotions and those of others is among the most important predic- tors of success. beyond its uses in helping. 2008). 2009. In summary. Empathy. happy families. we all come to an interpersonal . The special thing about empathy in the helping relationship is that here the term encompasses the experiences of both client and helper. We become so attached to our own perspective that we have no tolerance for those who do not share it. One group of researchers has suggested that this is due to a trend in young people becoming more and more self- centered and narcissistic (Twenge. and other differences between client and helper. A tutorial stance means that the helper becomes a learner. Social intelligence means having empathy and understanding the intentions of others and also possessing the social skills to respond appropriately. mental health. We automatically put ourselves in the other person’s position if we pay attention. 2009). Empathy is a crucial skill in overcoming cultural. Helper Empathy. Iacomboni. and now she has become pregnant by David. in fact. saying that he was an architect when. Empathy Is Not Pretending to Understand. Spend as much time as you need to hear the story before you tell the client that you understand. In fact. Chapter 2 • The Therapeutic Relationship 41 situation with cultural “baggage” and a worldview that contains prejudices of one kind or another. helpers’ fears about being overwhelmed by the client’s problems are unfounded. What Empathy Isn’t. Clients recognize our attitudes not only from the things we say. he is a paraprofessional in an architect’s office. Empathic people try to understand another person’s pain in order to relieve it (Johnson. Her parents have told her she cannot remain in their home because they do not wish to raise another child. however. rather than attempt- ing to convert them to our perspective. Recently. although she could empathize with the client’s situation. Merely responding according to the prescribed formula will not help the client if you truly do not understand the situation. Although empathy provides a doorway to the inner life of another person. though. These will show up in our verbal and nonverbal messages. In the next chapters. however. Clients pick up on the nonver- bals as well as on what you say. Consequently. it is important that our clients recognize that we are struggling to understand and that we care enough to try. You will discover. leav- ing behind the vestiges of our own beliefs? We may not be able to completely grasp another person’s reality. Empathy Is Not Merely Supporting or Agreeing with the Client. empathy can help clients examine their feelings at a deeper level and make decisions that are more consistent with their own feelings and values. The best advice for the beginning helper is to be patient. This situation presented a dilemma for the helper because. a young woman who has been accepted to col- lege with a full scholarship. She is considering an abortion because she feels that she misjudged him and cannot see a good future for herself or the child. we take up the issue of how to deal with these kinds of differences. she found out that he was lying to her about his relationships with other women and that he had even lied to her about his job. You can communicate understanding about the circumstances that spawned the problem without supporting or agreeing with the client’s subsequent action. she is afraid of him because she has heard he can become violent. She has always preferred older men. Although David will support her. Many helpers are afraid to empathize with a client for fear of taking sides. Empathy is a first step in moving us away from our ethnocentric narcissism and signals to clients that we are trying to “feel ourselves into” their world. Monique is also afraid to stay with him and feels that if she has a child with him. Empathy Is Not Taking on Your Client’s Problems. who is 15 years older than she. but also by body language that may signal sub- tle disapproval. that empathy is not effective if it is not sincere. Consider the follow- ing story related by a school counselor: Last week. they will be bonded forever. it may be natural to fear that problems are “catching” and that by entering another . For the most part. I saw 17-year-old Monique. is it really ever possible to enter that world completely. you will learn some techniques to help you communicate empathy to clients. she felt that by empathizing she was supporting the client’s decision to obtain an abortion. 1990). She has a keen intellect and is especially good in math. Later in this book. some writers feel that beginning helpers should avoid self-disclosure altogether. The great therapist Frieda Fromm-Reichmann (1960) claimed that we must learn to be like skin divers—not only able to go to the depth of a client’s problems. we may become depressed ourselves. and encourage expression of feelings (McCarthy. 1977. deepen client self- disclosure. 1994). in some sense. empathy remains essential through- out. instead of talking about the problems the kids are having at school. The point of view of this text is that by discussing its ramifications now. as marriage counseling progresses. 1957). Although it is impossi- ble not to be affected in some way by great pain. 2002. & Bannon. you learn over time to deal with it within the session and not let it hamper your time with the next person or carry over into your personal life. Empathy Is Not a One-Time Behavior. 2006). Hill & Knox. Jourard. make the helper more attractive (Goodyear & Schumate. Kubinski. 1973). trying to understand their perspectives and how these were shaped by their own families. Thus. a couple might begin to examine their attitudes about child rearing and their disagreements about how to discipline. 1996). Empathy Is Not Sympathy. It has great potential. p. 2001. 2001. we talk about “the thing next to the thing” (Rogers. Sermat & Smythe. Strassberg. sympathy is not compatible with a positive. & Purcell. . 2005). Although empathy is especially important in the relationship-building stage of the helping process. Empathy allows the client to eventually approach the thing we need to talk about. These very personal topics might require the helper to empathize at a deeper level. 1971). It has also been shown to increase trust in the relationship (Johnson & Matross. 1979. 1981. Edwards & Murdock. but also able to surface when we need to. Sympathy is a synonym for pity. Nietzsche (1920) contended that pity for someone creates a power imbalance that makes the pitied person resentful. Nilsson. Self-Disclosure and the Therapeutic Relationship If we hold that the ideal therapeutic relationship is one of genuineness and authenticity. nonhierarchical relationship. It appears that moderate levels of self-disclosure are better than highly personal or only mildly personal disclosures (Bannikotes. For example. For many reasons. because. yet it must be used with care.42 Chapter 2 • The Therapeutic Relationship person’s world too deeply. then shouldn’t the therapist be a real person in the therapy process? As real in the therapy hour as outside of it? (YAlom. 253) How can we become real. and be helpful at the same time? Should not our authenticity and self-disclosure be tempered with concern for the client? Indeed. you will be better prepared to disclose appropriately when the opportunity arises. As the relationship develops. 1999. Lilliengren & Werbart. the client may disclose more and more deeply. Carl Rogers (1972) cautions that disclosure by the helper must be “appropriate” (p. No one likes to receive pity because it suggests that the sufferer is somehow less than the other person. 1979). as Yalom recommends. It is a high-risk/high-gain strategy in helping (Farber. As Carl Rogers says. 129). the person’s dignity is being attacked. Self-disclosure is not initiated to develop a social relationship or to allow the helper to ventilate feelings (Weiner. Helper self-disclosure has been shown to be associated with positive outcomes for clients (Barrett & Berman. Helper self-disclosure occurs when the helper relates facts about himself or herself.” (self-involving statement) In general.. I’m married and have three children. 2003. Although one might be tempted to explain the lack of therapeutic connection as a feeling that the couple could not measure up. or narcissism is at fault. 2003). They had been dissatisfied with a previous therapist because “She didn’t seem interested in us. Field. 1997. 2003. Kottler and Blau contend that the saddest aspect of this situation is that the helper is usually unaware of the problem. Petersen. I found out that this therapist and her husband were getting a divorce because of serious problems. which may put more stress on a client who already feels overburdened. Chapter 2 • The Therapeutic Relationship 43 The research on self-disclosure has come to differentiate between self-disclosing and self-involving statements by the helper (Cashwell. Hess. 2001). Finally. a couple recently came to me for premarital counseling. I am wondering if it is just too stressful a topic. research has supported self-involving statements (Curtis. Watkins.” Later. Second. & Hill. To show this distinction. it is just as likely they felt ignored and bored. Kottler and Blau go on to say that cli- ents are “frightened away” because helpers who talk about themselves make the client feel less important. The common mistake here is that the helper simply spends too much time in self-disclosure.. The Imperfect Therapist (1989). Knox. and I find myself being reluctant to mention this even though it is one of the main problems we agreed to work on. Helpers may lose their authority as transference figures and might be less able to influence the client through modeling. Shcherbakova. 1990). 2004). insensitivity. It was a waste of time and money. 1979. & Mannix. there are all kinds of disclosures. It seemed like they had the perfect marriage. it appears that timing is important. more than a few clients have been chased out of treatment because they felt negated by the repeated focus on the therapist’s life” (p.” Too much self-disclosure can be a serious mistake. she spent the whole hour talking about her relationship with her husband and how they handled their differences. “Whether the therapist’s ignorance. the client becomes bored with the rep- etition of therapist stories and anecdotes. My practice here centers on individuals going through divorce. In other words. One of the best discussions of this is contained in Kottler and Blau’s book. clients vary in how much disclosure they can handle without feeling that the helper is too self-focused or unprofessional. which I really like. ranging from the superficial “I have a master’s degree” to the very personal “I once had a drinking problem. I have been practicing for the last 7 years in this area. Clients with low self-esteem do not want to hear about the successes of others. McCarthy. Instead. One reason is that much seems to depend on the client’s preference for self-disclosure (Cashwell et al.” (self-disclosing statement) “I’ve noticed in the past few weeks that you seem to be irritated whenever I bring up the fact that you have not been looking for work. whereas self-involving statements may be more effective later on (McCarthy. 137). Self-disclosing statements (facts about the helper) are more useful early in treatment. Self-involving statements occur when the helper shares his or her thoughts and emotions about the client. To give a concrete exam- ple. take a look at these two helper statements: “You said you wanted to know a little bit about me. & Cashwell. I also run couples groups. 1982). According to the authors. Knaan- Kostman. . but I grew up in New England where most of my family still lives. but has not always endorsed self-disclosure (Cashwell et al. Finally. After all.” In summary. It was a long time before I got over it.) Inappropriate Disclosure by the Helper: “I know just how you feel because my mother died about 5 years ago after a long illness.” Mistake 2: Self-disclosure is poorly timed. Situation: The client expresses that she feels like a failure because he or she is going through a divorce. So I went into therapy for over a year. Self-disclosure can be used to . or convey that the client’s experience is normal. Situation: The client’s mother died last week.44 Chapter 2 • The Therapeutic Relationship COMMON MISTAKES IN HELPER SELF-DISCLOSURE The purpose of self-disclosure is to enhance the relationship. I am supposed to help other people with their problems. but we will also reintroduce it as you learn building blocks skills. When a person has gone through a trau- matic event. the client cannot really appreciate or focus on another person’s story. it is a poor time to get him or her to focus on the helper’s story. and I can relate to those feelings. self-disclosure may have the opposite effect. No one in her family has ever gone to a university. self-disclosure shifts the focus onto the helper.” Appropriate Disclosure by the Helper: “I can relate to your story in that I have had some goals in my life that I wanted that badly. It must be frustrating to be almost there and run into this new hurdle. if the helper’s story clashes with the client’s. We discuss it here because it can affect the therapeutic relationship. the client should be encouraged to disclose more. Obviously. I guess they are pretty common. The following are examples of common errors in self-disclosure: Mistake 1: The helper’s self-disclosure is too deep. help the client realize that he or she is not alone. Rather. I can guess that this whole thing has been very painful for you. Situation: The client has received a basketball scholarship to go to college. Inappropriate Disclosure by the Helper: “When I was going through my third divorce. but I know a little bit about what it means to lose someone that close. However.” Appropriate Disclosure by the Helper: “I don’t know exactly what you are going through. But I had to go to one that cost a lot less because my family couldn’t afford it. Once dis- closure is made. (In this case.” Mistake 3: The helper’s self-disclosure does not match the client’s experience. Thus.000 per year. Many of the mistakes are due to the helper failing to realize that the client needs to focus on his or her own issues. Inappropriate Disclosure by the Helper: “Once I wanted to go to a prep school that cost $40. rather than focus on parallels between his or her own story and the helper’s. She is having trouble achieving satisfactory College Board scores for admission.” Appropriate Disclosure by the Helper: “I have been through divorce myself. it is imperative that the helper shift the focus back onto the client. help the client see another viewpoint. I thought that there was something wrong with me. self-disclosure is a technique that must be used with caution and at the right time. the client has to react to the helper. Weigel. 1977). posture. the creation of a warm atmosphere for help- ing. Con- trast this scenario with another office in which a secretary ushers you into the interviewer. Self-disclosure at the beginning stages of the relationship can help the client feel less alone. Under which circumstances are you likely to feel more comfortable and to open up about your past? In which situation are you more able to convey information you would like the potential employer to know? If one of these interviewers were to ask you to say something very personal about yourself. she smiles and welcomes you. openness. POSTURE. or an alternative viewpoint.1 Identifying Appropriate Helper Disclosure OTHER FACTORS THAT HELP OR STRAIN THE THERAPEUTIC RELATIONSHIP In the last section. These nonverbals invite the client into a safe relationship and lead to greater openness. you will learn the basic skills associated with physical distance. In the first case. especially at the beginning of a therapeutic relationship. turning it around so she can face you directly. & Trautt. MyCounselingLab Application Exercise 2. and the issues of transference and countertransference. the ability to create an inviting relationship can have a powerful effect on others in all kinds of situations (Purkey. Among these are the environment where helping takes place. we will talk about some other commonly identified issues that may lead to a stronger or weaker therapeutic alliance. it should not be the therapist’s living room. orderly. When you arrive at her office.” In other words. Decorating that is comfortable rather than “clinical” is helpful. even in this circumstance it is easy to see how powerful the small nonverbal enhancers can be in eliciting greater communica- tion. The office should not be merely an outgrowth of the helper’s personality . Most profession- als and clients prefer soft lighting to bright fluorescence. Facilitative Office Environment The helper’s office should be quiet. we examined the effect of helper self-disclosure on the therapeutic relationship. AND WARMTH In the next chapter. Chapter 2 • The Therapeutic Relationship 45 bond with the client. PHYSICAL CLOSENESS. to whom would you be most likely to disclose? Although inter- viewing is not necessarily a helping relationship. She spends much of the session staring at a file and making notes as she asks direct questions about your history. 2001). The interviewer greets you from behind her desk. the therapeutic blunders that we can try to avoid. Sigmund Freud called his office a “consulting room. comfortable. and other body language skills. People prefer rooms that are decorated and “warm” (see Pressly & Heesacker. 1987). the interviewer greets you by shaking your hand. and persuasibility. nor should it look like a laboratory (Bloom. confrontation. Let us assume that you are going for two different job inter- views. We will learn more about self-disclosure later when we look at invitational skills and more about self-involving statements when we discuss challenging skills. Then she sits down in a chair next to you. Her voice is friendly and informal. Self-involving statements can be used later in the process to (1) inspire hope in the client and (2) provide feedback. Here. and well lit. Although these may seem like small things. Sometimes. under the guise of honesty. appear credible to the client? You may be still training and you may be inexperienced. Hoffman. For them. organized. or lack of experience. Sometimes beginning helpers will be overly formal with clients in an attempt to hide their uneasiness. This is where the nonhierarchical therapeutic relationship comes in. Distractions Noise from outside can interfere with the session. doing home visits and actually conducting sessions in their clients’ homes.. in their classic book on therapeutic communication. it is recommended that the helper face away from the desk so that there are no obstacles between client and helper (Gass. disrupting a delicate moment or giving the client the feeling that he or she may be heard by persons outside. . 1984. Pietrofesa. Clients have enough going on without having to deal with your issues. 1984). 2002). noise. at this stage in your training. These are behaviors that you can develop. Don’t communicate your own lack of confidence to the client. not all helpers today have the model facilita- tive environment. it may be necessary to purchase a mechanical white-noise or ocean-sound device that can act as a “sound blanket. 1969). Other helpers work in cubicles without soundproofing. but the following suggestions can help you feel self-assured: 1. Sometimes school counselors see students in the hallways and in the lunchroom in 5-minute snatches. how would you feel if I answered the phone during our sessions or ate a bag of potato chips? What would you conclude about the importance I place on the session? Appearing Credible and Taking a Nonhierarchical Stance Certainly. Some helpers now work primarily on the telephone or conduct coun- seling online. Other disturbances to be avoided during the session include knocks on the door and phone calls (Benjamin. youthfulness. the helper must be seen as credible (Ritter et al. Remember that credibility is enhanced by appearing confident.” with clocks. tissues. the issues of distractions and privacy must be dealt with crea- tively. Many work out of their cars. Although it is easy to depict the ideal. There is no need to exaggerate your expe- rience or downplay your ability. In some cases. 2. Remember what you do know and use the skills that you have. helpers level with their clients and reveal their feelings of inadequacy. Generally. If you were a client. A “Quiet Please” sign or one that reads “Session in Progress” should be placed on the outside of the door. and in- terested and exhibiting nonverbal behaviors associated with attentiveness. but how do you. Beier and Young (1998). and play equipment for working with children. Don’t use emotional distance as a way of being professional. The Silent Language of Psychotherapy. Just forming a one-to-one working relationship is therapeutic. Side tables are useful for a clock and the indispensable boxes of facial tissue. & Splete.” Position office seating to provide the most free- dom from glaring lights.46 Chapter 2 • The Therapeutic Relationship but also a workplace. make the point that a helper communicates the importance he or she places on the relationship by the way in which these distractions are handled. 3. and the possibility of being overheard. Many have traveling kits that can be unpacked to create a “therapeutic space. Review your strengths that we discussed in Chapter 1. When insults or slights occur in a therapeutic relationship. She says. 1. Thomas Gordon (1986) identified 12 such “wrong turns. refer to each other as Lionel and Bertie. 2010). that somewhere among his distant relatives he had a Cherokee ancestor. In addition. Many of our attitudes are deeply embedded due to our upbringing. Consider the following three real-life examples. These are listed—with examples—in Table 2. One of my colleagues took a job at a university as a professor. no matter how educated or important. CULTURE CHECK Microaggressions in the Therapeutic Relationship The term microaggression means verbal and behavioral insults and slights that minority group members experience from those of the dominant culture (Sue. Chapter 2 • The Therapeutic Relationship 47 NONHIERARCHICAL STANCE Some approaches to helping such as narrative therapy emphasize the importance of an equal relationship between helper and client. the relationship should reflect collaboration as equals. He and his family are from Puerto Rico and when he met his new neighbors. “What is this? A protest?” 3.” that have particular relevance in the initial stages of developing a helping relationship.” Slights are more veiled and may be unconscious. They are roadblocks because they are obstructions the client must go around. Although the helper brings certain skills to the table. but as detours that can be corrected later. a white colleague goes to the copy machine and finds a number of African American co-workers chatting.1. and so the helper takes a nonhierarchical stance. By the same token. and behaviors. After all. the client is not allowed to retain his or her social rank. Perhaps the term microag- gression is too strong because it tends to focus on blatant insults while deemphasizing “slights. who was talking about her cultural background. 2. Lionel Logue. they threaten the very basis of the helping relationship. the result is a rupture in the relation- ship. undermining trust and liking. the client is the expert on his or her own life. A therapist at a university counseling center responded to a Cherokee student. they assumed that his job was in the university maintenance department. In an office workplace. How can helpers avoid microaggressions? Avoiding subtle slights and insults may take more than a simple class in multiculturalism. where King Albert George VI and his speech therapist.” known as the “dirty dozen. They must be dealt with in an open discus- sion between helper and client. he or she constantly gauges the effects of his or her words on the client. .” It is better to think of therapeutic faux pas not as mistakes. Either way. Consider the helper who dismissed the client’s Cherokee back- ground. This nonhierarchical relationship is well illustrated in the movie The King’s Speech. Faux pas is a French term meaning “false steps” or “wrong turns. The culturally competent helper must recognize biases and prejudices by continu- ally checking his or her own thoughts. He thought he was bonding with the client but completely missed the fact that the client was trying to tell him about the importance of her cultural background. feelings. Therapeutic Faux Pas Some of the factors that strain the therapeutic relationship are the responsibility of the helper. Probing. You are being a bit paranoid. .T. . Ridiculing. You are wrong. You want to look good. Shaming Threatening You are a sloppy worker. or else . Distracting. . . a division of Penguin Putnam Inc. Warning.1 Roadblocks to Communication 1. Let’s have lunch and forget about it. . . Adapted by permission of G. . You are jealous. . then . When did you become aware of this Experience tells us that . You have always made it in the past. Commanding 7. . Praising. . . Directing. . You didn’t do it right. You had better do this. You cannot do this. Sympathizing. You have problems with authority. What I think you should do is . Preaching. 11. Who has influenced you? Blaming 12. You should do this. Judging. It is your duty to do this. Moralizing. Think about the positive side. Ordering. 5.E. Supporting or Solutions You’ll feel different tomorrow. Questioning. 2. You’d better not try that. I urge you to do this. I expect you to do this. You are an intelligent person. It would be best for you if . . . by Thomas Gordon. It is your responsibility to do this. . Analyzing. Admonishing. feeling? 6. Suggestions. Giving Advice. . Try not to think about it until you’re rested. . What you really need is . It is always darkest before the dawn. Have you consulted with anyone? Here is the right way. What have you done to try to solve it? Let me give you the facts. Stop it. 4. Let me suggest . Kidding You are acting foolishly. Persuading with Logic. . Criticizing. Approving Go home and relax. Putnam’s Sons. You think you’ve got problems! That is a stupid thing to say. I wish you would do this. Go apologize to her. Lecturing. You are a fuzzy thinker. . . You ought to try it. Diverting. P. .? How long have you felt this way? The facts are in favor of . . Why not take a different approach? Don’t worry so much about it. Reassuring. 8. Consoling. . Imploring You’re saying this because you’re angry. copyright © 1977 by Thomas Gordon. . You’re talking like an engineer. Name-Calling. Behind every cloud there’s a silver lining. 10. Things will get better. The best solution is . You have so much potential. Disagreeing. That reminds me of the time when . It’s not that bad. You’ve made quite a bit of progress. You are out of line. You are not thinking straight. 9.” from Leader Effectiveness Training L. If you don’t do this. if you do that . You really goofed on this one! I warn you. Interrogating Arguing Why did you do that? Do you realize that . Diagnosing 3. Source: “Skills That Help Subordinates Solve Their Problems.48 Chapter 2 • The Therapeutic Relationship TABLE 2. You usually have very good judgment. Agreeing. . Interpreting. 2 Roadblocks Thomas Gordon (1986). These include the following: EXCLAMATIONS OF SURPRISE client: “I spanked the living daylights out of my kids last night. they indicate that the client needs another person to solve the problems for him or her.” Helpful: “You feel stuck and that you are not making any progress.” BEING PUNITIVE client: “I don’t think that you are giving me the help I need.” “What kind of help do you think would be useful to you at this time?” GIVING FALSE REASSURANCE Sometimes clients want us to give them hope that the helping process will be successful. you are feeling unsure about whether you can conquer this problem. client: “Will I ever get over this completely and be normal?” Not Helpful: “Of course you will. Besides these 12 common detours. Chapter 2 • The Therapeutic Relationship 49 MyCounselingLab Application Exercise 2. Both are disempowering messages that take the responsibility for change away from the client and place it in the hands of the helper.” “You are not making progress because you are not working on the problem. Second. who identified the “dirty dozen. First. how would you be feeling and acting?” “Right now. Wolberg (1967) has identified some other helper responses that can weaken or disrupt the therapeutic relationship. tell me how you would like your life to be.” Not Helpful: “You what?!” “That’s awful!” Helpful: “Sounds like you’re feeling guilty about it now.” PSYCHOBABBLE AND PREMATURE INTERPRETATIONS Psychobabble is a word describ- ing the overuse of psychological terminology. I am hopeful that we can make a significant change if we work together. I guarantee it. If you were normal. they suggest that the client is incapa- ble of solving his or her own problems.” Not Helpful: “Then I will just refer you to someone else. This can backfire if the helper makes promises that cannot be kept.” “I think that you are normal now!” “You will be better in 6 weeks.” “You’re wondering if I am the right person to help you. When the helper identifies a technical term .” feels that the 12 road- blocks communicate two general messages.” Helpful: “First. When the helper finds per- sonal needs spilling over into the therapeutic setting. on the other hand. Transference and countertransference are terms that originated among psychoanalysts to denote these powerful feelings that develop when client and helper bond.” “Then. Sometimes it is best to nurture the relationship and address the topic later.” Not Helpful: “We have to talk about it sometime.” Not Helpful: “That’s because your mother was codependent and that makes you ACOA [adult child of an alcoholic]. and other residue from parental or love relationships. we can come back to that another time. However. We lived in denial our whole lives. This is called transference. When the helper finds that the client’s progress is stymied by the relationship itself. This is called countertransference. lik- ing. respect. client: “I don’t want to talk about sex.” Helpful: “It is a painful subject for you. Premature interpretations. suggest deep meanings before adequate data have been collected to sup- port these interpretations. 2011). the helper may also see the client as a reflection of a past or present relationship or may experience strong emotions for the client. It creates favorable conditions for change (Rogers. An atmosphere of openness. This kind of therapeutic intimacy is gen- erally seen as a positive state of agreement and mutual caring. . As client and helper grow closer. let’s talk about your past sex life. intimacy also tends to elicit strong feelings—feelings that may have had their genesis in previous relationships (Wachtel. the helper must be trained and willing to examine the therapeutic relationship as a living model of the client’s social world. It is often a question of timing.” (psychobabble) “That is why you are a dependent personality. and suggesting that it can be put off until later. a sort of intimacy grows. reflecting. On the other hand.” Transference and Countertransference As the relationship develops.50 Chapter 2 • The Therapeutic Relationship for every issue. fear of abandonment.” “All right. Here is an example that incorporates both psychobabble and premature interpretation: client: “My father was an alcoholic and my mother seemed to tolerate it. he or she needs to consult with a supervisor and deal with these issues privately.” PROBING TRAUMATIC ISSUES WHEN THE CLIENT STRONGLY RESISTS Respecting the cli- ent’s wish to avoid a topic can be handled by noting it. Damage to the relationship can take place when the helper mercilessly pursues a topic.” “Tell me something about your family relationships now.” (premature interpretation) Helpful: “Tell me more about what you mean by denial. the client feels that his or her problems are trivialized or that they have become a clinical syndrome in the mind of the helper. a client may experience the same emotions of self-doubt. 1957) and increases client involvement and compliance with treatment. and trust is hopefully developing. Chapter 2 • The Therapeutic Relationship 51 STOP AND REFLECT Transference is not confined to the helping relationship; it is a part of everyday life (Andersen & Berk, 1998). In the book Blink (Gladwell, 2005), the author tells us that we rely on snap judgments about people and the world every day. It is said that we can form our first impressions of someone’s person- ality in less than 4 seconds (Bar, Neta, & Linz, 2006). In other words, we are constantly experiencing transference reactions at our very first meetings with people. Most of us are familiar with automatic feelings of liking or disliking a person on sight. These emotional reactions are most likely due to expe- riences with a similar person in the past, and they may be vague and impressionistic or, in other words, unreasonable. One simple way to categorize such reactions is to label them positive, neutral, or negative. As an experiment, take a look around at your classmates and mentally note your feelings for each one—especially for those you have never met before this class or know only slightly. List each person’s name or indicate some memorable feature such as “blue shirt.” Next to each person’s name, put a plus sign (+) next to those for whom you have a positive attraction and a minus sign (−) if you have a negative feeling. If there is neither attraction nor a negative feeling, write N for neutral. You may think that it is unfair to assign a value to your feelings without taking into account the fact that you do not really know all your classmates well. That is true, but these impressions, like all first impressions, can influence how you react. As mentioned earlier, we experience these first impres- sions within seconds and act on them whether or not they are valid. Are there any real reasons for the positives and negatives you recorded? Are they the result of experiences with similar people? Think about the names of your classmates. Do any evoke an emotional reaction? If you had to choose two people in the class to play your parents in a role play, whom would you choose? Are you transferring any of your experiences with your parents or significant others to these people? WHAT IS TRANSFERENCE? Transference is a client’s carryover of feelings from past rela- tionships into a new one—the client/helper relationship. Relationship-building activities, such as listening and providing conditions of safety, increase feelings of intimacy and enhance the possibility of transference. Clients’ feelings can be described as positive, ranging from liking to sexual attraction, or negative, ranging from suspiciousness to hatred (Watkins, 1986). Negative transference reactions are thought to be an important reason for treatment failures (Basch, 1980; Spinhoven, Giesen-Bloo, van Dyck, Kooiman, & Arntz, 2007), because clients often drop out of therapy rather than face them. Although it may be impossible to avoid transference altogether (Gelso & Carter, 1985), in many helping relationships, transference never endangers the relationship or the client’s pro- gress. For others, it is vital to examine the therapeutic relationship as a first step in setting other relationships straight. A client may experience such strong feelings toward the helper that they become a roadblock that must be overcome in order for treatment to continue. When issues of transference interfere with the attainment of goals, they must be dealt with, either in an isolated fashion or in conjunction with other relationship prob- lems the client may be experiencing. Why are we looking at a complicated issue like transference so early in your skill training? Dealing with such matters is certainly an advanced skill. But this chapter is about all the things that can delay or prevent the formation of a therapeutic relationship, and it 52 Chapter 2 • The Therapeutic Relationship is crucial to address some of the initial challenges that you will face as you learn the art of helping. You may find that this chapter is most helpful when you start seeing clients in a school, agency, or clinical setting, although it is background for the basic skills you will learn and something to refer to when real relationship breakdowns occur. TRANSFERENCE AS COGNITIVE DISTORTION Some believe that transference is caused by unfinished business from the past. This notion is central to psychoanalysis, which asserts that issues surface from the unconscious because they are unresolved (Corradi, 2006). Freud believed that resolution of transference was the most important aspect of therapy because it allowed the client to address emotional issues about parents and siblings. One alternative viewpoint that has emerged is to conceptualize transference as a set of cognitive distor- tions, rather than as unresolved conflicts or unfulfilled needs (Sullivan, 1954). These distor- tions are learned patterns of thinking, not unlike the irrational ideas that have been described by Albert Ellis (1985). Still, there is a common thread that binds the modern viewpoint to the psychoanalytic idea. In both conceptualizations, the client is seen as focused on the outside (external causes of behavior) versus the inside (self-direction). The client is thinking about the attributes of the helper, rather than focusing on self-awareness. Even if it is a positive distortion (the helper as ideal), it is not reality. Hero worship may damage self-esteem if one compares oneself in a negative way to the helper (Singer, 1970). To summarize, on the one hand, the client may have distorted ideas about the helper and the helping relationship that should be addressed. These may appear as inflated expectations about the helper, believing that he or she will solve all the problems single-handedly. Alternatively, the client may have strong negative feelings for the helper, especially when overblown expectations are not met. Watkins (1986) has identified five major transference patterns that are based on the concept of transference as cognitive distortion. Table 2.2, adapted from Watkins, shows these patterns along with the client’s attitudes and the helper’s reaction to them. COUNTERTRANSFERENCE: DEALING WITH THE HELPER’S FEELINGS Countertransference is defined as the helper’s strong emotional reactions to a client. To give an example of this, consider this true story that a practicum student tells about one of her first clients: My client is a 35-year-old woman who owns her own business. She showed up for her first session 5 minutes late. When I came to the waiting room, she complained loudly that she had been waiting for 10 minutes and then followed me to my office in a huff. Although I was pretty sure that she had been late, not me, I was on the defensive from the beginning, and I felt very uncomfortable and intimidated by her. As I watched the video, I saw the many unreasonable demands she made. For example, she said that she needed to change seats with me because there was too much glare in her eyes. She criticized the decorating and quizzed me about whether or not I had read the notes of the previous counselor. I watched myself just back down and become silent. I talked this over with my supervisor, who also noticed my passive behavior. I think that I reacted this way partially because this was my typical behavior with my previous boy- friend. Although he was not violent, he was verbally explosive, and I learned to become quiet and back off during his rages. Now I am doing the same thing with this client. Countertransference is an issue not fully appreciated by the beginning helper. When intellectualizing about the therapeutic relationship, one can hardly imagine the powerful feelings that some clients may elicit. In the preceding example, it would be easy to blame Chapter 2 • The Therapeutic Relationship 53 TABLE 2.2 Major Transference Patterns Client Behaviors/Attitudes Helper Experiences Helper as Ideal Compliments helper profusely Feels pride, satisfaction, and all-competent Imitates helper Feels flattered Wears similar clothing Experiences tension, anxiety, confusion, anger, General idealization and frustration Helper as Seer Ascribes omniscience and power to the helper Experiences “God complex” and self-doubt Views helper as expert. Sees self as Feels incompetent and pressured to be right incompetent and live up to client’s expectations Seeks answers, solutions, and advice Helper as Nurturer Experiences profuse emotion and sense of Experiences feelings of sorrow, sympathy, fragility depression, despair, and depletion Cries Has urge to soothe, coddle, and touch Feels dependent, helpless, and indecisive Desires to be touched and held Helper as Frustrator Feels defensive, cautious, guarded, suspicious, Feels uneasy, on edge (walking on eggshells), and distrustful tense, hostile, and hateful Tests helper Withdraws and becomes unavailable Dislikes and blames client Helper as Nonentity Shifts topics Feels overwhelmed, subdued, taken aback, Lacks focus used, useless Is voluble and desultory Feels bored Meanders aimlessly Experiences resentment, frustration, and lack of recognition Characterizes self as a nonperson the client for her behavior and label her as uncooperative. Although the client’s interper- sonal behavior may have to be addressed later in the helping process, the helper’s reac- tion merits examination, too. In practice, helpers need ongoing supervision to monitor the tendency to be too helpful and to deal with feelings of sexual attraction, as well as fear and insecurity. Anger toward clients is one of the most common forms of counter- transference (Dalenberg, 2004; Fremont & Anderson, 1986). Normally such issues are dealt with between helper and supervisor and not in the presence of the client. However, countertransference can seriously disrupt the client/helper bond. Table 2.3 describes common helper emotional reactions, based on Corey, Corey, and Callanan (2015). The essential point of the information in the table is that 54 Chapter 2 • The Therapeutic Relationship TABLE 2.3 Common Patterns of Countertransference Helper Emotional Response How Helper to Client Helper Behavior Sees Client Paternal/maternal nurturing Overprotective Fragile Failure to challenge Fear of client’s anger Reduction of conflict Aggressor Attempts to please Disgust, disapproval Rejection Needy Immoral Need for reassurance Socializing Friend Need for liking Failure to challenge Anxiety Avoidance of emotionally charged topics Insecurity Tentativeness Feelings of identification Advice giving Self Overinvolvement Failure to recognize client’s uniqueness Sexual Seductive behavior Sexual object Romantic Inappropriate self-disclosure Romantic partner Reduced focus on presenting problems Inappropriate exploration of sexual topics Frustration Extreme confrontation Product Anger Scolding Success Criticizing countertransference issues are generally inappropriate emotional reactions to clients, which can then lead to certain unproductive behaviors by the helper. Instead of helping the client achieve mutually derived goals, the helper develops a second (you might say unconscious) agenda that changes the helper’s view of the client as a collaborator in the therapy process. The helper has come to see the client as a project, as something fragile, as a sexual object, as a friend, or even as a reflection of the self. Much of the unethical behavior in which helpers indulge is probably due to the strong emotions elicited in the therapeutic relationship, which make us forget our con- tractual role. This is one reason why a supervisory relationship is so crucial for every helper. The supervisor’s role is to appeal to the helper’s professional and ethical sense, provide insight and support, and remind the helper to act in accordance with thera- peutic goals. DEALING WITH TRANSFERENCE FROM A CLIENT A client’s strong emotional reactions to the helper may be either the result of transference or honest reactions to the helper’s behavior. In both cases, the task of the helper is the same: to help the client gain more awareness and to nondefensively explore the source of these feelings (see Chapter 2 • The Therapeutic Relationship 55 Dalenberg, 2004). Let us look briefly at how a helper can react therapeutically when a client expresses strong feelings of anger. Step 1 Convey Acceptance of the Client’s Remarks but Don’t Retaliate. Dealing with an angry client is one of the most difficult and delicate issues in helping. One reason is that it tends to evoke anger or fear in the helper. Retaliation or a defensive response can be perceived by the client as a weakness, as an admis- sion of guilt, or as a punishment. The client’s anger may be triggered by frustra- tion over lack of progress or by the perception that the helper is unfriendly, inept, or destructive. After having expressed this hostility, the client may then be concerned about angering or hurting the helper or may fear abandonment. Example (conveying respect): client: “I don’t think we’re getting anywhere. When are we going to deal with the real issues? I’m sick of coming in here and paying all this money.” Helper: “I can tell you’re angry. I’m glad you had the courage to be so honest. I can’t think of anything that will be of more help to you than dealing with this issue.” Step 2 Explore the Client’s Feelings. Following an expression of hostility toward the helper, the client may retreat, fearing he or she will be punished, lose control, or hurt the helper. Exploration of a client’s hostile feelings involves continuing to encourage the expression and labeling of feelings while trying to clarify the source of the anger. Example (exploring): client: “I don’t think this is working, and I am tired of coming in here and being told that it is entirely my fault.” Helper: “What makes you feel that it is all your fault?” Or, Helper: “Do you have the sense that I am blaming you for not changing?” Or, Helper: “You wish I would be more supportive.” Step 3 Utilize Self-Involving Statements to Help the Client Become Aware of the Helper’s Genuine Thoughts and Emotions about the Client and the Cli- ent’s Behavior. Self-involving statements are the helper’s thoughts and feelings that are shared with the client as information about the relationship. Example: client: “You are darn right you should be more supportive. Nobody supports me, not my wife, not my boss. I have to blow my top before they will even listen.” Helper: (Self-involving statement) “I can tell you’re angry with me because you think I am siding with these other people. I don’t see it that way. I feel very much on your side, but I also feel a duty to help you look at what you are doing. And I can see where your anger is hurting your relationships.” 56 Chapter 2 • The Therapeutic Relationship Here is another example of a self-involving statement given by a helper when his client expressed feelings of romantic attraction: Example: Helper: “I must say I am flattered and a little uneasy when you say you feel this way about me. I am uneasy because I don’t want this to interfere with the progress we’re making. At the same time, I need to tell you I don’t share your feelings. I don’t want to hurt your feelings, and I don’t want to make you feel embarrassed. I also don’t want to lose the closeness that we have felt going through all the crises over the past year.” Step 4 Use the Experience to Help the Client to Find New and Better Ways of Expressing Feelings and Meeting His or Her Needs. If the helper can avoid blaming, embarrassing, or shaming the client, the client’s expressions of strong emotions such as anger or attraction can be used to examine the client’s interper- sonal life. Clients who exhibit excessive anger or who are indirect or revengeful may be alienating others. Clients who romanticize all close relationships may need to find ways of developing more intimate friendships that are not sexual in nature. Dealing with transference by listening, exploring, and using self-involving statements has the effect of making clients aware of these patterns. Example (using the therapeutic relationship to consider alternative behaviors): client: “I don’t know why I blow up. But I don’t know what else to do.” Helper: “In this session, you have mentioned a number of situations besides our relationship in which you feel that you have to explode in order to be heard. I am not at all sure that is your only alternative. I think it would be helpful to learn and try out some new ways of relating, and you can practice on me. How do you feel about that?” Summary The therapeutic relationship is the keystone in the pro- pas, a poor office environment, and the challenges of cess of change. In the road map of the helping rela- transference and countertransference. tionship, it empowers all the other activities that a One of the subtle points of this chapter is that a helper uses to aid a client, including assessment, goal helping relationship is not a social relationship. It is setting, intervention, and evaluation. There are a num- more important that there be a working alliance rather ber of helper behaviors that can enhance the relation- than a friendship, an egalitarian but not a social rela- ship, including nonverbals such as physical closeness, tionship. The social skills of making clients feel com- posture, and warmth. In addition, presence, empathy, fortable, talking about the weather, and being a friendly and self-disclosure can make the helping relationship person can reduce anxiety in the beginning stages, but stronger. The attribute of empathy is discussed in the helping relationship should not be inhibited by the some detail because it seems to be a foundational abil- constraints of politeness and cultural tendencies to ity, as well as an attitude that allows us to enter more avoid certain topics for fear of embarrassment or con- deeply into relationships. troversy. Entering a helping relationship requires you There are also issues and behaviors that can to boldly go where few have gone before, using the strain the budding alliance. Among these are Thomas relationship as the fuel to explore more and more Gordon’s 12 roadblocks, a number of therapeutic faux deeply into the mystery of another person. Chapter 2 • The Therapeutic Relationship 57 Exercises GROUP EXERCISES Step 2 Explore the client’s feelings. Step 3 Utilize self-involving statements to help the Exercise 1: Getting Feedback on Your Natural client become aware of the helper’s genuine Helping Style thoughts and emotions about the client and In groups of four or five, students take turns as the the client’s behavior. helper and client with the others acting as observers. Step 4 Use the experience to help the client to find The client talks about any minor problem he or she new and better ways of expressing feelings wishes to disclose. After about 5–8 minutes, the con- and meeting his or her needs. versation stops, and the helper receives feedback from The observer in the group keeps track of any helper the group, including the client, about the helper’s natu- statements that seem to help the client explore this ral style. Try to give the helper honest feedback about issue. your reaction to his or her manner. What did the group see as strengths or things to work on? Was the helper warm or cold? Was the helper light or serious, friendly SMALL GROUP DISCUSSIONS or professional, formal or informal? If you wish, you may use a metaphor to describe how the conversation Discussion 1: Case Study felt. Following are some interpersonal style traits ex- In a small group, read and discuss the following ex- pressed on a continuum. You might want to use these ample: Marisol is a counselor in private practice. The as a starting point for thinking about your feedback. following is her discussion of a client, Carrie, who Leading–Submissive, Competitive–Non-competi- was referred for help by her family physician when tive, Trusting–Mistrusting, Cold–Warm, Distant–Friendly, she came to the medical office crying and needing Inhibited–Uninhibited, Self-assured–Self-doubting to talk. Exercise 2: Barriers to Communication The client began the therapeutic relationship with much enthusiasm and high expectations Divide into groups of three to five students. The in- for achieving her goals. She was a 23-year-old structor will secretly assign each group one of Thomas only child who felt that she has never been Gordon’s roadblocks in Table 2.1. (Roadblocks 4, 7, 10, able to maintain a serious relationship. After a and 12 are especially effective.) Each group is to put few weeks of counseling on this issue, her together a presentation that demonstrates its roadblock enthusiasm waned, and she expressed disap- to the class in a role play between a helper and a pointment in me as a helper. By this time, I client and then show helper behaviors that could en- knew enough about her past to identify her dis- hance the relationship in that same situation. Following satisfaction in counseling as being similar to her history of intimate relationships. She began each demonstration, the rest of the class guesses which relationships with an idealized picture of her roadblock was demonstrated and then discusses the boyfriends and then was quickly disappointed. effects of the roadblock on the helping relationship. She came to the session one day indicating that It is especially useful for the client to describe what it she was angry that I had not been able to give felt like when the helper used one of these roadblocks. her an earlier appointment. During her phone call, she had said it was important but not Exercise 3: Dealing with Strong Feelings urgent that she see me soon. She admitted that from a Client she expected me to know how upset she was and to set up an emergency appointment. In groups of three, role-play a scenario in which the When we examined our relationship, the client client expresses strong feelings toward the helper. As was able to pick out several times when she left the client fumes, the helper is to try to use the four hints and clues about her needs but failed to steps given in the section “Dealing with Transference ask for things directly. from a Client”: I shared my feelings of surprise, being unaware of her real feelings. Naturally, this led Step 1 Convey acceptance of the client’s remarks to a discussion of how her behavior might but don’t retaliate. have affected other relationships. It was a very 2. that introduced this chapter. for someone in authority? Think for a moment about the concept of authority. Identify any similarities. Tell members of your small group a few things Does this necessarily mean that the helper should about yourself that you might disclose to a client. page or two. Recall that the appropriate uses the professional relationship has become too close? of self-disclosure are to (1) enhance the relationship. tary school to present. and they may sometimes a small group. how would you have han- Homework 2: Your Reactions to Clients dled Carrie’s expression of anger? One of the most common countertransference reac- tions is to feel sorry for a client and help the client too Discussion 2: Transference much. to send clear messages about her needs and expecting others to fulfill them. for a client. Which of termine ethical action in such situations? In each case. In her case. What guidelines can help you de- of Alicia B.58 Chapter 2 • The Therapeutic Relationship significant insight when she realized that she (3) help the client see another viewpoint. If you were Marisol.” How is this Homework 3: Involvement with Clients similar to or different from the transference reaction You will sometimes hear helpers talk about being discussed in this chapter? Discuss your findings with “overinvolved” with clients. You have probably heard it said that a person has “authority issues. Are there also client’s past to help her with the problem in the glaring differences? Now contrast them with some helping relationship? teacher or learning situation that was either very un- b. Do you think it was necessary to examine the these persons. is likely to “push your buttons” and elicit some of the tion about the client’s needs? Would it have feelings you have had in previous helping relation- helped the client if the helper had apologized or ships? Summarize your reactions to this exercise in two assumed partial responsibility for the misunder. List the traits or qualities of a. Get not care about a client? What ethical guidelines do feedback from the group about the appropriateness professional helpers rely on to determine whether of your disclosures. What do these experi- and that Marisol is just “saving face” by making ences say about how you like to learn? Based on your it the client’s problem? experiences with teachers. In a case such as this. or (4) convey was undermining relationships by her failure that the client’s experience is normal. dis- cuss how you would handle each of the two situations. what kind of helper do you c. how much responsibility think might be the best fit for you? What kind of helper should the helper take for the miscommunica. these reactions did she experience in her relation. which did not require that HOMEWORK she state her needs and rewarded indirect sug- Homework 1: Favorite Teachers gestions. Is it possible that the client has a legitimate gripe pleasant or simply unhelpful. Part 2 Have you ever experienced any of these feelings ethically and therapeutically. standing? d. suggest that you “keep a professional distance. In therapy. . Research the ethical codes of one of the actions in Table 2. Now think back on the case helping professions. what could be harmful about this particular counter- ship with Jim? transference reaction? In two or three paragraphs. or three paragraphs. Another reaction is strong feelings of attraction Part 1 Take a look at the common transference re. Write down your reaction to these questions in a (2) help the client realize that he or she is not alone. this pattern of behavior could be traced back to her upbringing. she was able to learn some assertiveness skills and practice them in Make a list of your five favorite teachers from elemen- a group setting.” What kinds of behaviors do you think would indi- Discussion 3: Self-disclosure cate that a helper were too involved in a client’s life? Pretend that you are a helper working in a public What limits should the helper set in the relationship? agency. where the helped someone. Was the development of the relation. Chapter 2 • The Therapeutic Relationship 59 JOURNAL STARTERS similar to you? In what ways? How did you your differences enhance or deter the relationship? How Remember that these starters are designed to warm did you overcome any obstacles to communica- you up to the issues. 2. with another time when you tried experience. What did you do and say that other person was significantly different from you. to help but you were not as successful. past or present. Reflect on a time when you think that you really 1. Recall a relationship. What was ship more challenging than with someone more different about the two situations? . You may take them in whatever tion? What did you learn from the experience? direction you like. if you can. Discuss the this. culture. seemed to have been especially helpful? Contrast either in age. or ethnicity. the therapeutic 60 . This desire to explain oneself has been met in various ways through the ages. you will be able to: 3. such as by keeping journals and diaries.1 Identify and demonstrate nonverbal skills for inviting the client into the therapeutic relationship. Humans have a great need to communicate and more importantly to be understood.2 Identify and demonstrate the opening skills of encouragers and questions for inviting the client into the therapeutic relationship. 3.CHAPTER 3 Invitational Skills Listening to the Client’s Story Nonverbal Communication between Helper and Client • Regulation • Intimacy • Persuasion Nonverbal Skills in the Helping Relationship • Eye Contact • Body Position • Attentive Silence • Voice Tone • Facial Expressions and Gestures • Physical Distance • Touching and Warmth Opening Skills: How to Invite • Saying Hello: How to Start the First Session • How to Start the Next Session • Encouragers • Questions Summary Exercises • Group Exercises • Small Group Discussions • Written Exercises • Self-Assessment • Homework LEARNING OUTCOMES • Journal Starters By the end of this chapter. by confiding in friends. and by praying. by taking part in religious confession. In the same way. session after session. Invitational skills are broken into two general categories: nonverbal skills and opening skills (see Table 3. Pennebaker’s work about disclosure also underlines the fact that when clients come for help. miscalculations. and they want to have a chance to hear themselves as well. The therapeutic relationship can provide the opportunity to heal the body and the mind if the helper can get out of the way and allow the client to open up and investigate all the nooks and crannies of the problem. as the helper listens to the client relate his or her progress. these two categories of invitational skills will allow you to convey to clients that you are listening to them and that they are invited to open up. 1990. Chapter 3 • Invitational Skills 61 relationship. they want to understand how things got so mixed up and how to deal with the unfinished business. In this chapter. Nonverbal skills such as using eye contact and body position set the stage for an open and confiding relationship. LISTENING TO THE CLIENT’S STORY My wife says I don’t listen to her . these same skills are used throughout the entire helping process. report setbacks. Lawrence Peter The quote by Peter points out how often we fail to fully listen to those around us—even those closest to us. Pennebaker’s work stimulated research supporting the fact that “opening up” is good for the soul and the body (Carmack et al. at least I think that’s what she said. they are not merely seeking absolution. . Opening skills are verbal catalysts that consist of encourag- ing statements and questions. 2011. they are seeking to explain themselves to a nonjudgmental listener (Pennebaker. However. you will learn and practice the first set of getting-out-of-the-way techniques in the art of helping.1). Frattaroli. Together.. . 2002) has conducted some of the most interesting research on the benefits of self-disclosure and confession. it must be disclosed verbally or in writing. 1990). . Most people do not expect others to solve their problems. Pennebaker found in his own research that college students who regularly wrote about their most troubling experi- ences in diaries showed better immune system responses and significantly better health compared with those who did not. Some operators said they had even received Christmas cards from some of those they helped to convict! This sug- gested to him that there is a powerful need to confess. James Pennebaker (1989. offers the client a way to disclose to another and hear himself or herself in a nonthreatening atmosphere with the safeguards of confidentiality. described in the previous chapter. He became interested in the phenomenon while talking to polygraph operators who gave lie detector tests to people suspected of crimes. It is not enough to think about one’s life. and describe new issues as they emerge. The invitational skills are especially useful early on in the helping session when they do not interfere with the client’s recitation of the story. These technicians told him stories of suspects who admitted their guilt under questioning and who even thanked the operators. but they do want someone to listen. The act of disclosing can be a great relief and is the first step in the healing process. Clients want to untangle the knots of traumas. They are called invitational skills. 2006). However. and resentments that are troubling them. a way of attending and encouraging without intruding on the client’s telling of the story. body position. and create a change. A number of competing thoughts and urges assail us. Sheldon Kopp (1978) emphasized the importance of clients needing to “tell their tales.” Questions Open question “Could you tell me what has been going on?” Closed question “Is she your ex-wife?” Can listening all by itself have a powerful effect on another person? Is it possible that merely giving someone your full attention is healing? Some writers have called this active listening. voice tone.” The tale is a full recitation of the problem from the client’s unique perspective. squarely facing the client Appropriate use of silence Allowing the client to fill in the “voids” in the conversation Voice tone Using a voice tone that reflects the client’s and is appropriate in volume and rate and shows warmth and support Nonverbal encouragers Encouraging the client to open up with appropriate gestures and head nodding Opening Skills Opening skills are verbal encouragers or questions. Frequently. Opening Skill Example Encouragers Door opener “Say some more about that. however. We want to ease the client’s pain. the client has probably heard a lot of advice already. One of the biggest distractions is the need to help. silence. It is this impulse that prompts friends to offer quick advice to difficult problems. In fact. If you think about it. A client’s story can create tre- mendous pressure on the listener.” “Okay. the best approach in the professional helping relationship is to allow clients to completely describe the situ- ation to you and to themselves rather than jumping in to offer an instant solution. quick advice tends to disqualify the helper in the client’s eyes. They also reassure the client that you are following the story. It is . They ask the client to explore a little deeper but are not very invasive. What makes you think that your ideas are likely to be any better than those of a close friend? It is through listening to the client’s story that client and helper are able to find the keys to change.1 The Building Blocks for Invitational Skills Nonverbal Skills Nonverbal skills are the use of eye contact. help him or her decide upon a course of action. It is called active because the listener is fully absorbed and commu- nicates this to the other.62 Chapter 3 • Invitational Skills TABLE 3.” Minimal encourager “Uh-huh. But listening is difficult. not by attempting to solve the problem in the first few minutes. and nonverbal encouragers such as head nodding or hand gestures that invite the client to talk. Nonverbal Skill Example Eye contact Direct eye contact with occasional breaks for client comfort Facilitative body position “Open” attentive body position. I have to call her at the end of today’s session and let her know I came. 2003). Renee. After the session. I would probably be living on the street. I want to go to school. Chapter 3 • Invitational Skills 63 the client’s story of his or her life. but I wanted to help her figure out what to do. If it weren’t for her. Juriga. 2000). They also anticipate the client’s unspoken question.” MaRcy: “Resist the temptation to intervene until you know more about the situation and about her. Morgan. family. even with my son. Goldberg & Crespo. But really I just need her to get off my back. and religious factors are in the background of this client’s story? How important are these things in understanding the client? What assumptions have you already made about Tia based on her background? How can you test them? • In this situation. Goodman. do you see any way in which the helper might actually be hurting the client by intervening? • What cultural. Hidden in each story are the clues to understanding how that person views the world. I can’t do anything right. She thinks I need counseling. would you be tempted to find ways for the client to change her mother? • Why is Marcy cautioning Renee to listen longer? What other issues does Tia struggle with besides her relationship with her mother? • What parts of Tia’s story would you like to hear more about? Why do you think that would be helpful? • What specific issues does Tia need to address in herself? Would encouraging her to take a job or move from her mother’s house solve her problems? . But my mother thinks that it doesn’t pay enough. I also wanted to agree with her that her mother is overbearing. & Brown. Michael White. Tia. My mother wants everything done her way. There are so many things I want to do. we also gain greater insight into the client’s world (cf. to discuss the case: Renee: “I had a hard time in the session because I just wanted to tell her to take the job and move out. what more would you like to know about her before you feel that you have enough information to help? As you look at Tia’s story. STOP AND REFLECT Many beginning helpers get stuck because they feel that they have heard the whole story in the first 5 minutes. calls these sto- ries “narratives” (White. and it’s walking distance from home. But when I try to get more independent. but she just won’t let me. the Australian therapist.” MaRcy: “Do you know enough yet to make that kind of statement to her?” Renee: “I guess not. they will end up covering old ground. Marcy.” Renee: “So I just listen? For how long?” • How would you answer Renee’s question? As you look back at Tia. But I have to start some- where. So besides the therapeutic effects of allowing the client to disclose. Tia is living with her mother and her 4-year-old son. Renee met with her supervisor. Helpers who take the time to let the client’s story unfold will design helping interventions that fit the unique client and his or her special worldview (cf. and I think I would like it. “What should I do?” Consider the first few minutes of this actual session between a 30-year-old woman. and her helper. They become nervous because they think that if they spend more time listening. it’s like she doesn’t want me to. 2004). have my own place. For exam- ple. I have a job possibility. pausing only to take a breath and perhaps ignoring most of the helper’s questions and comments. the role of the helper seems passive. silence. waiting for the client to finish the tale. It is difficult for many beginning helpers to listen to all these details. 2012). waiting until all the wrinkles have been explored. They cannot see where the story is going. some clients will open the floodgates of the story during the first session. The art of helping. facial expressions and gestures. NONVERBAL COMMUNICATION BETWEEN HELPER AND CLIENT Nonverbal communication is also called body language. They can affect us tremendously. 1998). and they can be persuasive (cf. For others. Even very minor movements and expressions can set off an argument. Everything appeared normal. Let us look at each of these functions. Body cues. physical distance. voice tone. requires the helper to initially place his or her own concerns. but it can be detected at distances of over 150 feet (Blum. the helper is listening with full attention so as to understand the facts. Nonverbals regulate the interaction (indicating pauses and stopping points). not just facial expressions. Many client stories are as ironic and full of twists and turns as a Shakespearean comedy or tragedy. At times the helper is stopping to clarify a very important point of fact. they can enhance intimacy. Some writers have suggested that as much as 80% of communication takes place on the nonverbal level. nonverbals are even more significant than what the per- son is saying (Aviezer. it has been found that a raised eyebrow takes only a sixth of a second. however. Actually. and their own personal anxiety and desire to help propel them to fall back on the skills they have used all their life: offering praise. we are required to interact with others without having access to all the non- verbal cues that the person is sending. In either case. For example. and touching (Gladstein. Have you ever participated in a conference call on . It has been estimated that only 7% of emotions are conveyed by verbal means. For example. body position. but we may not notice their presence. Regulation Occasionally. questions. Argyle. fixing it. and the unique perspective of the client. When strong emotions are being expressed.64 Chapter 3 • Invitational Skills Like Tia in the “Stop and Reflect” section of this chapter. whereas 38% are conveyed by the voice and 55% by the face (Mehrabian. and theories on the back burner and to focus on the client’s story. help us understand powerful feelings. nonverbal behavior has three other functions in human interaction. it is a grueling process as the client’s story is painstak- ingly extracted drop by drop. 1987). Trope. 1974). Nonverbals can be compared to the musical score in a movie. research- ers studying couples communication were at first confused when they examined written transcripts of troubled marriages. Besides conveying information. giving advice. the feelings. & Todorov. You cannot make a comment that a client will respect until you know the names of all the players and their relationships. It often seems that a client wants to get the story told as completely as possible before he or she will allow the helper to make an intervention. 1972). It was not until they watched the videos that they were able to see the subtle nonverbal signals of contempt such as rolling of the eyes. or trying to track the client’s problems back to some original cause. We generally talk about seven nonverbal ways that we speak to others without words: eye contact. are evidence of this. Chapter 3 • Invitational Skills 65 the telephone? In face-to-face conversations. Folded arms and drooping facial muscles tend to give us away. Think about the difference between sending a sympathy card and placing your arm around the shoulder of a grieving friend. This discussion brings up an important caution about nonverbal messages. They are ambiguous. 1977. Clients react to helper nonverbals from the very first contact by voice tone on the phone and even by the arrangement of the office where client and helper meet. Ekman. Astute helpers learn to read the body language of their clients as clues to the depth and meaning of the client’s problems. helpers try to present the most welcoming. 2003). too. Vrij. Recall that there are seven ways to . cues about when to speak and when to lis- ten are communicated nonverbally. Intimacy For example. helpers must be aware of the signals that they are sending. NONVERBAL SKILLS IN THE HELPING RELATIONSHIP One maxim says that you can’t not communicate. facial expressions. Soukara. most helpers are cautious about interpreting a client’s posture. Persuasion Nonverbal communication is also a powerful component of persuasion. Your willingness to take the time to provide the most inviting nonverbal atmosphere will ultimately affect your client’s per- ception of you and his or her willingness to open up. & Li. we might prefer e-mail from family members if we are merely exchanging information. but when we want to hear their voices to feel close to them we call or Skype to get access to their nonverbals. To increase intimacy. there is a wide variation in gestures and facial expressions because of one’s upbringing (Ekman. or about drawing serious conclusions about a client’s mental state from a single piece of data. nonthreatening. Liang. 2009. we increase proximity and use touch. 2009. For this reason. Crossed arms may be a better signal that the air-conditioning is too high than that the client is “closed” to what you are saying. & Bull. or voice tone. we have no control over what conclusions clients may draw from inadvertent nonverbal signals that we as helpers send. Without access to these regulators. On the other hand. and facilitative nonverbals that encourage the client to talk and do not interfere with the client’s telling of the story. Kim. How- ever. Certainly the most persuasive communication takes place when we can see another person’s face and when we are in the same room. Akehurst. A client whose voice seems monotonous and depressed may actually be suffering from a cold. The art of helping also relies on persuasive nonverbal messages to encourage the client to open up. Although many emotions come through loud and clear regardless of culture. Helpers use specific nonverbal behaviors to persuade their clients that they are listening nonjudgmen- tally and that the client is in a safe environment. The client is inter- preting and reacting to the nonverbal messages of the helper. from the initial meeting. everyone talks at once or there are long periods of silence. Our bodies are not very good liars (Archer & Akert. It is much easier to say “no” to the salesperson on the phone than to the one who is standing right in front of you. The gestures and voice tone of famous orators such as Martin Luther King Jr. Because of the ambiguous nature of nonverbal communication. 2004). a rude gesture. Discuss- ing it with the client might be distracting and make the client feel overly self-conscious. A rule of thumb is to maintain a moderate amount of eye con- tact while closely monitoring its effect on the client. voice tone. eye contact by the helper can be a powerful tool because it forces intimacy on the client and increases the helper’s ability to persuade (Goldman & Fordyce. eye contact will make his or her message more potent. This suggests that eye contact can have an important interpersonal effect. 1986. Depending on the situation. 1976. In addition. & Fraser. Levine.66 Chapter 3 • Invitational Skills communicate nonverbally: eye contact. During times when the helper wants to be heard. Further. eye contact is a powerful communication tool. they tend to look away (Brooks et al. Posture may be the most often noticed aspect of body language. 1986). independent.. Sometimes. 2000). 1988). Care must be taken when interacting with people from cultures (such as some Asian cultures) in which direct eye contact may be consid- ered offensive. assertive.” A . some African American clients may have been trained to look away when listening (LaFrance & Mayo. are struggling for words. but one should also be cau- tious in making assumptions about eye contact made by clients. Droney & Brooks. and in many cultures. One study showed that graduate students in a seminar class are more likely to participate when they receive more eye contact from the professor (Caproni. a sexual invita- tion. Body Position Actions speak louder than words. For example. body position. O’Neal. direct eye contact can be considered an act of defiance. indifference. In some situations. or do not trust the other person. Droney & Brooks. so it becomes important to have a “posture of involvement. 1977). 1983). McDonald. it might be useful to discuss this with the client. & Garwood. There is also evidence to suggest that eye contact may be more effective in some situations than others. and when thinking deeply. confident. 1991). a person breaks eye contact. we will address each of these as they are best used in the helping relationship. By contrast.” A relaxed alert- ness communicates. it might be best merely to respect the client’s own way of using eye contact and try to mirror it. “I am comfortable with myself and I have time to listen to you. speakers who maintain eye contact with their audience are considered to be more credible and create more interest than those who do not. In the sections that follow. Still. or a sign that you consider yourself to be superior. intelligent. or shame (see Kleinke. 1986. 2004). It conveys the helper’s confidence and involvement (Ridley & Asbury. Church. It can stimulate involvement. and decisive than those who do not (Brooks. When people discuss difficult situations. Eye Contact Eye-to-eye contact is the first and most important indicator of listening. the helper’s fixed stare may be disconcerting and should be broken naturally and intermittently if the client becomes uncomfortable. facial expressions and gestures. Clearly. 1993). especially those from different cultural backgrounds (Timm & Schroeder. it is common to lower the eyes as a gesture of respect to superiors (Galanti. attentive silence. we normally associate lack of eye contact with dishonesty. and touch. If cultures seem to clash. looking at the other person’s face takes a lot of mental energy. those who sustain eye contact are seen as more ambitious. physical distance. 1993). In Western culture. Majors. such as in the military and with some cultural groups. Helpers tend to use silence more as they gain experience (Hill. 2004). for example. Open postures seem to relax the client and encourage less defen- siveness. 2005). clients feel more rapport with the therapist when the therapist allows for intermittent silence (Sharpley. They do not use silence when a client is experiencing a great deal of anxiety or anger or if the client suffers from a psychotic disorder such as schizophrenia (Ladany et al. 1983). instead. the social expecta- tion to keep the discussion going may prompt the client to open up (MacDonald. When there is a gap in social conversations. Helpers normally maintain an open posture—no crossed arms or legs. 1986). the helper falls back on atten- tive silence in order to be present without interfering. people talk to fill the awkward void. Hill. In general. If the helper is able to endure the discomfort caused by these silences. It is suggested that the helper lean the torso slightly forward (not the limbs). silence is often the most appropriate response. to communicate empa- thy. Similarly. Sometimes. We can tell from the client’s tone which issues are the most painful and which are the sources of the greatest motiva- tion and excitement. clients respond to the helper’s voice tone. but it may also communicate that the level of the helper’s involvement is minimal. such as when a client has experi- enced a great loss. The helper may respond to the client’s situation by saying. 2004). Thompson. If used too much or too early. they may be in a state of emotional turmoil. raises the voice slightly or gives emphasis to words that convey that the client’s experience has been understood. “You were really angry. that a client describes a situation in which he or she did not get an expected promotion at work. Let us suppose. Attentive Silence Silence is a powerful tool in the helping session. the helper does not try to match the intensity of the client’s feelings but. Thus. Experienced helpers use silence to allow the client to reflect. Voice Tone A client’s voice can give clues to his or her emotional state. helpers use the voice to communicate that they understand how intensely the client is experiencing the problem. Thompson. Lounging or sprawling in the chair might add an air of informal- ity. Helpers attempt to show calm concern and empathy with their voices. Allowing for small periods of silence gives the client moments for reflection and the helper time for processing. using silence is something of an art.” or by . 1978). & O’Brien. and at times they try to mirror the client’s emotional tone. and to take time to think (Ladany. Words often seem somehow to deny the validity of a person’s grief or are perceived as attempts to sweep feelings under the rug. whether they are adults or children. 2003). When a helper uses his or her voice to mirror the client’s emotion. Clients also feel more positive about a session if the helper talks about one third of the time or less (Kleinke. Tepper & Haase. this kind of posture has been supported by research because it tends to increase rapport with the client (Sharpley. whereas in social settings silence is deadly. In addition. At times. it can make the client too uncomforta- ble and unsupported. Chapter 3 • Invitational Skills 67 relaxed and attentive posture is one of the fundamental tools for putting the client at ease (Maurer & Tindall. 2001). When clients come for help. At these times. & Ladany. 2005). The helper who conveys a sense of calm and empathy with the voice can help stabilize the situation and give the impression that the helper will not be overwhelmed by the problem (cf. because lean- ing forward conveys attentiveness.. impatience. and encourag- ing movements of the hands that are not distracting. a facial expression that indicates concern and interest. the smaller the physical distance. whereas a motion- less statue-like pose communicates aloofness. 1977). “You were really angry.” In the second sentence. Most one-on-one dialogues among Americans take place at a distance of 1 to 4 feet. Besides carefully attending to a client’s expressions.” varies considerably from culture to culture. gestures.68 Chapter 3 • Invitational Skills saying. 1979. Gestures are physical motions we use to convey emotion or emphasize important points. whereas those trained in the client-centered approach of Carl Rogers felt that facial expressions shown by the helper should be genuine responses to the client’s emotions. frequently shifting body position. and verbal messages are clues to deceit. Facial Expressions and Gestures All human beings express the six primary emotions of sadness. and conflict. the helper’s voice tone empha- sizes the word really to more closely reflect the intensity of the client’s feelings. or “bubble. and other such move- ments can be read by the client as nervousness. disdain. joy. dis- gust. Normally. Corn. many of which are culturally specific (Blum. 1983). Incongruities between facial expressions. although Americans can identify sadness in pictures of Japanese people. especially when it is important to determine whether these signals match the clients’ words. human beings can also discern about 5. for example.000 different facial expressions. Regardless of one’s theoretical persuasion. the more personal the interaction. casual. & Bellet. drumming one’s fingers. Tuemmler. there is some- thing culturally distinct about their expression as well (Marsh. 1975). Fidgeting. It has been said that some Italians. surprise. and natural. You may have noticed that people from Northern Europe require more space during a conversation than do Southern Europeans or Middle Easterners. At the two extremes. about 3 feet is a comfortable space for personal interaction. anger. Elfenbein. lack of self-awareness. anger or fear. Specifically. Although lit- tle research has been done on physical distance in helping settings. 2003). 1998). Physical Distance One’s personal space. but interestingly. checking a watch. in general. . & Ambady. excessive movement may signal anxiety. The first Freudian analysts were trained to avoid reacting to the client’s expressions of emotion. or boredom (Fretz. The listener who is moderately reactive to the client’s content and feelings is more likely to be viewed as friendly. laughter. it is clear that facial expressions that convey the helper’s reactions to the client’s joy or sadness. are perfectly comfortable with a conversation that is almost nose to nose (4 inches or less). playing with a pencil. 1974). and fear with the same basic facial expressions regardless of culture (Ekman. or disinterest. This slight lifting of the voice can quickly let the client know you are listening very closely. Setting aside the basic emotions. In general. Thus. helpers must pay close attention to facial expressions. excitement or bore- dom can serve as invitations to greater disclosure or potentially close the door if the client detects pity. this includes occasional head nodding for encouragement. many of these expressions have cultural “accents. not just to the facts but to the emotions as well. warm.” In other words. Maurer & Tindall. we can say that a culturally appropriate distance enhances disclosure (Hazlewood & Schuldt. the helper must consider what messages he or she is sending through facial gestures (Hackney. with people sitting about 18 inches apart. Goodman & Teicher. 2009). Newman. most beginning helpers should probably avoid it at first except for a greeting or parting handshake. it might be anti-therapeutic to avoid it. cer- tain taboos must be observed (Bonitz. Eyckmans. Because touch has its dangers. (2) touch should not impose a greater level of intimacy than the client can handle. On the other hand. Justice. 1988. or traumatized as a way of showing support. Although there is much to be said for the healing power of the human touch. especially during moments of grief and trauma (Driscoll. Hunter & Struve. dating back to Freud’s “pressure technique. and then the helper may actually be seen as less trustworthy (Suiter & Goodyear. Fisher. & Seals. Touch has a long history in the helping professions. Stone and Morden (1976) suggest 5 feet (knee-to-knee sitting down) as an optimal distance between client and helper in a Western setting. Touching and Warmth We usually greet our clients by shaking hands in Western society. They also encourage the use of touch as a greeting or at termination. Chapter 3 • Invitational Skills 69 Physical barriers such as desks increase distance and add a feeling of formality to the relationship. touch may be used to emphasize or underline important points (Older. There are several writers who contend that helpers need to use appropriate touch (Swade. but it may be experienced as forced intimacy when used routinely. Phelan. Many helpers like to set up office chairs at about this distance. The helper can still convey caring . 2008). 1985). The helper must be prepared to recognize this reaction in the client and be willing to discuss it. in fact. Willison & Masson. 1997). & Horton. A hug may be a special gesture at the end of the helping relationship. depressed. An embrace may be seen as phony. and any kind of touch might be inappropriate (Hunter & Struve. and (3) touch should not communi- cate a negative message (such as a patronizing pat). It must be recognized here that there is a “pro-hug” school of thought among some helpers. In addition. Perhaps fears about physical contact are overblown in the literature. & Imes. but many writers have cautioned that it is important to know the client well before initiating even the safest forms of touch. 1998). Holroyd and Brodsky (1980) recommend touch with socially immature clients to foster communication and bonding and with clients who are grieving. Shaking hands conveys our willingness to connect. 2008.” which involved placing a hand on the client’s forehead to encourage free association (Smith. Bayne. 1997. 1998). allowing the client to rearrange the chair in a comfortable way if he or she feels it is too close or too distant. Rytting. and Heslin (1976) established three useful guidelines for helper touch: (1) Touch should be appropriate to the situation. It signals that we are harmless and friendly (just as dogs roll over on their backs and stick their tongues out to communicate the same thing). Touching another person does increase one’s ability to influence that person (Goldman & Fordyce. For a client who has been sexually abused. 1983). 1982). extremely close quarters can also feel intimidating and create anxiety. 2004). 1986) and. Clance. One guide- line is to use touch only sparingly to communicate encouragement and concern. most social situations are closer. however. 1988. 1988). Touch can also engender powerful sexual and transference reactions in the client (Alyn. 2006. with the knowledge that even slight gestures may evoke sexual or fearful feelings in the client (Stenzel & Rupert. Touch can communicate caring and concern. a good deal of anxiety may be aroused. such as a pat on the shoulder or back (Eiden. 2009. In this section. customs. Warmth is difficult to define. we talked about his relationship issues as well as stereotypes and prejudice. MyCounselingLab Video Exercise 3. Soon I realized that we were not talking about the obvious differences between us. or dress. Dr.1 Dancing or Helping CuLTurE ChECk Culture is the system of shared beliefs. values. and artistic products that a group of people transmits from one generation to the next and that members of the group use to understand their world and each other. I saw a burly young man in Western wear and cowboy boots who possessed a strong Southern drawl. guarding oneself. 7/e. David Johnson (2000) shows how nonverbal messages can communicate either warmth or coldness. so I made the decision to cautiously open a discussion about his upbringing and how it differed from my own. welcoming Closed. we were able to form a good counseling relationship. In Table 3.70 Chapter 3 • Invitational Skills TABLE 3. tense Eye contact Look into other’s eyes Avoid looking into other’s eyes Touching Touch other softly Avoid touching other Gestures Open. onverbally by communicating warmth. He seemed very guarded initially. When I saw my client for the first time. and keeping other away Spatial distance Close Distant Source: David W. I was the only black counselor at a small. taboos. Copyright 2000. Johnson. and over the next nine ses- sions. Reprinted with permission of Allyn and Bacon.2. look. When I came downstairs. I expected him to be racist. and I . Despite this first encounter. Differences in nonverbal communication can be a stumbling block in forming a relationship with someone from a different cultural background. we recognize it and respond by opening up. Once I was called to the office to meet a new client named Ray. predominantly white institution in the South. frowning. Warmth is not a skill but a synthesis of nonverbal n communications that can have a powerful effect on a client’s willingness to open up. interested Poker-faced. he talked about his father being a racist and then admitted that he had almost walked out the door when he saw that his counselor was black. Andrew Daire. which I attributed to his discomfort in talking about his relationship problems. Reaching Out: Interpersonal Effectiveness and Self-Actualization. private. We make assumptions about people based on the way they talk. based on his clothing and accent.2 Nonverbals That Communicate Warmth or Coldness Nonverbal Cue Warmth Coldness Tone of voice Soft Hard Facial expression Smiling. uninterested Posture Lean toward other. describes how talking about these perceived differences can lead to a better helping relationship and turn a negative first impression into a source of growth for helper and client. relaxed Lean away from other. behaviors. but when it is present. During that first session. who worked in a university counseling center. Which cultural groups do you have the most experience with through friends or family? Which groups do you know the least about? How important do you think it is for a helper to experience a variety of cultural groups during his or her training? Do you think it is always possible for a helper to cross over cultural lines. the helper may be expecting the client to open up and the client remains silent and wooden. he probably would not have come back after the first session. We have now seen that nonverbal communication can invite or discourage a client from self-disclosure. which are verbal prompts that encourage clients to disclose themselves even more deeply. OPENING SKILLS: HOW TO INVITE Beginnings are always messy. John GaLsworthy Beginnings in the helping relationship are messy because each person comes in with expectations. I also began to understand a little about the fears that drive the attitudes of people like Ray and his father. many people wear religious jewelry. and giving the client hope that problems can be resolved. it is up to the helper to clear up the messiness of the first encounter by inviting the client into a helping relationship. giving a glimpse of their background. Most important. or jewelry as a form of communication? All of these can be culturally influenced. When do you think it might be important in a helping relationship to notice these and talk about them? When do you think it is best to ignore them? Is part of your job as a counselor to open up areas of discussion that are tradi- tionally taboo? Is broaching difficult topics a separate skill? Discuss this with your classmates. Had I not brought up the impressions we shared of each other. as Andrew did. skin color. What customs can you identify in your own culture that help you decide what clothes or jewelry to wear? Are certain colors best for certain occa- sions. hairstyle. • Have you ever thought about attitudes you might have about people from various parts of the country? Do certain accents lead you to make unfair assumptions about people? What does a Southern. and probably many other tiny cultural differences—but they were hesitant to mention them. I now believe that treating him in that way would probably have reinforced his stereotypes and prejudice. Chapter 3 • Invitational Skills 71 was tempted to pull back and not even address our differences. clarifying conceptions about the process. . For example. rather than provid- ing an opportunity for him to examine them. we were able to develop a relationship that helped him deal with the issues he had come to work on. both helper and client reacted to the nonverbals of the other person— clothing. and help someone who seems to be so different? • In Andrew’s story. Appalachian. accent. Perhaps the client has watched a television show about therapy and expects to lie on the couch. let us talk about beginnings. we turn to opening skills. In the beginning. Before we discuss the basic verbal skills that you will need. New York. Meanwhile. Next. such as black for funerals? • What can you really tell about a person from his or her clothing? Is there a risk of “pigeon- holing” people based on their clothing choice or the kind of car they drive? • Think for a moment about your experience with people from different cultural back- grounds. or British accent imply about someone? • Have you ever thought of clothing. I think your speaking up is very important because there might be similar issues in your other relationships that need to be clarified and because we need to correct the misunderstandings between us so that progress isn’t stalled. You and I would meet once per week at this time. I will try to be honest with you.72 Chapter 3 • Invitational Skills Saying Hello: How to Start the First Session Here are some examples of how to conduct the first session.” (It is important not to give false reassurance but if you feel hopeful. This can even be given to a client to read prior to the session. For children and adolescents. let’s talk now about what brought you to counseling. I will be here on time every week and I hope you will too. not a parent or a teacher. take the time to explain the process to them. Why don’t you come with me back to my office?” • Don’t spend the whole session doing paperwork. I am a counselor here. summarize and give hope. I am confident that we can successfully deal with the problems that you are confronting. • Let the client know something about yourself and about the process. At least one third of the ses- sion must be spent in building the relationship and understanding the client’s problem. as well as what to expect in a helping relationship. you will bring it up during the session. evaluating how well you are solving problems and reaching your goals. It would be up to you to continue to work on your goals throughout the week and complete whatever homework assignments we decide upon. training.) How to Start the Next Session Student helpers frequently begin subsequent sessions with: “How was your week?” . “Hi. For example: “Here is how I see us proceeding from this point. I am Mark. • The session begins with a self-introduction.” “Did something happen in the last few days or weeks that made you feel you needed help?” (Suggests that a certain event may have triggered the appointment) “How can I help you?” (Lets the client know that you are the helper and he or she is the helpee) “I see from the notes that you went to counseling before to deal with an addictions problem. • Specifically describe the helping process. the following are recommended beginnings: “All right. and I hope that at the next session we can focus in on one or two of the most important ones. We will continue until we both feel that you no longer need help. Some helpers have a printed professional disclosure statement concerning the helper’s schooling. For example: “Well. helping them see that your role is an advocate. and I hope you will be honest with me. we have talked about a number of different issues you are facing right now. How does that sound?” • When the time comes to discuss the client’s issues. Is that what brings you here today?” • At the end of the session. let the client know. That means if something is happening that you don’t like. Here are some examples of door closers: “I suppose you are going to sulk again this morning. p. aren’t you?” “When will you ever learn?” By contrast. the door opener signals availability on the part of the listener and encourages exploration and discussion.” the helper uses open- ing skills to prompt the client to talk more deeply about his or her troubles. we will simply refer to them both as encouragers because both serve the same basic function: to spark disclosure without taking over the conversation. 1979. The nonver- bal skills say to the client. but both types—door openers and minimal encouragers—are brief interven- tions to kindle the fire of self-expression. and so they must be presented in a way that the client feels that he or she has the opportunity to refuse. clients begin to ramble and tell sto- ries. We have divided these encouragers into two categories. and they fall into two catego- ries: encouragers and questions. but the client determines the depth of the response. Encouragers Encouragement means “to cause to have heart. “What did you want to talk about?” You can see that opening skills are actually demands.” and ask.” The preceding examples demonstrate how the beginning helper can effectively conduct the first two sessions with a client. We will discuss them separately here. Chapter 3 • Invitational Skills 73 Unfortunately.” Some parents and teachers use door closers and wonder why their children or students clam up. “I am ready to listen. How do you like it?” “You look down this morning (observation). Do you want to talk about it?” “What’s on your mind?” . The door opener is initiated by the helper. DOOR OPENERS The first kind of encourager is called a door opener. “Hello. After you say. Typically. Instead. nonjudgmental response made during the initial phase of a contact. “Tell me more. consider the following possibilities to get the client on track immediately: “Last week we left off talking about how you want to be more assertive in your relationships.” Encouragers are words the helper uses to bolster the client’s courage to confide. It may include observations by the helper such as the following: “I see you are reading a book about Sylvia Plath (observation). this conveys that the client should recount the recent past and to some extent evokes a social atmosphere. which is “a non- coercive invitation to talk” (Bolton.” “Last week we uncovered a number of issues that you are facing in your life. Let’s track one or two of these down and see if we can find the ones that are causing you the most difficulty right now. but later in the book.” “At the end of last session. I gave you a homework assignment about irrational thoughts. 50). a door opener is generally a positive. By contrast. They are soft commands. evaluative or judgmental responses are “door closers. Let’s have a look at your diary and talk about how you are doing with that. Let’s continue to explore how we can deal with this issue.” but the opening skills say. More than a passing social response or greeting. the client feels stranded and uncertain. Clients learn .” “Can you say more about that?” “What would you like to talk about today?” Door openers are invaluable to helpers because they can be used to get clients to expand on what they have been saying.” “Yes. “I am present. Frequently. It is directing the conversation away from what is powerful for the client and fills the need of the helper.” Of course. and to allow helpers additional time to formulate a response. Examples of minimal encouragers include: “I see. we can learn the most by patiently liv- ing with our questions until the answers come of themselves.” Minimal encouragers are verbal responses that show interest and involvement but allow the client to determine the primary direction of the conversation. 1999).” “I’m with you.” “Hmm.” but they do not interrupt the story’s flow. the client may feel interrogated and evaluated (Brodsky & Lichtenstein.” “I’ve got you. these responses are not sufficient to help a client achieve the goals of therapy. Sometimes questions get in the way of understanding for both helper and client.74 Chapter 3 • Invitational Skills “Tell me about it. Even more important is the fact that we are training our clients to answer questions rather than express themselves. Questions Most of us think that questions provide the ultimate road to understanding.” “I hear you. stroking his beard and saying. but if they are not used frequently enough (especially in the beginning of the session). We fall back on questioning when silence fails or when we feel uncertain about the direction of the conversation with someone we are trying to help. Minimal encouragers tell the client. questions inter- fere with the need the client has to tell the tale. Questions can sidetrack the client from the story that is emerging because a question is a demand. to begin conversations in the first place.” “Okay. MINIMAL ENCOURAGERS Minimal encouragers are brief supportive statements that convey attention and understanding. Of all the opening skills.” “Right. and on the other side. In the beginning. They are different from door openers in that they communicate only that the listener is on track (Hill. “Mm-hmm. Excessive questions distract us from listening. Such phrases reinforce talking on the part of the client and are often accompanied by an approving nod of the head. Most of us are familiar with minimal encouragers from the media’s image of the Freudian analyst behind the couch. 2004). But question- ing is not listening. questions are the most easily abused. you will soon see the answer to your problem. you may find the almost irresistible urge to revert to questioning because listening and waiting do not seem to be working. 2004). the helper must ask some questions in order to gain key information. Over time. At such times. rational process. Cichetti. So the problem is to know when to ask questions and which ques- tions to ask. it can convey a very deep level of understanding.” of the client’s behavior from the whole of the story. Adults tend to respond to “why?” questions with intellectualizations and rationalizations. Clients may feel belittled by leading questions . Therefore. 1968). may have been the result of a lengthy. The message usually is “If you follow my logic. but this chapter is about inviting the client into the relationship. LEADING QUESTIONS Leading questions have an embedded message. The next section takes aim at two common kinds of questions that are fraught with difficulty: “why?” questions and leading questions. On the other hand. or angry client.” Lead- ing questions are usually grouped together as a subtle argument or a covert way of giving the client advice (Hargie & Dickson. asking a client. When you encounter a sullen. if you ask a 5-year-old why he or she stepped in the mud. but beginners frequently ask the wrong kinds of questions too early in the session when they should be finding other ways to get client to open up. Frequently the reason for asking questions is that the helper feels stuck. “WHY?” QUESTIONS Asking the client why he or she behaves or feels a particular way is very enticing because this inquiry seems very psychological and appears to be getting to the root of a problem. we will talk about the appropriate use of questions in the beginning stages of helping. Chapter 3 • Invitational Skills 75 what helping is from the helper. & Freeman. or “why. This feeling generally leads to desperate measures that do more harm than good.” In reality. After that. At this point. exces- sive questioning puts the client on the defensive. a few decisions people make. helpers learn to ask fewer “why?” questions and learn to extract the motivations. When you understand why and share that with a client. 1999). silent. such as buying a car or a house. “Why did you get a divorce?” may put him or her on the defensive rather than stimulating deeper thought (Brodsky & Lichtenstein. reluctant. but the best answer to most “why?” questions is usually “It seemed like a good idea at the time.” This may be true even for important life decisions such as get- ting married or changing jobs. Later in the process you will see times when more complex questions can be help- ful. Some of the most useless questions helpers ask are: “How are you doing?” “How have things been this week?” “Why do you feel that way?” “How does that make you feel?” Research suggests that helpers ask fewer questions as they gain experience (Ornston. In fact. the inevitable and truthful answer is “I don’t know. Levine. The assumptions here are (1) that the client knows why and (2) that knowing why will be helpful. we want to be very careful. Still. not to convey the impression that helping is an inquisition into what is wrong. Certainly questions are called for when key elements of the story are confus- ing. the helper should fall back on attentive silence and encouragers to keep the door open. especially in the beginning. 76 Chapter 3 • Invitational Skills because their use implies that the client should have been able to figure out the cause of the problem. The helper.” These questions are leading because they are really disguised attempts to push through the client’s acceptance of the helper’s agenda. People have started looking at me differently. . In this incident.. They are open questions and closed questions. Unfortunately. an event that was the key to the client’s shame and remorse about the incident. how bad the damage was to the cars involved. was able to get the client to talk about many of the important issues. using door openers. my entire life has changed. These are the sorts of questions that sidetrack the client from the important issues. you would feel better?” (leading) raymond: “Yeah. and so forth. for example. but clients often talk about a problem on a super- ficial level at first. minimal encouragers. I am sick of being pitied. there are two other categories of questions that you will need to use regularly but at different times. Some closed questions can be answered with a “yes” or “no”. this type of questioning is very com- mon among those who are trying to work with children and adolescents. The student helper felt that the client should have volun- teered this vital piece of information. Closed ques- tions are important when you need to get the facts straight—especially when there is an emergency situation or when an understanding of the complicated facts is crucial to your getting the full picture of the client’s story. They look down on me like I can’t do the job anymore. Closed questions ask for specific information and usually require a short factual response. but the evi- dence suggests that this approach shuts down the conversation (Sternberg et al. it was the seriousness of the accident that needed to be explored. and appropriate nonverbals. Can you see that in this example the helper is trying to get the client to acknowledge that his lack of self-esteem is the cause of his problem? Notice that the client tacitly agrees. 1997). others demand information such as when you ask someone’s age.” LeiLa: “Would you let other people affect you so much if you had more faith in yourself?” (leading) raymond: “No. the helper must delve and pry to get the important facts. This became apparent in a recent dem- onstration session during which a client discussed the trauma and aftereffects of a seri- ous two-car accident. the student helper failed to ask whether the other victim of the acci- dent had been killed or injured.” LeiLa (heLPer): “Are you letting other people affect your mood?” (leading) raymond: “I guess so. Beginning helpers should not immediately try to fix the problem but should invite the client to explain and then strive to understand what the client shares. Consider this example: raymond (cLient): “Since I was diagnosed with cancer. probably not. Closed Questions. OPEN AND CLOSED QUESTIONS Although “why?” questions and leading questions are to be avoided. Many beginning helpers might ask about less relevant details such as when and where the accident occurred.” LeiLa: “Do you think that if your self-esteem were higher. but does not respond with more information or real enthusiasm. The difficulty is in knowing which aspects of the story are likely to be important. Sometimes. However. Open Questions. the client may begin to believe that his or her job is to respond to the helper’s questions rather than to tell the story. we discussed your relationships with men.” . The use of open questions will help these clients make a transition to greater involvement. Because open questions are less coercive than closed questions. waiting for the right line of questioning before speaking.” Open heLPer: “Can you tell me how you and your parents have been dealing with your differences recently?” cLient: “Well. either. depending on a client’s cultural background. Open questions do not request specific information but encourage one to speak about the general topic. but we’re not talking. It may also be true that. and phone number. Here are some examples. Would you mind going into that again?” “What makes you think that it is time to make a change in your life?” “Can you tell me about your problems with math?” “You say you have self-esteem problems. the helper is viewed as an author- ity. Compared to closed questions. address. but instead let the client know that help- ing means a partnership in which both people have the opportunity to contribute. 1999). The client can become passive. The client might feel that it is only respectful to wait for a question. Closed heLPer: “Are you getting along with your parents these days?” cLient: “Yeah. 1985). Just existing. Here are some pairs of open and closed questions that each explore a similar topic. really. What do you mean by that?” Now consider the following closed questions: “How old are you?” “What school do you go to?” “Are you planning to go to college?” “Would you describe your marriage as happy?” The difference between the two question types is something like the comparison between multiple-choice and essay exams. Sometimes the deadly silence in the session is due to the fact that you have trained the client to wait for questions rather than initiate conversation. If a helper begins with a series of questions such as name. clients who are reluctant to seek help may respond better to open questions (Brodsky & Lichtenstein. Multiple-choice tests check your knowledge of the facts. We’re not fighting. Consider how you might respond to them. Chapter 3 • Invitational Skills 77 Although there are times when closed questions are called for. Note the differences in the client’s typical response to open versus closed questions. At such times. but essays ask you to show a deeper level of understanding. they can have a dampening effect on the relationship and on the conversation. we haven’t been. the helper should not let the client suffer in silence. Pretty good. open questions allow more free- dom of expression and are perceived as more helpful (Elliott. “Could you tell me about the kinds of problems you have been having?” “Last week. even though they may not seem as direct (Johns Hopkins University. 2003). open questions eventually elicit more information than closed questions. and we will consider it in greater detail when we discuss its use in the assessment stage of the helping process. try to transform it into an open one first. Since then. Some people seem to have the inherent ability to get . See whether you can listen with- out closed questions. I haven’t really been up to seeing anyone. Open ques- tions also persuade the client to answer by giving the client the opportunity to refuse.” As these examples suggest. the ability to be attentive and available to another person. Other uses of questions are not discussed here because this chapter cov- ers the beginning of the helping process.2 Responding Using Opening Skills STOP AND REFLECT Are You a Natural Helper? In this chapter. keep a close watch on the over- use of questions in the exercises and practice sessions.78 Chapter 3 • Invitational Skills Closed Helper: “Are you married now?” Client: “No. we talked about opening skills. Good questioning is an art (Goldberg. there is a tendency for beginners to ask too many questions including “why?” questions.2 Can’t Delegate MyCounselingLab Application Exercise 3. MyCounselingLab Video Exercise 3. signaling that you are ready to listen. and one day she left me for this guy at work. Yet it is also important to get crucial information. We were married for over 7 years. Open questions enhance the therapeutic relationship (Boyd. and let your nonverbal skills and other encouragers be the workhorses of your helping conversation. For the time being. In summary. divorced. leading questions. and questions at this point are less useful than they may be later on in the process. I’ve been divorced for 6 months from my second wife. They do not box the client in by forcing him or her to answer directly.” Open Helper: “Can you tell me a little about your personal relationships during the past few years?” Client: “Well.1 Labeling Opening Skills MyCounselingLab Application Exercise 3. When you feel the need to ask a closed question. and unnecessary closed questions. 1998). 1998). position. how to help them set goals. They define natural helpers as individuals who are already sources of listening and support. thinking that everyone possesses them. Thus being a natural helper is a good foundation and makes the going easier—especially in the beginning—but professional training can allow you to help even more effectively and ethically. body position. and invitational skills relationship between client and helper. Beyond get- ting people to talk. faculty. Nonverbal skills Invitational Skills” section. school. and utilize natural helpers to deal with problems in the school. physical distance. “Tell me your story?” You may be a natural helper. facial expressions and gestures. and students.” Recognizing this. are messages used by helpers to provide the right conditions for the client to open up. Invite the client to talk and to tell the story. and QUICK TIPS: INVITATIONAL SKILLS touching. and develop advanced skills. In fact. and connected them with pro- fessional helpers (The Annie E. Here are some questions that might help you determine if you are a natural helper: • Do people you don’t know often strike up conversations with you? • Do people tell you that you are easy to talk to? • Do you enjoy finding out about people and know how to get them talking about themselves? • Do your friends say that you should be in a helping profession? • Are you basically a nonjudgmental person? Consider the qualities above. we must know how to listen. A summary of let the client know that you are interested in that suggestions about how to use invitational skills effec- story. Invitational skills have two basic components: tively is presented in the following “Quick Tips: nonverbal skills and opening skills. but they count for so much in the . If you are a natural helper. some individuals are identified by their peers as “someone you can talk to. There are also public and private k-12 schools that identify. while your fellow learners probably possess these abilities. Opening skills are the verbal messages the • Once you have adopted a facilitative body helper sends to facilitate the client’s disclosure. Summary Every client has a story to tell. ple to learn. Casey Foundation. behave ethically in a helping relationship. The skills are eye contact. Casey Foundation developed a project to identify good neighbors who are natural helpers in communities. Within every organization. Opening skills include encouragers and open and • Remember that the ball is in the client’s court: closed questions. attentive silence. These are all part of being a professional helper. and may include staff. provide training to. n. most people don’t. take a deep breath and relax. Does it seem sometimes that you are carrying a sign that says. or workplace. Do they apply to you? We have found that many beginning helpers take these skills and abilities for granted. voice tone. Chapter 3 • Invitational Skills 79 other people to talk. Invitational skills are relatively sim. does this mean that you don’t need additional training? Con- sider the fact that possessing these opening skills is only the beginning of helping.). the Annie E.d. Although you may be role-playing part of the dents in the class discuss what they liked about each time. confidentiality and its limits need to be Exercise 2: Practice and Feedback Session explicitly discussed in each group. You also feels comfortable talking. Training Group another the client. Still. rein to explore his or her deepest issues in a non- • When a silence occurs. invitational skills are needed at all • Rely on door openers such as “Go on” and stages of the helping process.” rather than comes to the surface. view the “Quick Tips: Invitational Skills” section. You can Observer 1 will use Feedback Checklist 1 to give the learn something in each role. Observer instructor likes to work. stop dreams.80 Chapter 3 • Invitational Skills • After an open question or two. You learn how they establish conditions in which the client how it feels to be challenged or supported. the client decides on the topic he or she wants seling person B. of mental health professionals. As each new issue “Say some more about that. Does the class think that this first should have an agreement for confidentiality in your impression is crucial? What skills did you observe in practice group. the helping conversation. in a role play. Using Invitational Skills Instructions for Group Exercise 2 Some Notes on the Helper/Client/Observer Break up into groups of four. we will the “session” begins. to discuss. stu. After each role play. the helper relies on invitational asking too many questions at first. don’t rush to fill the judgmental atmosphere. something about being in the client role. and finally person C counseling person A. while. Exercises GROUP EXERCISES same groups for all practice sessions. Exercise 1: First Encounters Practicing on fellow students is a method used In this activity. then person B counseling person C. some of the situations may be real and so you helper’s approach. with person A coun. It has been our experience that stu- each helper’s vignette? dents respect this confidentiality and take it very se- riously. one student get a feeling about what is too invasive or too super- might role-play a school counselor bringing an el. and the observers look over their checklists. Depending on how your helper data on his or her nonverbal skills. the instructor selects two or three in medical and dental schools as well as in the training people to demonstrate a first encounter with a cli. Mean- This works in a circular fashion. or you may fre- quently change groups. These may be students who have had some student who told me that he and his fellow students experience in the helping field or even individuals practice giving each other numbing shots. For example. Wait for the client to do it first. Recently. and most important facts. Pay attention to these feelings and share them ementary student from the playground to his or her with your colleagues during the feedback portion of office. the client and ask a closed question or two. you may be assigned to the 2 will use Feedback Checklist 2 to rate the helper on . but one of the prime benefits is that you learn clients and one by one demonstrate. ficial. One person is the helper. fears. Just as in who have worked in the professional or retail world. use the first Getting the relationship off on the right foot few minutes to listen to the client. Doing so will be extremely valuable to play how they greet the person and how they begin them even if it feels uncomfortable at first. Besides their importance in void. If you are unsure. skills and a nonjudgmental attitude to provide the • Use closed questions sparingly. but ask atmosphere of warmth and safety that allows for the yourself whether you have understood the deepest exploration of the client’s needs. and two act as observers. using means establishing the norm that the client has free minimal encouragers and head nodding. there is some risk involved in role- These “helpers” each select a student to play their playing. the beginning. the helper should take time to re- be asking you to break into groups of three or four. Before For many of the practice sessions in this book. The helpers should demonstrate in the role the exercise. I met a dental ent. giving an injection. (Circle one. Your task is to write Openness Relaxation Tension down everything the helper says during the interview. and respect from the helper.g. giving each person a chance to Rigid gestures experience helper. Feedback Checklist 2 (to be completed 1. the helper invites the client to apply. client. recording your comments for Helper’s face shows concern and interest each skill on a separate sheet as you observe it. Stares the observer should try to give feedback on checklist Suggestions for improvement: 2 and the client can comment on the helper’s nonver- 3. Face reflects client’s feelings at the end of the conversation. The client is encouraged 4.) impressions of the helper’s manner. For 5–8 minutes. Evaluate the helper’s gestures and facial expres- to give qualitative feedback that may include general sions. and observer roles. start at the beginning and review each skill. categorize each response and give the helper feedback.. If there are only three in your group. Categories ate eye contact. the observers and client give feedback to the helper.) Encourager (E)—include door openers and min- Avoids imal encouragers under this same category Occasional Open question (OQ) Is constant with breaks Closed question (CQ) . Evaluate the helper’s voice tone. When you are finished. What does the body position convey? (Circle all You are to give feedback on the helper’s use of en- that apply.) couragers (door openers and minimal encouragers) and questions (open and closed). try to work through the Expression: checklist systematically. Draw a stick figure sketch of the helper’s body by Observer 2) position. Nodding: Head nodding appropriate Feedback Checklist 1 (to be completed Head nodding too frequent by Observer 1) Head nodding too infrequent During the practice session. Suggestions for improvement: 2. Inviting gestures ticipants switch roles. Chapter 3 • Invitational Skills 81 opening skills. The en- tire process will take about 45 minutes. If you Face shows disinterest have time. Face is unchanging/masklike tions. Nervous movement or distracting movement empathy. warmth or use of touch) tions for improvement. The par. to check your observa. Stiffness Interest Aloofness At the end. Evaluate the helper’s ability to maintain appropri. The client should Gestures: indicate whether or not he or she felt genuineness. The observers Occasional gestures then give feedback based on their checklists. Be as honest as possible so that Suggestions for improvement: the helper can benefit from feedback. Other (e. (Circle all that apply. (Circle all that bals.) discuss one of the following topics: • How I chose my present job Too loud Cold • A trip I took that was very important to me Too soft Soothing • My relationship with a close friend Confident Clipped • A topic of the client’s choice • The problem of a friend or acquaintance whose Hesitant Interested role the client assumes Moralistic or smug Bored Warm Other Feedback Suggestions for improvement: At the end of the time period. write down any sugges. In the class discus- 1. Discuss your activities over the past week for about 4–5 minutes. Check the helper’s invitational skills against ent know he or she was listening? the list in Table 3. instead of open questions that might have given more Discussion 3: Eyes Closed depth to the discussion? Form dyads (groups of two) and sit facing each other Feedback on the Use of Questions with your eyes closed. What nonverbal behaviors did you and vitally important or merely asked out of curiosity? your classmates find it most difficult to do without? How many “why?” questions did you detect? 2. the helper. Provide one chair for the client and another for the helper. Based on the client’s responses. Remember. • What is your problem? • Why do you need help? 8. others in a small group. • Did you have fun on the class trip? • How old is your daughter? 11.1. your own open questions.82 Chapter 3 • Invitational Skills sheet. Afterward. While watching. take turns giving your reactions to helper. half of the class 1. Each member of a small group (two or three students) Once the chairs have been moved and the participants should individually turn the following closed questions are seated. • When did all of your problems begin? 9. Look at the list of closed questions used by the sion that follows. Alternatively. Next. Ask the group to comment on how the distance has affected the conversation. helper interaction. “opened” by changing it to “Can you tell me something about your family?” Share your open questions with 3. For example. expand and disclose? 6. and movements. gestures. and ask two participants to hold a conversation at that dis- The following activities can be done in a small group tance concerning a minor problem one of them is hav- or as a whole class. were they the experience. the 1. View 10–15 minutes of a video that shows a client/ 15. 2. Write your answers on a separate with a yardstick or tape measure and see whether it . an open question can expand a topic Helper Question or Statement Category beyond the original closed question. Feedback on the Use of Encouragers discuss the relationship of these nonverbal messages to the client’s concerns. Discussion 2: Watch a Video of a Practice 13. Were there more open or closed questions? Does Discussion 4: The Effect of Distance the helper need to increase the use of open ques- tions or decrease the use of closed questions? Set up a simulated office for a role-playing situation. write down any observations you may have concerning the client’s body posture. Think how you might answer 4. Do they give you room to 5. Session between Another Helper and a Client 14. Use a third chair to represent a desk if one is SMALL GROUP DISCUSSIONS not available. Did the helper supply enough encouragers during can observe the client and the other half can focus on the initial 2 minutes of the interview to let the cli. Were minimal encouragers used too often. 12. Place the chairs about 10 feet apart. closed question “Are your parents still married?” can be 2. measure the distance from knee to knee into open questions. • Where are you from? 7. • Do your mom and dad fight? 10. ing. allow the partici- Discussion 1: Open versus Closed Questions pants to move the chairs to a comfortable distance. ___________ Maryann: That I’m stupid and ugly. or is a very simple exercise. Mrs. You will find that some Discussion 7: Sustained Eye Contact people will feel comfortable with an interpersonal dis- In this exercise. Read the following excerpt from a session session on the helper’s face and the other half of the between a helper. Skill Used Mrs. and I hate my teacher. interesting natural. Henderson. touching clients. their final sessions will be. open question (OQ). Joe and Maggie have been calling me names. that the more practice you have in identifying skills. discuss your personal reactions to this exer- Whose needs are being fulfilled by touching? Is it all cise with your partner and then with the larger group. The cli. ent discusses a minor problem he or she is having at the more rapidly you will be able to produce the skills work or at school. Maintain eye contact with your partner and assume the appropri- Conduct a group discussion on the implications of ate helper’s posture while remaining completely silent. Henderson: Go on. Maryann. ___________ Maryann: Yes. Mrs. that is why I came to see you. and more attention is focused on the client. Mrs. 4. students form dyads. 3. Mrs. and her new stu- session on the helper’s whole body. observed lessens. ever since I moved here. it may help students who are closed question (CQ). The second Make a 10-minute video of two trainees. ___________ Maryann: I hate the other kids. As the normal fear of being Measure that distance. ___________ Maryann: Well. move the opportunities students have to be recorded. Maryann. Henderson: And how long ago was that? 5. Someone called me dummy today. ___________ Maryann: Everything! I hate this school! Mrs. What constitutes sexual touching? Afterward. one of whom step is performing the skills aloud. 1. and gestures. Although this er or minimal encourager). If participants from diverse eth. body position. The leader or tance of 6 inches or less. Henderson: What are they saying? 6. ___________ Maryann: About half a year now. Mrs. Chapter 3 • Invitational Skills 83 is approximately 18 inches. the helper’s responses become more nic backgrounds are members of the group. and then classify each of the eight and ask the helper to evaluate his or her own facial helper responses as an Encourager (E) (door open- expressions. 7. Henderson: It looks like you’ve been crying. Replay the tape dent. Henderson: I see. Mrs. We have found acts as the client and the other as the helper. Focus the camera for half of the yourself. instructor will keep time and signal the completion Discussion 5: Touch with Caution of the activity at the end of 2 minutes. variations can occur. the better chairs so close that the participants feel uncomfortable. feeling camera shy. Henderson: Can you tell me what’s upsetting you? 2. right for the helper’s emotional needs to be met by hug- ging a client? Under what circumstances would a hug be beneficial or harmful? What about hugging in group WRITTEN EXERCISES therapy? Exercise 1: Practice in Classifying Discussion 6: Try a 10-Minute Video Session Opening Skills Learning to identify skills is the first step. Henderson: Tell me some more about what has been happening. Try the exercise with participants standing instead of seated. ___________ . an average social distance. Our experience is that the more Does it seem too close or too far away? Next. family. based on your feedback. If it is just right. write down one or two In conversations with co-workers. write down one or two reaction to this exercise. ___________________________________________ JOURNAL STARTERS HOMEWORK Think about a secret that you have not shared with Homework 1: Sound Off anyone. try watching after sharing this information? What are your fantasies a program in another language and see whether you about what might happen if you were to disclose this can still get the gist of the story without understanding secret to a helper? Do you imagine the helper telling the words.” This consists of recognizing what you liked about your performance and what you want to improve.84 Chapter 3 • Invitational Skills Maryann: It happens a lot. ___________________________________________ lence on the communication of others. Homework 3: Experiment with Silence Based on your feedback and experience in the group exercise or other exercises so far. Mrs. How would they feel about being hugged or . ___________________________________________ strangely. things you could do to improve your skills: your friends and family will complain or look at you 1. or is it simply disquieting to think about the se- cret? Would any of these expectations affect your will- Homework 2: Hug Survey ingness to share the information with a professional helper? Conduct a survey among a few friends or family mem- bers. and friends. Write a half-page reaction to this assignment. Write a one-paragraph Now. (2) OQ. 2. (4) OQ. (6) CQ. ___________________________________________ pose of the assignment is to observe the effect of si- 2. Make notes and report findings to the group. How do you think you would feel if a helper Record a television show or movie and replay it with urged you to share this private information? Would it the sound turned off. If your silence is too long. (8) OQ SELF-ASSESSMENT touched by a professional helper? Try to be objective and prepare a one-page summary of their answers and One simple way of evaluating yourself is “Did Well” and your conclusions. (7) E. it should have the effect of encouraging them to talk. The pur- 1. It’s not fair. build in attentive silence and notice the effect. ___________ Maryann: Horrible! I feel like I want to go back to my old school. others. “Do Better. Try to see whether you can guess be easier to share it with a close friend? What kind of emotional content by examining the characters’ body response would you expect if you told a close friend language. (3) E. things that you did well in your first practice sessions: instead of immediately responding to what they say. Henderson: What has it been like—having to deal with this? 8. about this issue? How do you think you would feel If you want to have the voice tone added. (5) CQ. I had lots of friends there. Feedback for Written Exercise 1: (1) E. Plato The invitational skills you learned in the last chapter send this message to the client: “I am ready and willing to listen. convey that you are present and available. and What It Isn’t • When to Paraphrase and the Nonjudgmental Listening Cycle Common Problems in Paraphrasing • Simply Reciting the Facts • Difficulty Listening to the Story Because of “Noise” • Worrying about What to Say Next • Being Judgmental and Taking the Client’s Side • Being Judgmental of the Client • Turning a Paraphrase into a Question Summary Exercises • Group Exercises • Small Group Discussions • Written Exercises • Self-Assessment • Homework LEARNING OUTCOMES • Journal Starters By the end of this chapter. and Reflecting Meaning The Skill of Paraphrasing: Reflecting Content and Thoughts • How to Paraphrase • Paraphrasing: What It Is. and reflections of meaning. 4.1 Differentiate between different kinds of reflections including paraphrases.” Although invitational skills. such as eye contact. 85 . CHAPTER 4 Reflecting Skills: Paraphrasing Reasons for Reflecting Reflecting Content and Thoughts. you will be able to: 4. reflections of feeling. Reflecting Feelings.2 Construct paraphrases of client statements. The unexamined life is not worth living.3 Be aware of common problems in paraphrasing and understand strategies to overcome them. 4. students feel that they have reached a point with a client where there seems to . Reflecting shows the client that the helper understands what the client is going through. The helper’s words resonate with the client’s unspoken and perhaps unrecognized experience. In contrast. see Figure 4. the helper primes the pump with reflections. even if it is inac- curate.1). When the helper reflects these in a nonjudgmental way. 2. nonjudgmental understanding. 2004). Because clients do not always express or even recognize these deeper thoughts and feelings. Reflecting is a form of feedback or a mirror that enables the person to con- firm or correct the impression he or she is giving: Frequently. we dis- cussed the concept of empathy. you might want to think of them as three separate boxes that have to be unpacked if you are to accurately grasp the whole story. using different words and in a manner that communicates nonevaluative. the client does not agree with the helper’s reflections. beginning helpers should try to reflect without being concerned that every reflection is perfect or that the client endorses it. reflecting skills are specialized interventions used by professionals to stimulate deeper exploration of the facts. AND REFLECTING MEANING Every client’s message has three basic components: (1) the client’s understanding of the facts and his or her thoughts (a cognitive level). REFLECTING FEELINGS. and meanings by supplying the client with a condensed version of the story: a mirror that you hold up to him or her that represents the story as you hear it. can give the client an opportunity to clarify the experience to others and to himself or herself (Hill. In other words. Reflecting stimulates further exploration of what the client is experienc- ing: Accurate reflection has an “opening effect. (2) the client’s underlying feelings (an emotional level). 4. but a reflecting statement. reflecting entails repeating back to the client his or her own thoughts and feel- ings and implied meanings in a condensed way. Each of these three dimensions of experience can be stimulated or evoked by a helper using spe- cific skills. Reflecting is a verbal way of communicating empathy: In Chapter 2. in many cases the client will expand on the situation and explain it more clearly. As Figure 4. REFLECTING CONTENT AND THOUGHTS. Four functions are served by reflecting skills in helping: 1. 3.1 suggests.86 Chapter 4 • Reflecting Skills: Paraphrasing they do not indicate that you understand. or trying to “feel oneself into” another’s experience. Fre- quently. REASONS FOR REFLECTING In general. the client may suddenly recognize that the helper is correct. Reflecting captures important aspects of the client’s message that other- wise might remain camouflaged: Many people have difficulty admitting to neg- ative feelings such as fear and anger or ungenerous thoughts about others. If the helper does not hit the bull’s-eye. Reflecting can be compared to the soliloquy in a Shakespearean play where the main character turns to the audience and expresses what is going on inside of him or her. feelings. and (3) hidden meanings (an existential level.” bringing out more facts and deeper feelings. “Yes. Table 4.1 Components of the Client's Message be “nowhere to go.1 gives examples of these three types of reflecting skills. and the following chapter addresses the skill of reflecting meaning. reflecting story content and client thoughts. You will learn these skills separately and then practice putting them together in a com- plete helping session. at work and at home.” In most of these cases.” Topic B: “You want to see yourself as a forgiving person (meaning).” Reflection of Topic A: “You felt discouraged (feeling) about your job and sad (feeling) about feeling the problems at home.1 Three Types of Reflecting Skills Skill Examples Paraphrase Topic A: “So this week has been very difficult. you will learn about the first box.” Reflection of Topic A: “You began looking at yourself as a failure (meaning) because neither of meaning these two important areas of your life are fulfilling at the moment. When I greeted my clients. you were wary (feeling) about continuing your friendship and perhaps you are still angry (feeling).” Topic B: “After all that had happened. “That is the biggest dog I’ve ever seen. a skill that is called paraphrasing. an old friend contacted you about getting together (content).” If I had responded to the content of the message.” or even. Once I ran a private practice in a small town. I might have said. The next chapter focuses on learning the skill of reflecting feelings. but the fact that you harbor some resentment after all this time makes you doubt this view of yourself. Chapter 4 • Reflecting Skills: Paraphrasing 87 Facts & Thoughts Feelings Hidden Meanings FIGURE 4. “Yes. consider the following story in which a helper describes how he began to recognize that parts of a story are suppressed and must be reflected. They often said. it is because he or she has not examined all of the boxes. “Actually. In this chapter. he weighs over 100 pounds and has excellent teeth!” TABLE 4. The house next door to my office was guarded by a huge German shepherd dog that frequently growled at my clients when they approached the front door. that is exceptionally large for a German shepherd. and you are not looking forward to it (thoughts).” . I was always interested in how they framed their reaction. To gain a clearer idea of the distinction between the parts of the client’s message.” or.” Topic B: “If I understand. I’ve seen bigger. a helper can show that he or she also grasps the other layers of the story.’” (reflection of meaning—being a good parent and not repeat- ing his parents’ mistakes is a deeper level of meaning) . let us look at the case of Philippe. the helper begins to grasp the meaning. but I don’t want her doing something stupid.” traCy: “You remember that incident and worry that the same kind of thing might happen to her. That is why weather but not politics or religion is most likely to be an early conversation starter. a single father who has come for help with his adolescent daughter. The driver was drunk. When I was 16. To demonstrate how a helper can lead a client to fully explore a story. the content and the emotional side are equally important if we are to really know someone. the hidden message is an emotional one concerning the fear that the dog evoked but that very few people felt comfortable in expressing. From culture to culture. sometimes I get really scared. clients usually find it more comfortable if the helper is able to reflect the content of their stories. ‘Am I being a good parent. but I am not so sure about the kids she hangs around with. the helper makes a series of reflections. At the beginning of the helping relationship. Gender also affects what a person feels is permissible to share. I think she is a good driver. Eventually. For example.” (reflecting feeling—worry) PhiliPPe: “Yes.” traCy: “It seems that you’re wondering. which involves the client’s values and beliefs about the self. and the world in general. In general. As the client responds to the reflec- tions. and it sounds like driving is an important part of that. MyCounselingLab Application Exercise 4. that I don’t want her to grow up. I think of that. PhiliPPe (Client): “I am having trouble with my daughter. people vary in their willingness to reveal their feelings. Dur- ing a session. others. She has just started driving. My own parents didn’t care what I did. I don’t want to keep her at home all the time.” (paraphrase) PhiliPPe: “Yes.1 Differentiating between Paraphrases and Reflections of Feelings It is not usually possible to understand the deeper layers of the story right away. and one of the kids in the car was killed. Later. I guess it is.88 Chapter 4 • Reflecting Skills: Paraphrasing This example illustrates that every communication has at least two dimensions: the explicit and the implicit. In helping conversations. My wife says I am overreacting. I yell and scream. I stole a car with some other kids. A response that recognizes both will lead to deeper communication of understanding. Every time my own kid goes out on Saturday night. In this case. many men will not acknowledge feeling fearful or weak. we are all much more comfortable talk- ing about content or facts. the helper gets more information about what has happened and the client’s emotional response to the events. We went joyriding and had an accident.” traCy (helPer): “So the main reason you’re here is to think about how you are handling the conflict you are having with your daughter. and maybe I am too strict with her. But this year it seems like it’s getting on my nerves even more. and when to paraphrase. and I am used to working with rowdy kids. one of the teachers was fired during the first week for some unknown reason. Using a boxing analogy. not issues that sidetrack the client. and he or she will not stay on track. THE SKILL OF PARAPHRASING: REFLECTING CONTENT AND THOUGHTS How to Paraphrase The reflecting skill of paraphrasing involves two steps: (1) listening carefully to the client’s story and then (2) feeding back to the client a condensed. recognizing these deeper levels adds color to the black-and-white facts.” . the characteristics of paraphrase. and I have been having some problems at school recently. nonjudgmental version of the facts and thoughts.” Paulina: “I see. the paraphrase is more like a jab. I am a teacher. can you tell me about that?” (door opener) ZaCh: “I have a group of sixth graders this year that are just wild.” (encourager) ZaCh: “That has left a lot of people upset. it can fatally disrupt the client’s story. I am really feeling the stress. I’ve been teaching for 13 years. This year. Zach. Notice how paraphrase assists the helper in understanding the facts of the story and also allows the client to feel the helper is following the story: Paulina (helPer): “Can you tell me about what brought you in today?” (open question) ZaCh (Client): “Well.” Paulina: “So you are not sure if it’s just a wild class or if you are over- reacting.” Paulina: “Okay. With that kind of support from the principal. They won’t listen. To use a metaphor. I just don’t know what this year is going to be like. Okay. With the example of Philippe and Tracy in mind. I’ve sent notes home and scheduled a lot of parent conferences. and her client. A good paraphrase keeps the client’s story on course by mentioning only the important aspects. The second step in paraphrasing involves finding the important infor- mation in a large volume of client material and repeating it in a succinct summary. we are ready to explore how to paraphrase. and they constantly challenge me. Paulina. The helper gets in and out quickly.” Paulina: “Uh-huh. Chapter 4 • Reflecting Skills: Paraphrasing 89 The reflecting skills in this example go beyond invitational skills by bringing out a deeper level of the story—the emotional reactions of the client and the potential meaning behind the story.” (paraphrase) ZaCh: “For some reason. If the paraphrase goes on too long. Here is an example of a paraphrasing between a helper.” (encouragers) ZaCh: “I guess you get a bad group sometimes. I’ve sent more kids to the office this year than I can ever remember. The paraphrase is actually a miniature version of the client’s story. 90 Chapter 4 • Reflecting Skills: Paraphrasing Paulina: “So on top of the new students, you’re dealing with a new atmosphere at work.” (paraphrase) ZaCh: “I guess this atmosphere isn’t new. But it never really affected me before. I tried to stay out of all the politics and the com- plaining in the teachers’ lounge. This year, all the teachers do is gripe. At meetings and after school, somebody is always talking about it.” Paulina: “So for the first time, it’s getting to you and it’s hard to escape the gossiping.” (paraphrase) ZaCh: “Yeah. And I am wondering if the gossiping is worse or if it is me. There are a lot of other things happening in my life.” Paulina: “You are wondering if the things going on in your life are col- oring your whole viewpoint about work.” (paraphrase) ZaCh: “That’s it. That’s what is so confusing.” Paraphrasing: What It Is and What It Isn’t Now that you have read the dialogue between Paulina and Zach, consider the following characteristics of a paraphrase that distinguish it from other helping skills. A PARAPHRASE IS THE ESSENCE OF WHAT THE CLIENT SAYS, NOT PARROTING Do you notice how Paulina does not repeat Zach’s statements exactly? Paulina rewords Zach’s statements to show that she grasps the essence. The paraphrase is not a word-for-word reiteration (parroting). Instead, it is a distilled version of the content of the client’s mes- sage that restates the facts and thoughts in different words and in a nonjudgmental way. It is short and sweet and therefore does not slow the client down while he or she is disclosing. A PARAPHRASE HIGHLIGHTS WHAT IS IMPORTANT You might think that the helper’s paraphrasing is just mimicking the client. However, as you can see in Paulina’s para- phrase, “You are wondering if the things going on in your life are coloring your whole viewpoint about work,” she is picking out something said and very softly guiding and underlining a key issue. Now Zach is being asked to talk about what is going on in his life outside of school that may be contributing to his feelings. A PARAPHRASE IS NOT A QUESTION As a client tells his or her story, the paraphrase is used as a mirror to let the client know that the helper is following but does not pressure the client by asking a question. Questions, especially closed questions, can interrupt the flow of the client’s story and make the client feel as though he or she is under a microscope. A PARAPHRASE DOES NOT TAKE SIDES The helper’s paraphrase does not take sides with the client by supporting his or her version of the story but, rather, points out that this is the client’s perspective. Paraphrasing means reflecting what the client knows to be fac- tual, but these facts are those that are uniquely perceived by the client. Facts and the cli- ent’s thoughts and perceptions are intertwined. To accurately reflect them and at the same time remain nonjudgmental, the helper must take a neutral stance. Chapter 4 • Reflecting Skills: Paraphrasing 91 Here is an example of a helper/client exchange where it is tempting to support the client’s view. In the first helper response, the helper unfortunately takes sides, and in the second, the helper remains neutral yet correctly identifies the essential message. Client: “Okay, I came in 2 hours late. And then my mom sent me to my room for the rest of the day. I am 17 years old. She treats me like a baby just because she likes to be in control all the time.” helPer: (Paraphrasing and taking sides) “Your mom treats you like an infant even though you’re nearly an adult because she needs to be in charge.” helPer: (Paraphrasing and remaining neutral) “So you were punished again for breaking curfew. You think it is unfair and that she is doing it to control you.” When to Paraphrase and the Nonjudgmental Listening Cycle Of course, each client tells his or her story in a particular way and at a particular pace, depending on personal history, previous experiences with helpers, and present emo- tional condition. So it is not possible to predict the exact order in which you will use the skills you are learning. However, we can assume that, in general, helping sessions will follow a fairly similar path. We call this the nonjudgmental listening cycle (NLC) to emphasize that it is a repeating series of basic helping skills. The nonjudgmental listening cycle is a way of conceptualizing a normal or average helping session during which you use the most common building blocks. It is shown here so that you can see where the skill of paraphrasing fits into the larger picture of exploring a topic. The listening cycle is repeated with each major topic the client presents. Following is an example of helper responses to client statements that represents each major skill in the listening cycle. The session is condensed here to illustrate the major components in sequence. 1. Open question: “Can you tell me about your relationship with your family?” 2. Minimal encouragers: “Okay,” “Uh-huh,” “Yes,” “Can you tell me more about that?” 3. Closed question (important facts): “So, Ron is your stepfather?” 4. Paraphrase: “In a lot of ways Ron has acted as more of a father to you than your biological dad.” 5. Reflection of feeling: “You feel a bit guilty about including your stepfather.” 6. Reflection of meaning: “Still, it is important for you to acknowledge someone who has been so supportive in your life.” 7. Summary: “You are a torn between feeling disloyal to your biological father and yet you think it would not be fair to leave out someone who has been there for you in a fatherly role.” WHY IS THE CYCLE DESCRIBED AS NONJUDGMENTAL? The listening cycle is called non- judgmental because the helper must demonstrate the attitude of positive regard—the ability to suspend judgment and accept a person regardless of his or her actions. Without such an underpinning, the client may perceive the helper’s skills as cold and robotic and feel dissected rather than understood. How can a helper develop such a nonjudgmental attitude? One way is through vicarious learning. By watching videos or live demonstrations 92 Chapter 4 • Reflecting Skills: Paraphrasing by helpers who demonstrate this nonjudgmental attitude, you may be able to acquire it. If you are a very judgmental person, you will have trouble learning reflecting skills. Judg- ments come from your own perspective and what you believe to be true. The ability to be nonjudgmental can be developed by putting yourself in situations where you can see another person’s perspective. CULTURE CHECK Self-Disclosure, “Face,” and Culture Helping can only be successful if the client discloses personal information about his or her rela- tionships and problems. Because of cultural differences, some ethnic minority clients may be unwilling to disclose intimate details of their lives because they find it hard to trust the helper right away. Yang and Kleinman (2008) suggest that this cultural mismatch may be responsible for the fact that Asian American clients are underserved and have high attrition rates in therapy. One of the possible reasons that Asian Americans are slow to disclose is related to “face.” Saving face means monitoring one’s words so as not to put oneself or one’s family in a bad light. If an Asian American is afraid of losing face by disclosing family secrets and would feel a sense of shame and betrayal in doing so, the helping process is stymied until trust is developed (Zane & Ku, 2014). Zane and Ku first suggest directly addressing the issue of losing face with the client as well as discussing the associated sense of shame. Second, they recommend using “face saving” strate- gies to win over the client. These may include affirming that self-disclosure is a natural part of the helping process and reframing the client/helper relationship as the exploration of problem solving rather than personal therapy. In any case, trust may develop much more slowly when a client is concerned with face. Zane and Ku say that concern for face is found not only in Asian Americans but also in other groups, including Midwestern farmers. FOLLOWING THE NONJUDGMENTAL LISTENING CYCLE THROUGH THE SKILL OF PARA- PHRASING Figure 4.2 shows the nonjudgmental listening cycle on a single topic in the first few minutes of a session. Later in the book, you will see the next steps, which include reflecting feelings, advanced reflecting, challenging, and summarizing. A general guideline for the beginning of the session is to use a sequence of invitational and reflect- ing skills from an initial open question to encouragers to paraphrasing. This slowly allows the client to open up and discuss more difficult issues. In this book, I use the term topic to refer to a specific subject that the client is discussing. Each topic is represented by a single circle, as shown in Figure 4.2. It is quite possible to discuss more than one topic in a given session. For example, a client might, in the same hour, discuss the topic of her relationships, the topic of her problems at work, and the topic of her family. These would be represented by a sequence of circles, each on a different topic. As a beginner, you might have the tendency to rush a client through a topic without discussing all the facts, feelings, and meanings, going on to the next issue and then the next. Beginning helpers generally have more and smaller circles because they cover a greater number of topics in less depth. More experienced helpers instead take time to ask open questions, check out key facts with closed questions, and paraphrase to make sure they understand the story. They explore every nook and cranny. Experienced helpers generally have fewer and bigger circles because they explore a smaller number of topics Chapter 4 • Reflecting Skills: Paraphrasing 93 Door Opener (start) Paraphrase Minimal Encourager Closed Question One Topic in the Story Paraphrase Open Question Minimal Encourager FIGURE 4.2 A Typical Sequence of Helper Responses in the First Few Minutes of a Session in more depth. They are more patient, allowing the client to go down every alleyway. Beginning helpers become impatient at this point. They would like to do something to alleviate the client’s discomfort and to solve the problem, and they quickly find them- selves at the end of a topic. As you practice, see for yourself how a gradual warm-up and staying with a topic can lead to deeper sessions. The first steps in the nonjudgmental listening cycle are shown in Figure 4.2. In the following conversation between a child and a school counselor, we will follow that sequence so you can see how a paraphrase fits into the exploration of a topic. Later, you will have a chance to identify these elements and to practice paraphrasing along with the invitational skills you have learned thus far. Chris: “The teacher said I have to tell you what happened yesterday.” sChool Counselor: “Do you want to give me an idea about what went on?” (encourager) Chris: “Well, I was walking around the playground, not really look- ing at anything, you know? I was bored.” sChool Counselor: “Yes; um-hmm.” (encouragers) Chris: “And then these three second graders came around the corner and started calling me names. I said, ‘Shut up.’ And later I punched William in the nose. It was bleeding, and he was cry- ing, but I didn’t care because he’s mean.” sChool Counselor: “Can you tell me more about what you mean when you said, you didn’t care that William was hurt?” (open question) Chris: “Well, I didn’t mean to hurt him, but I am not saying ‘Sorry’ because he started it.” sChool Counselor: “So, you got into a fight with William. He got hurt but you don’t think it was your fault.” (paraphrase) Can you see how the counselor used encouragers and an open question before paraphrasing? These invitational and opening skills allow more of the story to come out. 94 Chapter 4 • Reflecting Skills: Paraphrasing Notice that the counselor’s paraphrase is not just a restatement of what Chris said. It is a summary of the child’s story, giving its essence in a nonjudgmental way. The paraphrase is brief and therefore does not interrupt the child unduly as he talks. It does not take sides by supporting one version of the story, but recognizes instead the child’s perspective. It also identifies the child’s thoughts, “You don’t think it was your fault.” Let us now look at some of the challenges in using paraphrases. MyCounselingLab Video Exercise 4.1 Paraphrasing COMMON PROBLEMS IN PARAPHRASING Simply Reciting the Facts A common mistake (Corey & Corey, 20106; Corey, Corey, & Corey, 2010) is to simply list the major points the client has made in exactly the same way that the client said them. This is sometimes called parroting. The best way to illustrate this mistake is to take an example from Paulina and Zach’s dialogue in the earlier section “How to Paraphrase.” Here is a statement by Zach (the client) followed by two alternative paraphrases by Paulina (the helper). The first one is copied from the actual dialogue, and the second is a less effective paraphrase that merely recites the facts. ZaCh: “I guess this atmosphere isn’t new. But it never really affected me before. I tried to stay out of all the politics and the complaining in the teachers’ lounge. This year, all the teachers do is gripe. At meetings and after school, somebody is always talking about it.” Paulina 1: “So for the first time, it’s getting to you and it’s hard to escape the gos- siping.” (paraphrase) Paulina 2: “So the atmosphere isn’t new. You tried to stay out of the politics and the complaining that all the teachers are doing. Everywhere you go, somebody is talking about it.” Besides the fact that this last reflection is longer and tends to parrot the client’s exact words, the helper would be merely reflecting the content without getting to the important point that now, for the first time, the situation is bothering Zach and he can’t seem to get away from it. Difficulty Listening to the Story Because of “Noise” Another problem is caused by distractions. Of course, helpers must select quiet environ- ments so that listening is not impaired by external noises. However, the biggest distrac- tions come from “mental noise.” You cannot grasp the client’s message when you are listening to your own thoughts. Helpers sometimes experience mental noise when the client’s story evokes a personal memory of a similar situation. Internal noise may interrupt because the client is expressing something that you find distasteful or that evokes moral outrage. When you realize that you have lost track of the client’s story because of mental noise, stop and request that the client repeat the last part of the story again. Then respond with an appropriate paraphrase. Even though it is a distraction, it is better to stay on track than to miss the key elements of the story. If you find a client boring, morally repugnant, Chapter 4 • Reflecting Skills: Paraphrasing 95 sexually attractive, or pitiful, you are probably going to have difficulty really listening. You can start now to identify those issues that trigger mental noise and discuss them or write about them in your journal. Worrying about What to Say Next Worrying about what to say next is perhaps the biggest source of mental noise. Rather than responding to the client’s statement, the helper is sidetracked into thinking about what his or her response ought to be. This is especially true when you are being observed by others, such as your instructor. One thing to remember is that almost everyone becomes less anxious as time goes on. Practicing in front of others may expose your weaknesses, but it is also the best way to get feedback and to learn. Still, there are a few things you can do to cope with this kind of worry. The first antidote is to shift your attention to the client. Because it is difficult to do two things simultaneously, when you become focused on your own thoughts, you lose track of the client’s story. This happens to everyone at some time. Your mind will go blank! The remedy is to refocus your attention keenly on the client’s story. A second helpful hint is to remember that your job is to respond to the last thing the client said, rather than stimulate a new topic or ask a question. This will lead to greater exploration of the topic rather than shifting topics. If you cannot remember the client’s last statement, ask him or her to repeat it. Both of these suggestions share a common idea. As the helper, you must be present; when you are thinking about yourself and what you are going to do, your focus shifts away from what the client is saying. In Chapter 2, we identified presence as a relationship enhancer. Carl Rogers (see Brodley, 2000) used the term and defined it as being com- pletely absorbed in the relationship in the present moment. Rogers felt that presence itself is healing (Baldwin, 1987). Certainly being looked at and listened to tells the client that he or she is important in your eyes and conveys an acceptance that transcends words. Being Judgmental and Taking the Client’s Side Earlier, we tried to distinguish paraphrasing from other behaviors and we noted that it is not support but a nonjudgmental reflection of the facts. Still, beginners are often too quick to take the client’s side and to agree with the client’s judgment that the problem is caused by other people. You may think you are being supportive, but you may be accepting the client’s version of the story prematurely. For example: raChel (Client): “At work, the other women ignore me because I don’t go drinking with them on Friday nights, and they think I am the boss’s favorite. The boss always compliments me on my work. I can’t help it if they don’t work as hard as I do.” santiago (helPer): “Things aren’t going very well at the job because your co- workers mistreat you.” (judgmental paraphrase) With a judgmental paraphrase, the helper has essentially agreed that the co-workers are at fault. Shifting the blame to other people will not widen the client’s perspective or help the client change his or her behavior. The following is a nonjudgmental response to Rachel’s problem: santiago: “So you see yourself as a hard worker, but you think your co-workers may be critical of you because of your dedication.” 96 Chapter 4 • Reflecting Skills: Paraphrasing Here Santiago is subtly telling Rachel that his mind is open about who is causing the problem and that he hears Rachel’s perception. It is possible that her co-workers have no such thoughts. Being Judgmental of the Client This error is the flip side of taking the client’s side. It often occurs when the helper feels strongly that the client should correct his or her behavior. This is an error, especially in the early sessions, because it will undermine the trust that has been building. raChel: “At work, the other women ignore me because I don’t go drinking with them on Friday nights, and they think I am the boss’s favorite. The boss always compliments me on my work. I can’t help it if they don’t work as hard as I do.” santiago: “You’re having trouble at work because you haven’t been a team player.” (judgmental paraphrase) Sometimes helpers show a judgmental attitude when they try to sneak in a little advice. In the previous example, there is a hidden message, “If you want to be liked, be more a part of the team.” A nonjudgmental response would be: santiago: “So you’re saying that your boss appreciates you, but in your mind, your co-workers don’t accept you.” (nonjudgmental paraphrase) In summary, the purpose of a paraphrase is to make sure that you understand the facts and the client’s thoughts rather than to supply a solution, support the client’s version of the situation, or place blame. MyCounselingLab Application Exercise 4.2 The Skill of Paraphrasing MyCounselingLab Application Exercise 4.3 Making Your Paraphrases Nonjudgmental Turning a Paraphrase into a Question As we mentioned earlier questioning makes a demand on the client that he or she must address, and although a paraphrase slows the client down, it does not stop the flow of conversations. Here are two examples, one of a paraphrase and the other of a paraphrase and a question: helPer a: (Paraphrasing) “So, your stepmother and your dad divorced when you were 6 and then remarried when you were 12.” Client: “And it’s been up and down ever since.” helPer B: (Paraphrasing then questioning) “So your stepmother and your dad divorced when you were 6 and then remarried when you were 12. What happened then?” If you were the client in the second example, would you react to the paraphrase or respond to the question? Generally, when the helper tacks on a question, the client feels obligated to follow it. It is better to let the client respond to the paraphrase. A subtle point the client can talk about career helper responses as indicated in the Category column goals from childhood to the present. all of The nonjudgmental listening cycle is a way of which involve feeding back to the client a distilled ver. way. . Wait until you have a firm grasp of the important details and thoughts. derstanding and even push the client to examine his or her version of the story more objectively. the helper will try to demonstrate all of Exercise 1: Practice Using Invitational Skills. you learn Paraphrasing may seem like a very minor skill. The helper should review the “Quick Tips: aphrasing to record the helper’s responses or may Paraphrasing” section while the client takes a moment simply write the responses on lined paper. them. and then building up to a but encapsulates the essence in a slightly different paraphrase when the helper has enough data to reflect. the paraphrase should be non. not implying any advice or taking sides. paraphrase the client’s thoughts and intentions as well as the basic facts. The observer may use the Feedback Checklist: Par- server. use encouragers liberally to invite the client to supply essential information. The first part of the sequence begins with an paraphrase so that it does not mimic the client’s words open question. • Remain present by responding to the last thing the client said. QUICK TIPS: PARAPHRASING • Don’t paraphrase too early. and then compress them into a short paraphrase. Chapter 4 • Reflecting Skills: Paraphrasing 97 here is that the paraphrase should be made as a statement rather than allowing your voice to rise at the end of the sentence. and Paraphrasing paraphrase once or twice during the practice session. • Don’t repeat the client’s exact words. Give a condensed version in slightly different words. it is important to derstand the facts and the client’s thoughts. At the same time. Just like learning keyboarding skills. Following to think about a story that is often told in his or her the session. divide into helper. encouragers. ask the client to repeat his or her last statement and try another paraphrase. The challenge is to construct the learning. At each stage. A good paraphrase can convey un. client. In the following chapters. and ob. • Early on in the conversation. understanding how to sequence the skills you are sion of the story. The exercise of the checklist. telling the client that you really don’t understand what has been said and you want clarification. Exercises GROUP EXERCISES begins with the client relating his or her story. • If you get lost. • When you can. all three participants join in labeling the family. the opening and invitational skills first and then try to Opening Skills. into words. tion by adding more advanced skills to the nonjudg- Good paraphrases let a client know that you really un. As the client talks. we will build on this founda- judgmental. but it is how to type each letter separately before putting them deceptively simple. Alternatively. mental listening cycle. In groups of three. but they practice the skills separately until you have mastered do not stifle the client’s attempts to get the story out. Doing that can turn a paraphrase into a question. Summary Paraphrasing is the first of three reflecting skills. floor first and describes a problem to person B. or P for paraphrase. of their partner’s statements because of noise such as quence in the nonjudgmental listening cycle?” “Were defensiveness. who This exercise asks students to replace questions with en- then paraphrases what person A has said. fies how many times the helper’s voice rises at the end When person B holds the floor. CQ for closed question. One member writes “The Floor” on a piece of paper. Whoever is holding the floor is the only Earlier. The client’s topic is “a brief history accurate (distilled version with correct and important of my life. & Blumberg. were questions the primary tools of the helper?” Stanley. If person couragers and paraphrases and to take turns as helper. _________________________________ _____________________________ ___________________________ 9. Try to par- aphrase the facts of the stories as well as unspoken Exercise 3: Give Me the Floor thoughts. Exercise 2: Replacing Questions with In this version of the program. “Were Couples often have trouble hearing a paraphrasing the helper’s interventions in line with the expected se. words than the client did. then person A passes the floor to person B. and the cycle continues until time is called. students form Encouragers and Paraphrases groups of three. _________________________________ _____________________________ The group then considers the questions. _________________________________ _____________________________ ___________________________ 2.98 Chapter 4 • Reflecting Skills: Paraphrasing Feedback Checklist: Paraphrasing Observer Name: _______ Helper Name: _______ During the session. person C listens and of a sentence (which is a nonverbal cue that a question paraphrases. the client’s feelings for now.” and the helper’s job is to use encouragers and information). Person A holds the and trying instead to use encouragers and paraphrases. _________________________________ _____________________________ ___________________________ 4. the observer reads the helper’s statements aloud and the group categorizes the responses with the following symbols: E for an encourager (either door opener or minimal encourager). _________________________________ _____________________________ ___________________________ 6. leave out tional approach to improving couples’ communication. _________________________________ _____________________________ ___________________________ 7. After each helper/client conversation. The observer If the paraphrase is not 100% accurate. and observer. person A contin- notes any questions that the helper asks and also identi- ues to talk until person B gives an accurate paraphrase. _________________________________ _____________________________ ___________________________ 8. Category Helper Response Client Feedback ___________________________ 1. paraphrases but not questions of any type. Was it difficult to withhold questioning? What is SMALL GROUP DISCUSSIONS the difference between “Are you and your mother not getting along?” and “I’m picking up that things between Discussion 1: Constructing Paraphrases you and your mother are rather strained”? Following are parts of three clients’ stories. Compare your paraphrases . we talked about reducing the use of questions one in the group who is speaking. the class discusses the activity. _________________________________ _____________________________ ___________________________ 5. In your responses. called the Speaker/Listener technique (Markman. A feels that the paraphrase by person B is completely client. 2010). One of the techniques used in the pro- paraphrases and encouragers the most common or gram. After everyone has had a chance to be the helper and receive feedback. _________________________________ _____________________________ ___________________________ 3. _________________________________ _____________________________ ___________________________ 10. See whether you can use slightly different The PREP program is a well-known psychoeduca. the observer records the helper’s responses verbatim on a sheet of paper. is being asked). OQ for open question. allows the speaker to contin- ue talking until the listener gives an accurate paraphrase. paraphrase the content of the following television program with the sound off to see whether . • Did you find it hard to leave out the feelings? Is _____ there a time for listening to the facts of a story 4. But here’s 1. My friend wants me to go into business with him. But how can I be sure?” Feedback 3.’ I believe there is only one person out there for everyone.” ‘the one. “I was recently laid off from my job as vice presi. “There seems to suddenly be distance between After you have read and responded to these you and your friend and the fact that you are short stories. He 2. you know. Did you get the 1. We met last week. but I guess she wouldn’t be seeing me if every- wasn’t really my fault. and I don’t feel ready to move on. rather than just ent’s thoughts. answer the following questions for drinking is part of that. “My best friend and I are both seniors and head- just walked away. She looks down on me because true. SATs are over and I 2. I don’t know too much about her. I was forced to follow the rules. part of you thinks this is a great thing and at me that feels that I gave my heart and soul to that the same time you are thinking about the fact that company. but it feels like being fired. It’s crucial information in your paraphrase? the best thing that’s ever happened to me. any differences in your approaches. everything I find can’t even talk anymore because she’s so down out about her makes me feel more like she is on me. _____ What part of the skill do you need to work on? ______ ___________________________ WRITTEN EXERCISES Exercise 1: Making Your Paraphrases HOMEWORK Nonjudgmental Homework 1: Stop the Show and Paraphrase The following client statements test your ability to be nonjudgmental—neither agreeing nor criticizing. and I couldn’t do anything thing were fine between her and her husband.” 2. Listen carefully using invitational and opening indicate that you were taking sides? skills before paraphrasing. “So. They have your paraphrases get the main points without judging farmed out my work to my subordinates. 2. Yours might be slightly different. But since then. he didn’t say much. It ship. Supply a distilled version of the facts and the cli- including the client’s thoughts. We only I started drinking. _____ • How well were you able to distill the story. “I’ve just started a relationship with a co-worker. low and indicate with a check mark whether you have ing nonjudgmental? Why? been able to: • What might you be tempted to say that would 1. Chapter 4 • Reflecting Skills: Paraphrasing 99 with those of others in your small group. On a In the last chapter. She says I’m an alcoholic.” yourself: • Did any of these stories challenge your ability to SELF-ASSESSMENT be nonjudgmental? Now that you have had the opportunity to practice • What feelings were aroused in you? paraphrasing. When I told him. I don’t want on the trip. _____ without reflecting the feelings? 5. “I had to tell one of my co-workers he couldn’t go the thing: She’s married and has a kid. but there is a big part of 1. _____ reiterating the facts? 3. and discuss client statements without taking sides. Do layoff. look at the aspects of paraphrasing be- • Which one was the most challenging to remain. He had not put in enough time with to be the kind of person who breaks up a relation- the company. Make paraphrases that are nonjudgmental. Make the paraphrase in slightly different words. it was suggested that you watch a separate sheet.” you are potentially breaking up her family. They said it was a statements above.” ing off to college next year. Respond to the last thing the client said. “I met this woman.” about it. many of the clients? whom were not let go. Below are two suggested paraphrases for the client dent in charge of purchasing. She seems too good to be am partying a lot. 100 Chapter 4 • Reflecting Skills: Paraphrasing you could guess the emotional content based on JOURNAL STARTERS body language alone. Using a remote control. watch a television program where one individual is speaking. and then press the mute health and you encounter a client who smokes. let us say you value of minutes of the dialogue. This activity can provide anxiety-free practice Do you think you would have trouble listening to the because you can turn the “client” off while you are client’s story? Do you think that clients pick up on non- paraphrasing. perhaps the client has a different sexual orientation. and takes other substantial health risks. verbal indicators of disapproval? . tences. See whether you can paraphrase the content excessively. Or of the preceding 2–3 minutes in a couple of brief sen. and An interview on a news program works well for this think about how you might react to a client who holds activity. For example. listen to a couple the opposite value. Think about a strong personal value you hold. drinks button. For this assignment. you will be able to: • Self-Assessment • Homework 5. Daniel Goleman. • Journal Starters 5. As an example. It might even save your life. and how he or she views the world (Izard. the author of Emotional Intelligence (2006a). CHAPTER 5 Reflecting Skills: Reflecting Feelings The Importance of Understanding Emotions The Skill of Reflecting Feelings • The Benefits of Reflecting Feelings • Why It Is Difficult to Reflect Feelings How to Reflect Feelings • Step 1: Identifying the Feeling or Feelings • Step 2: Putting the Emotion into Words Common Problems in Reflecting Feelings and Their Antidotes • Asking the Client. describes an incident in Iraq where a group of soldiers 101 .” 5. current mental state. 2009). behavior.3 Identify and avoid major problems in reflecting feelings. “How Did You Feel?” or “How Did That Make You Feel?” • Waiting Too Long to Reflect • Making Your Reflection a Question • Combining a Reflection and a Question: The Error of the Compound Response • Focusing on Other People • Interrupting Too Soon and Letting the Client Talk Too Long • Confusing the Words Feel and Think • Missing the Mark: Overshooting and Undershooting • Letting Your Reflecting Statements Go On Too Long Summary Exercises LEARNING OUTCOMES • Group Exercises • Written Exercises By the end of this chapter.2 Reflect feelings using the algorithm “You feel ____.1 Identify feelings in a client’s story. THE IMPORTANCE OF UNDERSTANDING EMOTIONS Understanding another person’s emotions helps us better understand the whole person because emotions give a window into motivation. “Yes. however.” The client’s response may be one of surprise.” and looks down. . I guess I am.102 Chapter 5 • Reflecting Skills: Reflecting Feelings who were distributing relief supplies were surrounded by an angry mob of people who thought the soldiers were there to arrest one of the villagers.” Because a reflection is done in a nonevaluative manner. “I can tell that you are terribly angry about that. The emoticon is an unfortunate attempt to communicate the emotions behind a text-based message or e-mail that cannot be communicated by the words alone. was able to transmit the message through nonverbal means that the soldiers were nonthreatening and friendly. Let us sup- pose that the helper makes a reflection such as. There is little doubt that helpers must possess this emotional intelligence in the same way that an engineer must have the intellectual ability to understand higher mathematics. For one thing. 2003). and smile. Reflecting feelings involves listening and then expressing in one’s own words the emotions stated or implied by the client. Many clients under- disclose. Here is an example of how clients may not openly express a feeling but it is implicit in the message. Lieutenant Colonel Christopher Hughes. 1990. it communicates understanding of feelings that the client may not be conscious of and that the client may even think he or she has no right to feel. Reflecting feelings shows the client that you understand the deeper message. The ability to recognize and express another person’s feelings can be learned. Emotional intelligence has been described as the “ability to monitor one’s own and others’ feelings and emotions. and it has power to deepen the relationship and allow the client to release his or her emotional burdens. The client’s feelings (shock. The Benefits of Reflecting Feelings A number of therapeutic events occur when feelings are reflected. 1996). “I just lost my job. This time. point their guns at the ground. Yet emotional intelligence can be developed just as mathematical skills can be enhanced (Goleman. but not emo- tionally smart. Using emotional intelligence. THE SKILL OF REFLECTING FEELINGS Being able to recognize emotions in others and convey that you understand their feelings is a special ability. Goleman’s story is in support of his thesis that there is a kind of intelligence that is quite different from what IQ tests capture (Goleman. 189). The officer. These emo- tions may be hidden in the content of the story or in the nonverbal responses of the cli- ent. the officer in charge ordered his men to kneel. The client says. and to use this information to guide one’s thinking and actions” (Salovey & Mayer. embarrassment) are beneath the surface of the nonverbals and the description of the event. the cli- ent becomes more keenly aware of the emotions surrounding a topic. and any method or technique that allows them to more fully experience and express their feelings is thought to be therapeutic (Young & Bemak. p. all of which defused the situation without anyone being hurt. The building block of reflecting feelings involves essentially the same technique as paraphrasing. to discriminate among them. it might have been a logical move. hurt. 2003). This skill of reflecting feelings tells your client that you recognize the emotional background of the story. the focus is on emo- tions rather than on content and thoughts. If the soldiers had attempted to explain their mission to the villagers. He ran the gamut. This can be frustrating when the client does not seem to respond to your reflections. by the end of the first session. Tsai. A beginning helper who is able to accurately reflect feelings can provide support and understanding without any other tools.” can help to normalize what the client perceives as a deeply conflicting emotional experience. East Indi- ans. 2009. When a client’s fam- ily background or culture is constantly sending the message “Don’t let anyone see your feelings. In addition. For example. Somehow we can accept our feelings as normal reactions when we bring them to the surface and sort them out. emotions. on an emotional roller coaster. a conference was held in Amsterdam on the “underexpression” of emotions as a mental health issue in Europe. Nothing transmits nonjudgmental understanding more completely. from confusion to shock to disgust to affection to rage. “You feel so betrayed. & McCoy. 2006). Untangling the emotional knots seems to be healing even if no real action is taken. Chapter 5 • Reflecting Skills: Reflecting Feelings 103 Reflecting feelings also brings the client to deeper and deeper levels of self-disclosure. even a small crack in the voice may be quite a strong emotional sign and should be valued as a deep disclosure. .” the job of helping is more difficult because the helper can only guess what the client is experiencing. Even if the reflection is not quite accurate. one must learn to become sensitive to the unexpressed and listen with the “third ear.” Even though there were still con- flicting feelings. This is why this technique. perhaps more deeply felt. for example. the client felt more in control simply because he had sorted out his feelings and labeled them. reflecting feelings brings genuine relief from emotional pressure. For some clients. Finally. family back- ground. and even then expression may seem faint by comparison. the famous analyst. p. many individuals with Appalachian and English roots may tend to express emotions in very subtle ways. has gained such wide usage. “The voice that speaks in him speaks low but he who listens with a third ear. Some Native Americans. but it is not an easy one to learn. and culture affect the way we express them (Matsumoto. and Europeans may come from cultures where open expression of feelings is rude or is a sign of weakness. for example. Reflecting feel- ings by saying. Levenson. hears also what is expressed almost noiselessly. An accurate reflection focuses the client on emotions and teaches him or her to become aware of and to report feelings. 165). claimed that in order to hear deeply. Why It Is Difficult to Reflect Feelings Reflecting feelings is one of the most valuable tools of the helper. an accurate reflection of feelings has the almost magical power to deepen the relationship between client and helper. the client will provide a correction that is more on target. Reik said. the client whose wife had left him but she would not say why. Take. One reason that feelings may be hard to hear is that our upbringing. Getting to feelings may require more time and effort. For instance. and yet you still feel a bond of affec- tion. which originated in the client-centered tradition of Carl Rogers (1961). It stimulates the client to express other. what is said pianissimo” (Reik. 1968. He came for help. It taps the enormous healing properties of the therapeutic relationship. though. Theodore Reik. Experiencing all these conflicting emotions in one session can make anyone feel “crazy. crying about the lost relationship.” Refer- ring to the fact that the client may not even be aware of these feelings. Imagine how he or she feels in this situation. Take a look at the feeling words in Table 5. Consequently. practicing with classmates will be more realistic as you must pay attention to the nonverbal expressions as well as the words. When feelings leak out. the client may be better able to own and accept those emotions. 1997. women. In other words. You can learn the first step in your practice sessions as you listen intently to the client. In my experience. become the client and think about how he or she might feel. reflecting feelings involves two steps. and then it will be easier to put them into words. & Tsao.1 to see whether another word is closer to what the client seems to be expressing. do not try to think about how you would feel in this situa- tion. Later in this chapter you will find more opportunities to identify feelings in writing before you try to actually reflect them to a person. Although this sounds easier than the first step. the second step is articulating the underlying emotions that you detect in his or her statements. a man may feel weak or out of control. Steinfeldt. and then first try to label the feeling. Madrid & Kantor. 2012). taking into account all the facts and also thinking about what you know about the client’s personality and history. Feminine socialization. the next step is to put your understanding of the emotion into words. 1998. Take some time to practice identifying feelings. that are not considered feminine. more than women. it may be difficult for some men to openly display feelings in the helping relationship and in their other relationships. . 2009). too. Emotional health means recognizing one’s own feelings and appropriately expressing them. The first step is identifying the client’s feelings. 2010). HOW TO REFLECT FEELINGS Step 1: Identifying the Feeling or Feelings Like paraphrasing. Men. are asked to repress certain emotions. the two steps to reflecting feelings (identifying and expressing in words) are often learned independently.104 Chapter 5 • Reflecting Skills: Reflecting Feelings CULTURE CHECK Gender Gender also has a bearing on emotional expression. is more relationship-oriented and is more likely to encourage telling another person how you feel (Kring & Gordon. too. Do not forget that nonverbals are major clues to the client’s feel- ing state. instead. Step 2: Putting the Emotion into Words Once you have identified the emotion the client is feeling. However. it is actually more difficult because you must accurately express emotions in words. such as anger or even confidence. The best way to do this is to think of yourself as the client. When a helper sees a cultural handicap to emotional expression and helps the client recognize what is being suppressed. have been trained to “never let them see you sweat” and to believe that “big boys don’t cry” (Kottler. Although reading and responding to vignettes in this book will be a good train- ing exercise. even on Facebook and Twitter (Parkins. LaFollette. The next section provides a formulaic way of reflecting the feelings you have recognized. Identifying feelings seems to be a precursor to actually reflecting them. on the other hand. Wong. Chapter 5 • Reflecting Skills: Reflecting Feelings 105 TABLE 5. saddened downhearted dejected low melancholy despondent blue miserable gloomy dismayed grieved sorrowful Anger annoyed angry furious irritated mad outraged miffed resentful enraged ticked indignant bitter antagonistic incensed fuming exasperated Guilt and self-hostility responsible mad at yourself guilty at fault self-reproachful remorseful culpable contrite blameworthy Shame chagrined embarrassed mortified disgraced ashamed humiliated Fear apprehensive anxious alarmed uneasy scared frightened wary worried terrified restless afraid dreading concerned nervous panicked insecure unnerved on edge Disgust offended turned off repulsed put off disgusted repugnant averse abhorring repelled appalled sickened revolted nauseated loathing revulsive (continued) .1 Feeling Words Feeling Mild Moderate Strong Joy at ease glad overjoyed pleased enjoying jubilant satisfied happy elated content peaceful thrilled delighted Sadness down glum depressed sad. think about what the reflection of feelings brings to the client’s story and to the relationship.106 Chapter 5 • Reflecting Skills: Reflecting Feelings TABLE 5. “You felt shocked.” (simple reflection of feelings) Or.” Abdi (helper): “It must have been quite a shock.1 (continued) Feeling Mild Moderate Strong Contempt disliking disapproving disdainful disrespect scornful hateful Surprise perplexed amazed awed puzzled bewildered shocked stumped baffled in wonder startled surprised stunned astounded astonished Interest/excitement bored amused excited interested curious marvel inspired in wonder engaged stimulated fascinated intrigued Feelings Associated with Thoughts about Power and Confidence Feelings of Weakness unimportant inadequate worthless awkward incompetent helpless unsure inept dependent confused powerless impotent weak discouraged Feelings of Strength able confident self-assured capable strong potent authoritative powerful secure optimistic competent Feelings of General or Nonspecific Distress upset frustrated pained concerned disturbed miserable troubled perturbed anguished bothered distressed agitated uneasy restless overwhelmed A FORMULA FOR REFLECTING FEELINGS Statements that reflect feelings take two forms. The simple version of reflecting feelings is a helper statement with the structure “You feel ____.” . Joseph (Client): “You can imagine how everyone in the family reacted when Grandpa got married 6 months after Grandma’s death.” As you look at the following interactions between helper and client. The third column shows a way of coding the response when you practice in class or in your transcripts.” Abdi: “You felt really disappointed when you found out he had apparently gotten over her death so quickly. paraphrase. including examples of simple reflection. the skills we have presented in this chapter are illustrated. when you understand the connection between feeling and content. As the conversation between Joseph and Abdi continues. and a combined form. TABLE 5. you add a paraphrase to the reflection of feeling.2. Sometimes it is sufficient to reflect the feeling using the simple “You feel _____.” The reflection of feeling “You felt really disappointed” is connected to the para- phrase “when you found out he had apparently gotten over her death so quickly. Abdi begins to understand and articulate the reason for Joseph’s resentment and anger: Joseph: “I was floored.” There is nothing wrong with a simple paraphrase or a simple reflection of feeling. But.” Can you see that Abdi’s statement is essentially a mirror image of Joseph’s. containing both a paraphrase and a feeling? MyCounselingLab Application Exercise 5. In other words. The second blank explains the feeling by paraphrasing the content while. I had always thought that they had the perfect marriage. In Table 5. a helper may then use a reflection of feelings that connects emotions and content. The format of this combination response is “You feel _____ when _____. at the same time. Counting reflections of feeling and paraphrases will give you a rough idea about how deeply the session is reaching.1 Practice in Identifying Specific Feelings Not every reflection has to be connected to a paraphrase.2 Skills in This Chapter and How to Code Them How to Code Your Classroom Practice Skill Example or Transcripts Reflecting a Single Feeling You felt angry ROF You felt foolish You were shocked Paraphrase (facts/thoughts/ Someone stole your wallet P events) The car hit the mailbox It was not what you had expected Reflecting a Feeling and You felt angry when you found out who stole your wallet ROF + P Content You felt foolish when you hit the mailbox with your car You were shocked when your expectations were not met . you can then utilize the combined form because it shows the client you recognize the connection between the feeling and what happened. 1987).” The first blank is a reflection of the client’s feeling. showing the connection between the feeling and the content (Carkhuff. Chapter 5 • Reflecting Skills: Reflecting Feelings 107 CONNECTING FEELINGS AND CONTENT After one or two reflections of feeling. In English. Somewhat troubled about the relationship when there are both highs and lows.1. contempt. and those of your classmates may vary because in a written example we cannot hear the client’s voice tone or see body language to clue us in on how strong her emotions are. disgust.1.1 categorizes feelings in a way that will help you recognize the fundamental emo- tions. intentions. They are joy. 2003). and violet. The primary emotions are listed top to bottom on the left-hand side of Table 5. 2013). Use qualifiers like a little or very as needed to try to get the right shade of emotion. I had a lot to do that day. we went to the drugstore. producing a completely unique hue. your answers. 1889). • Try to make a connection between what Teresa is feeling and the content of her story: Teresa feels _____ (emotion) when _____ (reason you identify from content). green. and interest/excitement. we have at least 3. . Try to pinpoint her feel- ings using the words in Table 5.000 words that describe feelings (Elert. and facts that she relates. answering the related questions and comparing your responses with those of your classmates. Remember that the content includes thoughts. I give some possible paraphrases and reflections of feelings. All because he wanted this particular kind of candy. guilt and self-hostility. Youngstrom & Green. “What can you do?” IMPROVING YOUR FEELING VOCABULARY To learn the first step in reflecting feelings— identifying feelings—it is important to recognize that emotions have many shades and variations. My answers. 1977. Table 5. blue. then we went to the grocery. shame. He’s a lot of fun most of the time. he is a pain! What can you do?” • What might Teresa be feeling? Identify as many emotions as possible. and your job is to identify the particular shade. Teresa: “First. My Answers: Some of the things Teresa might be feeling and a brief paraphrase: 1. orange. sadness. Read the following excerpt from a client’s story and see whether you can respond as a professional helper would. And this wasn’t the first time this kind of thing had happened. We went to two or three other places and ended up in a bad part of town. People around the world can recognize facial expressions of these primary emotional states whether the people are from remote parts of New Guinea or New York City (Izard. They could be compared to the primary colors in the light spectrum: red. fear. At the end. These facial expressions appear to have deep biological roots (see Darwin. surprise. other times. indigo. Annoyed or irritated when she had to spend so much time on a minor errand 2. anger. A little angry and rather scared when she ended up in a bad part of town 3. yellow.108 Chapter 5 • Reflecting Skills: Reflecting Feelings STOP AND REFLECT Let us take another look at the distinction between content and feelings. • Why do you think Teresa does not express her feelings about the situation in this opening statement? • Try to summarize the content of Teresa’s message (not the feelings) in a single sentence. and perhaps hopeless when she says. The color analogy is used here because the emo- tions of clients are often mixed together. “Is this right?” The client then gives feedback that allows the helper to hone in on what the client is trying to say.” rather than. The outer ring shows the feeling words that the helper attempted to use but that did not hit the target. and feelings of general or nonspecific distress. “You were very angry. three other categories of emotions are indi- cated in the table: feelings of weakness. try reflecting more than one feeling such as. moder- ate. and strong). It is better to say. you can qualify your reflections by adding terms like a little. “You were filled with consternation. Sometimes though. Chapter 5 • Reflecting Skills: Reflecting Feelings 109 Despite this. feelings of strength.1. somewhat. Take a look at the emotion of fear in the table. much as colors can be described in terms of brightness. looking down. Across the top of Table 5. the more the client will sense that you understand his or her emotional experience.1 shows a helper’s attempts to target a client’s exact feeling of disappointment. Suppose you had a client who was a little nervous about an upcoming exam. and you reflected “terrified” in the Strong category. and avoiding eye contact when they don’t wish to dis- close their feelings. and very to zero in on the client’s exact feeling. the emotions are categorized by intensity (mild. In fact. “You are both excited and scared. In addition to the primary emotions. Figure 5. especially at the beginning of a client’s story. individuals have also learned through their culture to disguise their emotions by turning away. The more closely you express the exact shade of feeling. Normally. Can you see that the client would feel misunderstood? Besides finding precise words that suggest different intensities. The helper is like an artist who holds up the client’s feelings as a portrait and says.1 to familiarize yourself with a wider variety of feeling words. some clients do not have large feeling vocabularies or do not understand the culture-bound language of the helper. REFLECTING MULTIPLE FEELINGS INSTEAD OF STRUGGLING TO FIND THE RIGHT WORD When you cannot find the exact feeling the client is expressing.” Use Table 5. a client might say he or Sad Hurt Disappointed Annoyed Ashamed FIGURE 5.” For example. you may only be able to reflect these nonspecific emotional states before honing in on the target feelings. the helper should be trying to identify the specific feeling that a client is experiencing.1 Hitting the Emotional Target . when reflecting use multiple basic emotions rather than trying to find the exact English word. I believe that every helper should speak more than one language (consider Spanish).” For example.” In summary. you may find it easy to use opening and invitational skills and even paraphrase. She replied. After a few minutes. I met a pleasant older woman who was very relieved to meet someone who spoke her language. In this case. Instead of translation.” One of the clients being serviced. and I was the only person in the social services (maybe in the whole county) who spoke French. Table 5. Emotions connect us with others. stuff. For example. When I went to her home. and when our language ability only allows us to conduct business it can be lonely. If this is not possible and the client has some English fluency. it is important for the helper to be patient and take the process very slowly. “I can tell you were both embarrassed and angry. and we received a call from “Meals on Wheels. however. in reality many sim- ple communication problems could be alleviated if someone spoke the language of the client. This was the reason for her angry outburst. an elderly French woman.1 Reflecting Feelings Accurately CULTURE CHECK Language Helping someone in his or her own language is ideal because language is a basic element of one’s culture and allows the helper to quickly connect. and let the client’s response guide you to the exact feeling. “You feel close to your family and a sense of happiness when you are at home. you may wish to review the . and insight. “Tell him that is not the way you cook liver!” There was both a language problem and a cultural disconnect over cuisine. rather than jumping to conclusions about the meaning of the client’s words. So how can you help someone if you do not speak his or her language? Our first thought is.110 Chapter 5 • Reflecting Skills: Reflecting Feelings she is disappointed but you sense there might be more than just the feeling of sadness. recognize that not being able to express your feelings in another language is frustrating and isolating. why not use a translator? Many of us have tried to help clients using translation. was yelling and screaming at the one who had delivered her meal. the helper might say. One way to format your response is as follows: “You feel ______ and ________ when ______. Once I worked at a rural mental health clinic.” Clients frequently tell stories that contain multiple feelings.3 shows some emotion words from other languages that we do not have in English. MyCounselingLab Video Exercise 5. she indicated that there was a problem with communication— she just could not get her point across to the person who had delivered the food. At these times. when you find yourself confused about what the client is feeling. go ahead and reflect the two or three major feelings you suspect. Although this might seem like an isolated situation. Translation is sometimes unreliable because certain words just cannot be expressed in another language. “What would you like me to say to him?” I asked. you may find that some practice sessions seem to have gone by without a single reflection of feeling. Finally. try to refer the person to a helper who does speak the language. COMMON PROBLEMS IN REFLECTING FEELINGS AND THEIR ANTIDOTES In your practice sessions. translators say that it is difficult to accurately translate the English words nice. Next. boredom. a Ennui. Under each problem are some suggested ways of dealing with that issue (antidotes). or a small so cute you want to squeeze animal. Rest after working hard unwillingness to work or go out Litost Czech Anguish caused by seeing one’s Realizing one’s suffering makes own misery it worse Pena ajena Mexican Embarrassed by witnessing Seeing another person put Spanish someone else’s humiliation down Schadenfreude German Pleasure from someone else’s pain Someone else. or being frustrated with or pinch it. If you find that you are having dif- ficulty with one of these typical hurdles. also when you get someone frustrated and want to “shake” the person Zhalost Russian The positive feeling when someone When you feel hopeless and takes pity on you someone understands your situation following common problems. desperation to pining without a source make sense out of life Hiraeth Welsh Homesickness and sadness for those Reminiscing when parted who are lost or dead Saudade Portugese A feeling of sadness and A history of loss (also in fado incompleteness. Chapter 5 • Reflecting Skills: Reflecting Feelings 111 TABLE 5. 2013) Language Some Typical Events Emotion Word Source English Concept Associated with the Feeling Toska Russian Spiritual anguish. a yearning for music) something that may not return Ti vogleo bene Italian Sense of attachment to friends and A moment of closeness family Gezelligheid Dutch Coziness and togetherness of being Coming home and “cocooning” at home with loved ones Ei viitsi Estonian Feeling of mild laziness. a cry of the soul. Ishwar.3 Emotion Words without English Translation (Adapted from Elert. These problems and their solutions have been gathered from students and teachers who have experienced them. 2013. perhaps a competitor. . several things work going perfectly out at once Cafune Brazilian Running your fingers fondly through Spending time with someone Portugese someone’s hair Forelsket Norwegian The euphoria of falling in love Falling in love Gigil Filipino The feeling that something is Seeing a dog. let your instructor and fellow students know so that you can receive specific feedback during practice sessions. fails Lykke Danish Feeling that everything in life is Suddenly. a baby. Antidote: To avoid the mistake of waiting too long. Make full use of the written exercises in this chapter. and see whether you can pick out the feelings. Making Your Reflection a Question As we noted before. To make matters worse.” tori (Celper): “Are you feeling sad over the death of your mom and a sense of helplessness as you worry about your dad?” . particularly daytime dramas. A question demands that the client answer and it is rude not to respond to a direct question. and now my dad is in the hospital with pneumonia. the client can rarely pinpoint the feeling when asked. and I am running out of sick leave at my work. My mother died about 1 month ago. I’m here 2. “How Did You Feel?” or “How Did That Make You Feel?” When you are not able to reflect the client’s feeling. It is better to reflect inaccurately than never to reflect at all— be courageous. Go ahead and reflect even if you are not entirely cer- tain.112 Chapter 5 • Reflecting Skills: Reflecting Feelings Asking the Client. the client does not feel that you understand—empathy is lost. In the conversation that follows. we are giving the client the option of saying either “yes” or “no” instead of agreeing with our reflection or correcting it. Also. This is usually because we lack confidence in our reflection. That will force you to wait for feelings. and the conversation stalls. you may be tempted to ask the ques- tion. Eventually you will realize what the client is feeling and be able to reflect. the best advice is to use your opening skills. read the client statements. Give yourself a break from closed questioning for a while. work first on becoming profi- cient at identifying feelings. “How did you feel?” When you ask a closed question like this. the helper’s grasp of the client’s feeling is correct but she waters down her reflection by making it a question. Antidote: At such times. to see whether you can listen to people’s statements and then reflect their feelings immediately after they speak. The result is that the client does not have to expand her answer. XiomArA (Client): “I’ve had a very difficult time. Look at exercises in pre- vious chapters. Sometimes just lifting the voice at the end of the sentence is enough to turn a reflection into a question. clients respond better to statements because the helper’s making a statement does not interrupt the story as much as questioning does and it conveys under- standing. watch television shows. asking open questions and door openers to keep the client talking. You may want to reflect a feeling after 2–3 min- utes of listening if possible. but merely has to answer the question. utilize invitational skills to help elicit the client’s story. but don’t wait too long. When we ask a ques- tion.000 miles away. Another error is when we are able to reflect the client’s feeling but state it as a ques- tion. A common mistake is to wait 10–15 minutes before going on to reflect the client’s feelings. picking up on nonverbal as well as spoken cues. Waiting Too Long to Reflect In the opening minutes of the helping session. and it is best to keep bringing the conversation back to the client’s viewpoint and reaction to events even when he or she complains about others. Tell your practice partners to alert you when you use compound responses. and (4) talking about external factors such as the environment and other people. feelings. had the helper reflected the client’s feelings with a statement. Antidote: Practice boldly stating your reflections and then let the client react. Do you have any other close friends?” Client: “Yes. tell your fellow students and ask them to alert you when you do it. This is based on the assumption that the client cannot change others. Get in and get out. Rather than responding to a ques- tion. For example. as a beginning helper. This is called focusing on the client. Consider the following interchange between client and helper: Client: “I am sick and tired of my sister butting into my life when she knows I need to make my own decisions. However. there are four domains that can be a topic of discussion between helper and client: (1) talking about what is going on inside the client. a compound response confuses the client because he or she has been asked to do two things: respond to the reflection of feeling and answer the question. I have one other friend. The first domain. “It must be a very helpless feeling for you to be so far away when you are worried about your dad and still trying to deal with the sadness of your mom’s death. is where you. (2) talking about the helper. should focus most of your conversation. she could have said. the client can then go on to explore whatever issues seem important to him or her.” In this example. Focusing on Other People In a therapeutic conversation. In this example. and meanings. Combining a Reflection and a Question: The Error of the Compound Response In the early stages. the client goes on to tell you about another friend but fails to return to “feeling alone” that the helper reflected. the client. helper: “You feel really alone since your best friend moved away. Chapter 5 • Reflecting Skills: Reflecting Feelings 113 Can you see how a client might respond with a simple “yes” or “no”? The question suggests that the helper is confused.” . and it does not provide as many options to explore. try elimi- nating questions altogether for a while in your practice sessions and try to keep your reflections simple. it is tempting to add a question after the reflecting statement. (3) talking about the relationship between helper and client. If you have the tendency to turn statements into questions by raising your voice at the end of a sentence. We might call this a compound response. It is the domain of the client’s story including his or her thoughts. Antidote: If you have the tendency to add a question to your reflections.” Such a statement more effectively communicates understanding of the client’s situation and is more compassionate. but we are not that close. the main reason to stop the client is so that the helper does not miss crucial information. you are frustrated by her advice and look forward to being able to run your own life. and go over your responses and write Wrong Focus or WF next to such a response when you see it. and I are not as close as we used to be.” or “She must not be a really good friend. It seems like she has no time for me. When the client makes statements about other people. MyCounselingLab Application Exercise 5. Thus. the helper is tempted to focus on the client’s friend: Client: “My best friend.” If the helper wants the client to go deeper. Hope. . Interrupting really means asking questions too early in the session.” In the next example. Beginning helpers hesitate to interrupt. check to see what you are reflecting: the client’s thoughts and feelings. Antidote: To eliminate this problem. However.2 Keeping the Focus on the Client While Reflecting Feelings Interrupting Too Soon and Letting the Client Talk Too Long INTERRUPTING WITH QUESTIONS Interrupting too soon is a mistake and so is its opposite—letting the client talk too long without responding. Antidote: Eliminate questions for the time being and focus on understanding the client’s story by encouraging the client to talk. Antidote: The main cure for this error is to give yourself permission to stop clients and make reflections. it is not polite to interrupt. clients need para- phrases and reflections in order to know that their story is making sense to the helper. LETTING THE CLIENT TALK TOO LONG Now let us look at the error of letting the client talk too long.” One way to get off track is by paraphrasing in a judgmental way by focusing on the client’s friend: “She neglects you. record your practice sessions. or the issues of the third party. You may have to do this several times during a session. Some- times I think she just wants to neutralize our relationship. such a statement is unfair and perhaps inaccurate. espe- cially when the client is very talkative. like she doesn’t care. Questions interfere with the flow of the cli- ent’s story. Because some clients are talkative or anxious.114 Chapter 5 • Reflecting Skills: Reflecting Feelings helper: (Focusing on client through reflection of feeling and content) “So. they leave little room for the helper to reflect and the important issues just fly past.” Can you see how focus- ing on the other person can send a judgmental message about the friend? Because you do not know anything directly about the other person. he or she needs to keep attention centered on the client: “You miss the relationship you used to enjoy so much. In social situations. Chapter 5 • Reflecting Skills: Reflecting Feelings 115 Surprisingly, stopping and reflecting often serves to reassure clients that each aspect of their story is being heard in a systematic way. Here are two examples of ways that a helper politely requests a pause to verify that the right message is being received: helper: “Let me stop you here for a second and see if I understand correctly. You feel both angry and hurt that your friend is not spending time with you, but you are afraid to mention it because you are afraid that she may sim- ply terminate the friendship.” Or, helper: “I’m sorry to interrupt, but let me tell you what I know so far. You resent the fact that you and your friend don’t get together much anymore, but it is too scary to think about bringing it up.” A footnote to this discussion is that a helping relationship needs to have both peo- ple actively participating. By stopping the flow of the client’s story to catch up, the helper is becoming involved with the client, creating a connection and actively listening, rather than becoming a “listening post.” Confusing the Words Feel and Think When you watch a recording or view a transcript, you may believe you are reflecting feel- ings when you are actually paraphrasing because you are confusing the words feel and think. For example, when the client says, “I feel that I am making progress,” and you reflect, “You feel you are getting somewhere now,” you have made an accurate para- phrase but it is not a reflection of the feeling. Can you see that in this client’s statement, he or she might be feeling optimistic or confident but that “getting somewhere” is not a feeling? In this case, you might say to the client; “You think you are getting somewhere now and you feel more confident.” Thus, you have a paraphrase, “think you are getting somewhere,” and the reflection of feeling, “confident.” Antidote: This is where practice in identifying feelings can help. The alter-ego technique is one of the best methods for practicing this skill (see Group Exercise 1). Some people use feel instead of think a great deal in their daily conversations. If you have this tendency, try to become aware of it and change your feel to think whenever you can. By being specific about these two words, you are subtly teach- ing clients to recognize the differences between thoughts and feelings. Missing the Mark: Overshooting and Undershooting Has anyone ever said to you, “I know exactly how you feel”? Frequently, the person goes on to tell a story that really doesn’t match what you are saying at all. The feelings he or she experienced are not identical to yours. Helpers reflect the client’s feelings and thus avoid the error of comparing the helper’s situation to the client’s. Sometimes, though, when you reflect a client’s feeling you do not quite hit the bull’s-eye, and accurate reflect- ing is essential in developing rapport. Take a look at Table 5.4. The situation is that a client feels anxious (general emotion), and you are trying to reflect just the right amount 116 Chapter 5 • Reflecting Skills: Reflecting Feelings TABLE 5.4 Undershooting, Accurate Reflection, and Overshooting Accuracy of the Reflection Undershooting Accurate Reflection Overshooting Feeling Helper Reflected Concerned A little nervous Paralyzed with fear to accurately convey what he or she is feeling. In this case the client feels a little nervous about an upcoming job interview. Overshooting and undershooting are two common mistakes in reflecting feelings (Gordon, 1975). Overshooting means that the helper has reflected a feeling that is more intense than the one expressed by the client. Undershooting is reflecting a feeling that is too weak to adequately mirror the client’s emotion. Consider this client statement and three possible responses: Client: “Becky told Mrs. Gordon that I was not a fast worker, so she started giv- ing the most interesting work to Rolando instead of me.” helper: “You must have been mad enough to kill!” (overshooting) helper: “You were mildly annoyed.” (undershooting) helper: “You were mad.” (accurate intensity) Antidote: Overshooting and undershooting are beginners’ mistakes; this ten- dency normally corrects itself as you gain a larger feeling vocabulary. Like play- ing darts, you learn to hit the bull’s-eye more often when the client corrects you. In your practice sessions, note the difference between a polite “Yes, that’s right” and “Yes!” from the client when you hit the mark. If you undershoot, in your next statement, you can raise the intensity a notch, or you can lower it if you over- shoot. If your feeling vocabulary seems limited at present, study lists of feeling words like those in Table 5.1. You may also try using qualifiers such as a little angry, somewhat angry, or very angry to convey various shades of emotional intensity. Letting Your Reflecting Statements Go On Too Long Sometimes helpers tend to continue to reflect and paraphrase, not in sentences, but in chapters. When this happens, the important aspects of your response are lost in the verbi- age. The student thinks, “If I reflect several different things, one of them is bound to be right.” Antidote: Try thinking of reflecting as a form of gambling, like playing poker. You must wait until you think you understand and then you place your bet on a single brief reflection, paraphrase, or combination. If you are wrong, the client will correct you and proceed to describe the accurate feeling, helping you to find the bull’s-eye. You will become more aware of your tendency to make lengthy reflections when you record your sessions and transcribe them. You may notice that you are saying more than the client. That is a good indication that you are saying too much. Try sticking to the formula “You feel _____ when _____,” which will help you limit the length of your interventions. Chapter 5 • Reflecting Skills: Reflecting Feelings 117 Summary The reflecting skills are a quantum leap from the invi- message is often hidden because disclosure of feelings tational skills because they do much more than en- is bound by culture, gender training, and family rules. courage clients to tell their stories. The reflecting skills Labeling and reflecting feelings can be one of the most move clients to greater self-awareness and encourage difficult processes to learn. There is a great variability them to address deeper issues beneath the surface. in how quickly students learn to reflect feelings. Some They forge an empathic bond between client and come to it very naturally and quickly. Others take helper as the client senses that someone has taken the longer but can learn the skill eventually through per- time to try and understand. sistence and practice. There are a number of common Reflecting feelings involves identifying and labe- stumbling blocks or problems you will encounter as ling the client’s feeling and then reflecting the feeling you develop this skill. Return to this chapter later as back to the client, whether or not such feelings have you identify the specific difficulties you are having and been openly expressed. The feeling component of the review the antidotes. Exercises GROUP EXERCISES The Alter Ego Exercise 1: The Alter-Ego Technique for The third student, the alter ego, stands beside the client Identifying Feelings and speaks for the client, identifying anything the cli- ent might be feeling but has left out. Standing beside Identifying feelings precedes reflecting them. One of the client gives clues to the client’s facial expressions the best action methods for learning to identify feel- and body language. It is very important that the alter ings is the alter-ego technique, which comes to us from ego speak using the word I as if he or she were speak- psychodrama (Moreno, 1958). The alter-ego technique ing for the client: “I am angry,” “I am embarrassed,” asks the student to pretend that he or she is the client and so on. in order to imagine the client’s feelings. This group exercise requires four members: the client, the helper, The Observer the alter ego, and the observer. It is in the role of alter ego that the student learns most about how to identify The fourth member of the group is an observer who re- feelings. cords the alter ego’s remarks on a blank sheet of paper. In the discussion phase, the client gives the alter ego The Client feedback on the most accurate and the least accurate reflections and paraphrases. The observer should gen- The client discusses an experience with either posi- tly correct the alter ego if he or she forgets to speak as tive or negative ramifications, such as a good or bad the client and lapses into “you feel” rather than “I feel.” vacation, a relationship that ended abruptly, a missed opportunity, or another minor problem. If the alter ego correctly identifies an emotion, the client repeats it, Action Phase such as “Yes, I do resent that.” Once roles have been assigned, the client tells his or her story to the helper/listener. The alter ego, standing The Helper or Listener beside the client, expresses underlying feelings in the The trainee who plays the part of the helper has little client’s story. The client should be directed to ignore the to do in this exercise. The job of the helper is to listen alter ego, except when the alter ego really hits the mark. with appropriate body position, using only open ques- At that point, the client should incorporate the alter ego’s tions and minimal encouragers, providing a focus for comment into his or her statements. For example, if the the client but rarely intervening. alter ego says, “I am angry and embarrassed,” the client 118 Chapter 5 • Reflecting Skills: Reflecting Feelings may then respond, saying, “I am embarrassed.” The cli- identifying thoughts and feelings. The next step is ent always directs his or her response to the helper/ to incorporate the skill within the helping interview. listener, even when reacting to the alter ego. Although Break into groups of three with a helper, client, and client and helper/listener may find this exercise frustrat- observer. During a 5–8 minute session, the client de- ing, it allows the alter ego to stand outside the relation- scribes a small problem he or she has been having ship and he or she can learn to hear feelings, imagining with a friend, a family member, or someone at work. himself or herself as another person. The helper uses invitational skills, paraphrases, and, whenever possible, reflects feelings. The helper’s goal Discussion Phase is to reflect at least three feelings during the practice session. After 5–8 minutes, the group members discuss their The observer makes certain that the time lim- experiences, and the observer gives the alter ego feed- its are observed and, during the period, records every back. Members then exchange positions until everyone helper statement on the Feedback Checklist: Reflect- has had a chance to experience the role of alter ego. ing Feelings. At the end of the time, he or she shares feedback with the helper. The client gives the helper feedback on which responses on the checklist were QUICK TIPS: REFLECTING FEELINGS most accurate and which were least accurate. The cli- • You will probably need to use invitational ent makes a check mark next to those that seem to skills and paraphrasing before you have hit the mark. The group members exchange roles un- enough information to reflect feelings. Don’t til everyone has had a chance to practice the role of expect to hear feelings immediately. When helper and receive feedback. you have heard enough of the client’s story to grasp the emotional content, stop the client and make a reflection. Feedback Checklist: Reflecting Feelings • If you don’t know how the client is feeling, imagine yourself in the client’s shoes. What Observer Name: ______ Helper Name: _______ would you be feeling if you were the client? If you can identify what the client is thinking During the session, the observer records the helper’s responses verbatim. After the session, the group decides on a category or you understand the client’s problem, ask for each response: E for an encourager (either door opener or yourself the following: “What would I be minimal encourager), CQ for closed question, OQ for open feeling if I were thinking that?” or “What question, P for paraphrase, ROF for reflecting feelings, and would I be feeling if I were in that ROF + P for a response that paraphrases and hits the feeling. situation?” For example, the client says he is Were any of the helper’s responses focused on the wrong being treated unfairly. The trick is to ask person? If so, note WF for wrong focus. oneself, “If I were being treated unfairly, Category Helper Response Client Feedback how would I be feeling (hurt, angry, ignored, devalued)?” _________ 1. _______________ _______________ • If you can’t home in on a particular feeling, _________ 2. _______________ _______________ reflect two feelings to get at what the client is experiencing. _________ 3. _______________ _______________ • Keep your focus on the client’s viewpoint _________ 4. _______________ _______________ and reflect that. Convey that you understand the client’s perspective without agreeing _________ 5. _______________ _______________ that other people are at fault. _________ 6. _______________ _______________ _________ 7. _______________ _______________ Exercise 2: Using the Feedback Checklist _________ 8. _______________ _______________ in a Practice Session _________ 9. _______________ _______________ The alter-ego technique is a good way to develop _________ 10. _______________ _______________ the initial skill of imagining oneself as the client and Chapter 5 • Reflecting Skills: Reflecting Feelings 119 Exercise 3: Reflecting More than One Feeling 4. “I can’t believe I trusted my sister-in-law. She is such a backstabbing witch. I hate her. She’d start Clients are usually not experiencing a single emotion bad-mouthing my mother-in-law and get me associated with their problem. Emotions are often tan- going. Then after she got me saying negative gled like spaghetti. When you are trying to reflect all of things, I found out she was going back and repeat- the feelings a client is experiencing, it helps to untangle ing everything I said to my mother-in-law! Now the problem so that it begins to feel more manageable. my mother-in-law hates me.” In this exercise, you will try to identify more than one 5. “We just moved here, and I’m working two jobs. emotion in a client statement from Written Exercise 1. But somehow I’ve got to find time to take my kids First, form circles of four students. Each student to their schoolmates’ houses so they can get to reads one of the eight client statements in turn as if he know people and have some friends. I just don’t or she were the client, using voice tone that expresses seem to have time.” the client’s feelings. The student across from the client 6. “My son keeps staying out late at night with his reflects the feeling the client seems to be experiencing friends. He won’t tell me where he goes. I’m afraid using the “You feel ___ when ___” format. But this time, he’ll get hurt. He’s probably able to take care of the student attempts to identify two or more feelings that himself. I don’t know what to do.” might be associated with the statement. For example, 7. “My best friend was hoping that Glenn would “You felt angry and hurt when you thought manage- invite her to the formal, but he invited me. She’s ment didn’t care about the workers.” In groups of four, not talking to me now and I don’t know what to each student will have two chances to reflect more than say. It’s not my fault.” one emotion. Following each round, the group should 8. “My dog is really sick and he’s suffering. I know discuss the accuracy of each student’s reflections. You you probably think it’s silly but I am paralyzed. I may want to consult the list of feeling words in Table 5.1. don’t know whether I believe in putting him out of his misery, and I don’t know how I would cope WRITTEN EXERCISES with that loss on top of everything. But am I being selfish?” Exercise 1: Practice in Identifying Feelings and Reflecting Feelings in Writing Exercise 2: Connecting Feelings and a Paraphrase Listed below are eight client statements. First go through and identify the major feeling or feelings in Using the stem “You feel ________ when _______,” each client statement. Then write down, “You feel create statements that reflect feeling and the related ________.” If more than one feeling exists, reflect all events, which come out of the content of the story. that you can. If you have identified the right primary Write your reflection + paraphrase down on a sheet emotion but differ on the exact shade of emotion, you of paper and compare your answers with mine. Make could be right depending on the context and nonver- your paraphrase brief. bals of the client. 1. “My husband and I keep fighting. We argue over 1. “There I was, standing in front of the entire assem- very minor things. I didn’t really mind before, but I bly, and I froze. Everyone was staring at me. My think it’s having a big impact on the kids.” heart was pounding and I started to shake. I 2. “I think my girlfriend likes someone else. When- thought I was going to die right there on the spot. ever I turn around, I see her talking to Kent. She I can never show my face again after that.” seems to laugh a lot when I see them together.” 2. “And for the third time in a row, he failed to show. 3. “I’ve always wanted to be an actor. But my mom What a jerk! My daughter looks forward to these and my teacher have told me it’s a crazy idea and times with her father, and I hate to see him treat I need to get a proper job. It makes me wonder.” her this way. But I can’t seem to do anything to 4. “I told my best friend something that was top make him listen.” secret. I found out yesterday that she has told my 3. “The more I do, the more the boss seems to worst enemy in the whole school.” expect. He’s never satisfied and is always finding 5. “My sister’s boyfriend is just terrible. He drinks too fault. I think I should start looking for another job much and never works. I have heard things about because I can’t take it anymore.” him that she doesn’t even know.” 120 Chapter 5 • Reflecting Skills: Reflecting Feelings My answers: (1) “You feel more concerned about To the Helper: the fighting when you thought about the effect on the Based on the feedback you received, identify kids.” (2) “You feel jealous and concerned about the one or two things you hope to work on in upcoming relationship when you see her enjoying other people.” practice sessions. (3) “So you begin to feel uncertain when other people bring doubts about your career choice.” (4) “You feel 1. ___________________________________________ angry with your friend and a bit worried when you 2. ___________________________________________ discover that someone who dislikes you knows that secret.” (5) “You feel afraid for your sister when you HOMEWORK think about her boyfriend’s drinking, his lack of a job, and rumors you’ve heard about him.” Homework 1: Keeping an Emotions Diary Make a copy of Table 5.1 and keep it with some SELF-ASSESSMENT blank paper on a clipboard near your bed. Think about an emotion you experienced today. For ex- Practice reflecting feelings with a fellow class member ample, if you felt angry at work, at school, or with who plays the role of the client. This practice can be as family, record that feeling as the answer to the first short as 10 minutes. Following the practice session, ask question below. Fill out this diary for 2 successive your client to fill out the following feedback. days and then write a one-paragraph reaction re- To the Client: cording your discoveries. Please respond as honestly as possible to the following statements, using the 5-point scale below: • What was the emotion? • Think of a synonym for the emotion as you expe- 1 2 3 4 5 rienced it today. • Describe the situation in which you experienced Strongly Disagree Disagree Neutral Agree Strongly Agree the emotion. • Who was present when you experienced the 1. ____ The helper’s nonverbal and opening skills emotion? seemed appropriate. • What do you think caused your emotion? Do you 2. ____ The helper interrupted me with questions. blame other people for your emotion? Which of 3. ____ The helper showed warmth. your personal values and beliefs might have 4. ____ The helper’s responses seemed concise. given rise to this emotion? In other words, what 5. ____ The helper seemed to understand the facts. did you say to yourself about this emotional 6. ____ The helper identified one or two primary response? feelings accurately. • How did you express the emotion? 7. ____ The helper reflected a feeling of which I was • What societal rules come to mind when you think unaware. about expressing this emotion? 8. ____ Overall, the session helped me think a little • Record any other thoughts you have about your more deeply about the situation. experience today. Please identify one or two things the helper did well in the session. JOURNAL STARTERS 1. ___________________________________________ Think about the ways emotions are commonly ex- 2. ___________________________________________ pressed in your own family. Do you think that, in Please identify one or two things the helper can your family, some emotions are more acceptable than do to further improve his or her skills. others? How do you think your family or ethnic back- 1. ___________________________________________ ground might affect your willingness to listen to a cli- 2. ___________________________________________ ent’s feelings? CHAPTER 6 Advanced Reflecting Skills: Reflecting Meaning and Summarizing Meaning, Uncovering the Next Layer • Why Reflect Meaning? • Challenging the Client to Go Deeper: The Inner Circle Strategy • Worldview: Meanings Are Personal How to Uncover Meaning in the Story • Reflecting Meaning • Using Open Questions to Uncover Meaning Summarizing • Focusing Summaries • Signal Summaries • Thematic Summaries • Planning Summaries The Nonjudgmental Listening Cycle Ends with Summarizing • What Happens after the Nonjudgmental Listening Cycle? • A Questioning Cycle Typically Found Early in Training Summary Exercises • Group Exercises • Small Group Discussions • Written Exercises • Self-Assessment LEARNING OUTCOMES • Homework • Journal Starters By the end of this chapter, you will be able to: 6.1 Recognize reflections of meaning and helper statements that move clients deeper. 6.2 Reflect meaning in client statements. 6.3 Make summaries to signal transitions, begin and end sessions, and identify themes. 6.4 Identify the various parts of the nonjudgmental listening cycle (NLC). It is not what happens to us but what we make of it. EpictEtus The quote that starts this chapter is from the Greek stoic philosopher Epictetus, who reminds us that how we look at things determines our 121 a client may not let you help until you have qualified to do so. a method of binding together the parts of the client’s story into a capsule account. the helper must recognize the therapeutic value of mak- ing clients aware of the meanings in their narratives (Adler. and beliefs. Viktor Frankl’s Logotherapy (2006) emphasized that human beings are meaning-makers.” or “I am invisible and irrelevant to her. a client once told me her 90-year-old mother failed to recognize her at the grocery store. needs. the person who has passed on becomes an inspiration. she knew a few quick fixes but I was not ready to try them until I knew that she fully understood the problem. Summaries are ways of pulling together the loose ends and communicating that the helper has grasped the totality of content. “My mother is elderly and perhaps her eyesight is failing. MEANING. Both summarizing and reflecting meaning are advanced reflect- ing skills that strengthen the client/helper relationship because the client feels understood at a very deep level. as the helper. but in this chapter. Let me relate a brief story to illustrate this point. Notice that the client did not say. I called my telephone service provider to report problems I was having with my phone. For some. Understanding and then reflecting meaning to the client is perhaps the most difficult skill you will learn. You can commu- nicate this by showing a complete understanding of the facts. and perceptions are formed by his or her particular history. If the client does not feel completely understood. UNCOVERING THE NEXT LAYER We don’t see things as they are. feelings. values. In this chapter. For example. 2012). The emotions add color to the story and help us imagine the . Through her experience. If you. Harmerling.” Can you see that reflecting the content (she didn’t recognize you) and the feeling (sad. Before I could describe the problem. values. we will also look at summarizing. Still. the person began describing solutions. Later in the book. and meanings. & Walder- Biesanz. a death in the family can be a tragedy that ruins their lives. we will present several different ways for you to get a feel for this advanced skill. we see things as we are. the next phases of helping falter. Similarly. feelings. In this chapter.” This example illustrates how each person’s interpretations. then you will not truly comprehend the story.122 Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing reaction to them. and meanings. do not understand the meaning of the event to the client and reflect it. The way to qualify is to show the client that you fully grasp the issues. AnAïs nin Understanding the content of the client’s story gives us an outline or picture in our minds about what has happened. Two people expe- riencing the same event will have different views of its significance. We want to make sense of our experience and this meaning-making process can help us endure the crises of life (Wong.” Instead the client assigned a very personal meaning to the fact that her mother did not greet her. For others. we will identify some change techniques aimed at helping a person change unhelpful or unproductive perspectives. angry) does not capture the client’s whole message? Underneath the story is the meaning that is something personally constructed by the client: “I am nothing in her life. Here was the client’s statement: “I saw my mother and she didn’t even acknowledge or recognize me. Our emotional reaction is largely determined by the unique meanings we assign to the events of our lives. including reframing. 2013). our focus here is to understand and reflect rather than intervene. In other words. we will look at how a helper can identify and respond to the meanings behind a client’s story. That’s typical. to be part of the group. It used to be a good place to work. A couple of weeks later. because it helps us understand the client’s unique background and perspective. Joan went to the company’s employee assistance program and asked for counseling. 244). It just seems a nasty thing to do to someone who was trying to be friendly.” (reflection of meaning) If Lynn had merely paraphrased the story of Joan’s problems at work. However.” (door opener) JoAn: “Well.” (reflection of feeling and meaning) JoAn: “Yeah.” There was considerable animosity because of a power struggle between the leaders of the two groups.” Lynn: “Okay.” (reflection of feeling and paraphrase) JoAn: “Not really. and her underlying feelings. I don’t like that about myself. that’s the thing. when we understand a person’s meaning system. Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing 123 sometimes overwhelming feelings that he or she is experiencing.” Lynn: “You’re afraid of his reaction when he finds out that you leaked the infor- mation.” (reflection of feeling and paraphrase) JoAn: “Yes. Thus. I wish I were secure enough to have my own opinions about people. we begin to grasp how the person views the world. I think I did it just to be part of the club. Somehow this information leaked to the administration. say more. Bob told me about his treatment for alcoholism one night when we were working late. sort of offhandedly.” Lynn: “It sounds like it has always been very important for you to be approved of. During the interview. On the other hand. who had been having problems at work for 2 years. Her co-workers had split into two factions that everyone on the job called “the red- birds” and “the bluebirds. Bob. Lynn chose to dig more deeply. JoAn: “There is just so much turmoil. not only paraphrasing Joan’s feelings about recent events but also looking at the underlying meaning—the perceptions and values her client attributed . that among other things. It also allows clients to become aware of the lens through which they are seeing them- selves and others. p. and Bob was investigated as a security risk. had sought treatment for alcoholism. Meanings are built from a person’s past experiences. you are disappointed in yourself for having betrayed a confidence. and sometimes.” Lynn: “In other words. During one of their after-work gripe sessions. you find yourself doing some- thing you don’t even agree with. she revealed that she knew one of the redbirds. Bob had told her this several years ago when they were on good terms. reflection of meaning is a significant step beyond reflection of content and emotion. which are “alloyed with firm beliefs. it would have been a productive session. Joan found herself allied with the bluebirds. she and the helper (Lynn) had the fol- lowing exchange. fuzzy ideas. and unconscious schemes and prejudices” (Leontiev. I even thought of him as a friend. Consider the case of Joan. 2007. Now it’s ‘dog eat dog. her thoughts. Bob’s boss called him “on the carpet” because the company was working on several government contracts.’” Lynn: “You are sad because things have changed and now there is so much com- petition. TO UNDERSTAND THE CLIENT AT A DEEPER LEVEL Some investigations into the transcripts of Carl Rogers have found that 70% of his responses were reflections of meaning. has several layers. like Joan’s.1 Levels of Disclosure to the self. but at the same time. Therefore. If the helper can keep the cli- ent focused on deeper issues and provide a safe environment. its personal meaning.1 shows that every client’s story. such as feelings and meanings that evoke embarrassment and shame. Figure 6. the full meaning of the story starts to emerge and the session trends deeper. Why Reflect Meaning? The story of Joan and Lynn demonstrates that unless we understand meaning. some of the rea- sons for reflecting feelings are described using Joan and Lynn’s conversation as an example. and the other workers involved. then the feelings it evokes. not feelings (Elliott. starting his sentences with “I. a client is likely to give us first the content of the story. depth varies as the client discloses. more threatening material emerges. Previous paraphrases and reflections of feeling were not nearly as effective as when the helper keyed in on what was really bothering Joan. Notice how Lynn under- stands Joan’s disappointment in herself and how this leads to a deeper response by Joan. Bohart. the office situation. You might notice that he some- times speaks for the client. 2011). there are occasional returns to more superficial material. and finally. Paraphrase Level 1—Content "What happened?" Level 2—Feelings "How did you feel?" Reflect Feelings Level 3—Meaning Reflect Meanings "What did it mean?" Time FIGURE 6. The figure also illustrates the fact that as the client’s story becomes deeper over time. & Greenberg. Watson.124 Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing Depth of client responses varies through the session. As if peeling an onion. we are missing a crucial aspect of the message. Increasing depth is due to the development of trust. Depth based on the helper's statements. In the section that follows.” such as “I just don’t trust myself . to her long-felt need for approval. The helper holds up a mirror to the client. They feel that once the basic facts are known. instead. Thus. she begins to see that her actions were due. recall that the events in Joan’s story clearly have a deeper significance than Joan herself is able to identify at first. a helper’s inability to tap meaning results in more superficial conversations. The helper lets the client get a good look at his or her own values and viewpoint about the self. Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing 125 to be a good partner. and how she is going to inter- act with her colleagues in the future. the client begins to realize their significance and begins to understand that these meanings are part of the unique way he or she constructs the world. Here are some leads a helper might use to emphasize the point that this is the client’s distinctive story and to avoid agreeing with the client that his or her perception is reality: “In your mind. this was another piece of evidence that trusting people is dangerous. Figure 6. in part.” “From your perspective. When she makes this connection. reflection of meaning allows the client to recognize that the story he or she is telling is not the facts but is. if only you had had better parenting. one of the benefits is that the helper gets a feel for the cli- ent’s worldview. TO LEAD TO DEEPER SELF-UNDERSTANDING IN THE CLIENT Thinking back about the con- versation between Joan and Lynn. “reflecting” rather than agree- ing with what the client says. you were snubbed. he or she begins to envision how to make constructive changes. TO EXAMINE THE CONCEPT OF DEPTH Beginning helpers are often confused when the client’s story seems to have run its course. When the helper highlights them. and the world. When a client sees himself or herself through the eyes of another.” “For you. TO EMPHASIZE THAT THE STORY IS THE CLIENT’S VERSION Besides increasing the cli- ent’s insight and the helper’s understanding of the client. According to this model. Whereas reflecting meaning leads to more disclo- sure and exploration of a topic. In Joan’s case. others. superficiality is the result of traveling too rapidly through .” Rogers used this method of pretending to be the client as a way of getting in touch with the meaning the client assigns to events. where her values came from. you wouldn’t be so down on yourself. by opening up to the meaning of the story. Take a look at the end of the dialogue between Joan and Lynn.1 shows the concept of depth in a client’s story over time.” TO PUSH THE CLIENT TO GO DEEPER Reflecting meaning inevitably has the effect of get- ting the client to discuss even deeper issues than those brought out in the first version of the story. Can you see how Joan’s next statements in her dialogue with Lynn might progress? Perhaps she will discuss how she was raised. it paves the way to set a goal for becoming more self- directing. a perspective. thereby understanding him or her at a deeper level. where else can the conversation go? This is because the helper has not gone deeper into the meaning of the story. Why is it important for the helper to bring this deeper level of meaning to the surface? One reason is that the client takes these backdrop issues for granted. the only factors that the helper can control are his or her own actions. even if the helper is very inviting and uses reflecting skills. Lazarus advocated using the diagram to confront the client when therapy has become too superficial. the helper draws a series of concentric circles labeled A. the helper may ask the client to write in the names of individuals. B. Arnold Lazarus. trustworthy.2). going deeper takes a much longer time. and E (see Figure 6. who have access to the various rings from A to D. and core beliefs (see Shaughnessy. Using the inner circle strategy. secrets. p. “It seems to me that we are dis- cussing issues that fall in the D or C category.1). the helper might say. the helper used questions and reflections of meaning to get at the deeper levels of the story. Sometimes clients have difficulty recognizing that their sto- ries have these deeper layers. the client will normally remain at level 1 (Figure 6. more per- sonal issues (1981. If the helper does not invite the client to reach deeper levels by reflecting feelings and mean- ings. The depth that a client is willing to reveal depends on a number of factors. D. including one’s appearance and occupation. Of course. some clients are not very talkative and are uncomfortable with expressing feelings and uncovering personal issues. Issues at ring A are very personal such as sexual problems. The most effective work occurs at level A or B. The helper cannot always break through a client’s reluctance to open up. and when they do. In that case. Among these are helper responses. and whether or not the client feels safe in the therapeutic relationship. Challenging the Client to Go Deeper: The Inner Circle Strategy In Joan’s case. rather than going deeper.126 Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing the story in a horizontal direction. some relationships remain very close to D. they only visit briefly. Encouragers like “Uh-huh” and “Go on” do not necessarily nudge the client to go deeper. They tend to keep the client at whatever level the discussion has reached. On the other hand. Clients are more likely to disclose deeply if the helper is perceived as com- petent. For example. and deeper topics are never broached. negative views of the self. To understand a cli- ent’s willingness to disclose. Obviously. and nurturing. anger and resentment toward people. some clients are very psychologically minded and will quickly discuss the deeper aspects of a problem with little prompting. but even insightful clients frequently miss the importance of mean- ing because they take their meanings for granted. 55). C. However. the founder of multimodal therapy. and secrets that the client feels are immoral or dishonest. Such clients may have trouble getting to the feelings and meaning levels. At ring E are issues that are essentially public and might be discussed with almost anyone on first meet- ing. I am wondering whether you do not feel comfortable talking about these deeper levels yet. the helper must not only avoid the overuse of closed questions and an interrogating attitude but also rely on reflecting skills to enhance empathy in order to deepen the client’s story whenever possible. client readiness and willingness. or vertically. including the helper.” . 1987). and it is useful to challenge them to move from a super- ficial recounting to the area of personal meanings. used what he called an “inner circle strategy” for getting clients to identify deeper. To increase the likelihood of greater depth in the client’s explorations. Most relationships start at D and move toward A as the relationship grows. 1993.” In Alcoholics Anonymous. yet we . When we reveal secrets.2 The Inner Circle Strategy STOP AND REFLECT Secrets “You are only as sick as your darkest secret. how important is it that he or she be completely honest? Is it permissible for a client to retain some privacy and under what circumstances? How can we invite clients to share but show respect for their refusal to examine every nook and cranny of their private lives (Kottler & Carlson. We may see a reduction in psychological and physical problems. we may gain insight and see the issue in a different light. 2009. 4. Kelly & Yuan. Cogar. It is a paradox that we are to keep our client’s secrets. 1996) Although being honest within a professional relationship has these benefits. more than 50% of therapy clients report that they have kept secrets from their helpers (Hill. Thompson. 2011). Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing 127 E D C B A FIGURE 6. 3. this aphorism is used to remind those in recovery that being truthful and open about themselves is much healthier than put- ting on a false front. When a client comes to a helper for help. We may be better able to quit smoking or other addictions because we are affected by the opinions of others. 2. 2011)? Many ethical guide- lines of professional organizations deal with the issue of secrets because their members are expected to maintain their clients’ confidences. (Kelly & McKillop. & Denman. The secret does not have to be suppressed and therefore it loses its power to dominate one’s life. The positive consequences of disclosing to others include the following: 1. Robey. what should you do? Should group leaders have rules about keeping secrets? • You have been seeing a client. discuss them with a small group of fellow learners. you hap- pen to see two of the women from the group sitting together at a restaurant in the mall. How would you deal with this situation? How far would you go in insisting that he learn to open up? • You are conducting outpatient group therapy for 12 women. How do you think their secret relation- ship might affect their interactions with each other and with the group? As the group leader. At first. What do you fear might happen if you were to disclose the thoughts. Apparently he has no friends and confides in no one. During his sessions. and illnesses • Times when you were dishonest or unethical . and perceptions. but not to reveal the ongoing affair. for 4 weeks. • Your client is a 43-year-old married man who has just returned from an alcohol treatment center. What would a person need to know about you before you would feel that he or she were sufficiently informed to help you? How long would you have to know someone before discussing your deepest secrets? Read each topic in the following list. You feel that going to AA would be helpful in maintaining his sobriety and in providing a social outlet. One of the rules of the group is that there will be no socializing outside of the group. One evening while shopping. feelings. disabilities. What would be the best response to Isabel? Can you agree to keep this secret if you see them as a couple? STOP AND REFLECT We have been talking about the fact that the most productive therapeutic relationships are devel- oped when clients feel free to reveal their deepest thoughts. and identify something relevant about yourself that you would be willing to discuss with a helper during the first session and something else that you probably would not discuss. he is open about his substance abuse issues but is very quiet about his family relationships and his sources of social support. Isabel admits she is having an affair with a co-worker. Isabel says that her husband senses something is wrong in the relationship and wants marriage counseling. Write down brief notes under each heading.128 Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing cannot force them to be completely honest with us. feelings. and perceptions that you would prefer not to discuss? Topic I Would Disclose I Would Not Disclose • Your family values and family history • Your religion or spiritual beliefs • Your sexual history • Your personal dreams and ambitions • Happy and unhappy childhood memories • Physical limitations. Clients who venture to this level of disclosure are. she discussed her dissatisfaction with her job and her concerns about parenting her teenage son. unbeknownst to her husband. risking a great deal. On the fifth week. They are deep in conversation. Consider the following scenarios and think about how you might handle them. If possible. however. Isabel believes they could benefit by being seen as a couple and asks you to do the counseling. and they do not notice you. He does not want to attend Alcoholics Anonymous (AA) for aftercare but comes weekly for counseling. Isabel. The issue boiled down to Joan’s feeling that she had betrayed herself as well as a friend’s confidence.” “I am a bad parent. . Without understanding Joan’s moral dilemma and disappointment in herself. it must take into account her worldview and values. and trauma all influence the development of one’s worldview. physical abilities. Worldview is a term that refers to a person’s view of self. others.” . Recall the discussion between Lynn and Joan. (a good person) (evil) (selfish) (okay/not okay) (smart/dull) (damaged) (unlovable). from day to day and from hour to hour. ethnicity/race. What matters.” “I am a victim. Following are some other examples of client statements that give a window into worldview or values. Viktor FrAnkL One way to think about meaning is that it is a product of a person’s worldview. Who are these people. 2004). There is no need to discuss the issues at each of the levels. Now think of one or two issues that you would not discuss with anyone. religion/spirituality.” “Nothing I do seems to work out.” “I always land on my feet. Language. and the world (Koltko-Rivera. is not the meaning of life in general but rather the specific meaning of a person’s life at a given moment. The helper’s job is to understand both the client’s worldview and his or her values so that the client’s viewpoint—and the meaning of his or her story—can be appreciated and an appro- priate solution to the client’s problems found. therefore. Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing 129 Draw an inner circle for yourself like the one in Figure 6.” “I am unlucky.2 and write down the names of people who have access to the deeper issues in your life. age. a client’s personal values (what is important in life) are sources of meaning that can be brought to the surface. What would stop you? Are there also issues at rings B and C that would be difficult but not impossible to discuss with a helper? What issues would you discuss only if there were safeguards of confidentiality? Share your inner circle with a small group of classmates if you feel comfortable in doing so. View of Self “I am essentially . do you think it would be possible to help her deal with her situation at work? The appropriate solution must be consistent with her ideas of what is right and healthy. One of the ways that helpers can understand a client’s worldview and access the meaning a cli- ent ascribes to his or her situation is to be sensitive to client disclosures. Viola- tions of one’s personal values are frequently background issues in client’s messages. and how did they gain this kind of trust? Worldview: Meanings Are Personal For the meaning of life differs from person to person. socioeconomic status. . gender. In addition to world- view. it might be interesting to compare the numbers of people who have access to the various levels of your life. even a professional helper. In other words. However. ” “White people are .” Beliefs about the Environment or the World in General “It’s a jungle out there.” “You can’t get ahead.” “Men are all alike.” “People will take advantage of you if they can. and so on.” Values “People should treat each other fairly. Reflecting meaning is preferred to asking questions because of all the drawbacks ques- tions raise in slowing down and sidetracking the story. . changing jobs. . Reflection of meaning is difficult to learn because each person’s take on a situation is unique.130 Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing Notice that these statements express general notions about the self. For example. View of Others “People are . . . If you have ever been in a stress workshop. we discuss a number of methods for accomplishing this but the two most basic are reflecting meaning and asking questions about meaning. Still we describe both methods here because there will be times when reflecting meaning is difficult to achieve and ques- tions offer a shortcut. rather than defining specific abilities such as being a good piano player or having a good sense of direction. .” “God punished you.” “Conflict is bad. divorce.” “Asians are .” “Family secrets should be kept in the family. you may have taken a “stress scale” that lists life events such as moving. Reflecting Meaning Reflecting meaning is one technique that helpers use to restate the personal impact and significance of the event the client is describing.” “It’s bad luck. .” “Life is a vale of tears.” “Things always turn out for the best. Each event is given a weight . In this chapter. much work was done in the 1960s and 1970s on the effect of stressful life events (Holmes & Rahe.” “You should always try to do your best.” HOW TO UNCOVER MEANING IN THE STORY So far. we have emphasized the importance of understanding and listening for meaning in the client’s story. 1967).” “Men should be the head of the family. (unreliable) (essentially good) (selfish) (trustworthy) (kind). The meanings are implicit in the client’s story. Therefore.” To reflect meaning. In other words. but one must learn to read between the lines to unearth them. If you can only grasp the feelings. although divorce is highly stressful to most people and gets a high score on the stress scale. we place an accurate reflection of feeling in the first blank and a reflec- tion of meaning in the second blank. then reflect those feelings and wait until you know more before playing a hunch about meaning. This sometimes involves employing intuition or hunches. “You feel disappointed in yourself because being a good daughter is an important value to you” (see Table 6. In addition. Because meaning is even deeper below our awareness than feelings. but in this case. “You felt angry when you didn’t get the promotion. you learned to reflect feelings using this formula or algorithm: “You feel _____________ when _____________. How do you know when to use each one? The answer is that you try to reflect as deeply as you are able. the greater the likelihood that your hunches will be correct. and paraphrasing as needed. basic beliefs. but rather the meaning and importance you place on the events is significant. For example. Sometimes it may be necessary to include both a reflection of feeling and a short paraphrase of content in the first blank so that the client knows exactly which event you are referring to—for example. by adding up the scores. Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing 131 based on its predicted impact on your life.” The first blank was to be filled in with the client’s emotion and the second with paraphrased content—for example. divorce may actually lead to a reduction in stress. using invitational skills. it is quite possible. reflect- ing feelings. as one goes deeper into the story.1). They can be delivered alone or in combination. paraphrasing. The more you know about a client. It is not really possible to know how an event has affected someone until you understand his or her experiences. one could anticipate how much stress a person would feel based on the number of changes during the past year. to choose among reflecting meaning. meanings are harder to detect. we link them with the word because. TABLE 6.” The word because shows the connection between the content and feelings of the story and their relationship to the underlying meaning for the client. “You were excited (feeling) when you received your driver’s license (paraphrase) because it meant you were becoming an adult (meaning). It turns out that it is not the number of events that is very predictive of stress or illness. Initially it was thought that. In the last chapter. and reflecting feelings to help the meanings emerge. in conflict-ridden relationships. and values. we use the same formula.1 Formulas for Reflecting Feelings and Meaning Reflection Formula Example Feeling You felt _____ (emotion) You felt frustrated when you couldn't seem to when ________ (event or make him understand thought) Or. as in the statement. You felt disgusted when you thought about how much effort you had wasted Meaning You felt ______ (emotion) You felt really angry with yourself because this was because ______ (meaning) the way you were going to prove to your parents that you were a success . helpers are encouraged to be patient. the easier it will be to reflect the underlying meaning. Doing so provides the best atmosphere for clients to tell their stories. The more fully we understand the content and feelings. Everything I worked for is going down the drain. Now. Assume that each reflection of meaning comes after a longer period of listening during a helping session.132 Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing EXAMPLES OF REFLECTED MEANING Here are some examples of reflections of meaning (ROMs). and because she will not be there for graduation (paraphrase). Notice that the word because connects the feeling and meaning logically: The client feels lost because the dream was so important. The helper may only make a reflection like this when he or she has ade- quate knowledge of the client’s hopes and ambitions from previous statements. it seems less special (meaning). We must plod away at our reflecting until the lightbulb comes on and we see the meaning. The main difference between a beginner and an experienced helper is that the experienced helper knows the lightbulb will come on. and it also means that the helper must fully comprehend the client’s distinctive situation and values. Example 3: cLiEnt: “When my mom died.” Can you see that the helper took a risk and played a hunch? The helper intuitively grasped what the client might be feeling now and what it meant not to have her mother at this milestone event. The surest route to reflection of meaning is to patiently and persistently use the basic invita- tional and reflecting skills.” HELpEr: “In a way.” Here the helper reflects the feeling of being lost. Then the helper connects the feelings to the underlying meaning: The client feels that she has failed. and she won’t be there. and now she’s moved in with that boy. Example 1: cLiEnt: “I don’t know what to do now. Although we can guess what meaning most people might derive from a situation to accurately reflect the meaning of an event. . She stays out late. and I don’t have the heart to tell anyone where she’s staying.” HELpEr: “You must feel pretty lost (feeling) because the dream of having your own business was so important to you (meaning). which reduces anxiety considerably. my high school graduation is coming up.” HELpEr: “You are a bit ashamed (feeling) about your daughter’s living situation (paraphrase) because you think you have failed as a parent to convey your values (meaning). Reflecting meaning requires that the helper think intuitively. your feelings have changed from shock to sadness (feeling). at first I was disoriented. The helper then ties this feeling with the unique meaning that the client’s dream has died.” The helper reflects the client’s feeling of being ashamed and briefly paraphrases by mentioning her “daughter’s living situation” in a nonjudgmental way. like I was in a haze. we frequently must have some understanding of its cultural context. Example 2: cLiEnt: “My daughter isn’t living right. If you want to practice using open questions to get at meaning. The client responded by revealing the meaning of the event: She does not think her family cares about her needs. Chris: soniA: “There was a big family problem because I told them I couldn’t pick up my sister at the airport. instead of using questions to try to reveal meaning.” • The formula for reflecting meanings is “You feel (specific emotion) because (the personal meaning behind the situation that accounts for the feeling). she used an open question to try to under- stand the deeper issue. The family is important. Everyone in the family jumped on me. Getting at these feelings seemed to pave the way for the client to expose more about the deeper significance of the problem. Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing 133 MyCounselingLab Application Exercise 6. I guess I was wrong. Note that some instructors may want you to abandon questions for a while in order to strengthen your reflecting skills. and I am mad!” cHris: “What is it about this situation that makes you so angry?” (open question focusing on meaning of the event) soniA: “My time isn’t important.” • For example. and a helper. letting Chris know that she had only understood part of her emo- tions. Now my mom is mad at me and so is my brother.1 Practice in Reflecting Meaning QUICK TIPS: REVIEW OF REFLECTING FEELINGS AND MEANINGS • The formula for reflecting feelings is “You feel (specific emotion) when (the facts of the situation that account for the emotion). In that case. Because Chris could not quite identify and reflect the meaning in the client’s statement. “You felt embarrassed because you don’t want to be singled out as someone that needs help. “You felt embarrassed when your teacher saw you get a free lunch. Chris correctly reflected a feeling of confusion. . Sonia.” (reflection of feeling) soniA: “Yeah. especially when a client is not very forthcoming. My sister Camilla is important.” cHris: “You feel confused about what happened. rely on reflecting skills for the time being. consider the following exchange between a cli- ent.” MyCounselingLab Video Exercise 6.” In this interaction. but Sonia added that she also felt angry. but I am not important to my parents.” • For example. but I was busy and no one seemed to understand.1 Identifying Reflections of Meaning and Depth in Helper Statements Using Open Questions to Uncover Meaning Open questions focusing on meaning can be useful. The summary ties some of the major issues that have emerged into a compact version of the story.” Question: “Why see new things?” Answer: “Because you can see different ways of doing things. Because summaries have different purposes. we place it here because you cannot really use summarizing until you have paraphrased and reflected feelings and meanings in a client’s story. letting the client hear his or her viewpoint in a more organized way. they can be divided into four types: focusing. But perhaps you can see that each person’s answers to the questions will be different and based on what he or she believes to be important. Try to put down 20 or so answers. buy a house. it could be considered the broadest brush. It may include any of the fol- lowing: (1) content. you would need a longer series of questions and different topics to get a clearer insight. Of course. ?” and then following up with more “why questions” to the answers. and end. If you would like to try the ultimate meanings technique for yourself.” Question: “Why see other ways of doing things?” Answer: “Because then you will be able to think of new ideas. themes. bringing together main content. middle. and (4) future plans. “Why do people . The summary helps the client make some sense of the tangle of thoughts and feelings just expressed in the session. Of all the reflecting skills. But sum- maries are not to be used only at the end of a session. etc. For example. and feelings in the client’s story by concisely recapping them. .)?” Here is an example using the question “Why do people travel?” Answer: “To see new things. respond to the following question: “Why do people work?” Write down your answer. “Why do people watch TV (smoke cigarettes. it serves a reflecting purpose. Although it is easier to learn than reflecting meaning. and competing with others. . The ultimate meanings technique consists of writing down your answer to a question with the stem. (2) major feelings.” Question: “Why think of new ideas?” Answer: “So that you can create new products at work and get an edge on other people. and then look through your answers to see whether you can spot some key values and meanings for yourself. and planning summaries. Summaries may be used at all points—beginning. SUMMARIZING Summarizing is the final reflecting skill you will need to learn. suc- cess at work. Summarizing pulls together everything a client has said in a brief synopsis of the session up to that point. thematic.” This example is truncated but perhaps you can see that this person may value creativity. signal. Then ask a series of “why questions” based on your answers. In other words.134 Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing STOP AND REFLECT The Ultimate Meanings Technique Leontiev (2007) devised a creative technique for identifying the meaning. (3) meaning issues and themes. . have a long-term relationship. a helper says: “Let’s review what I know so far. and reflections of meaning (ROMs) in this parent’s story. Signal Summaries In the middle of a session. The first is the way that you are trying to renew your social network and find some supportive friends since your breakup with Jesse. . see whether you can spot the paraphrases (Ps). You’ve always been the kind of person who likes to leap into action when a problem arises. there is not much force you can apply. the signal summary tells the client that the helper has digested what has been said and that the session can move on to the next topic. The other issue is your mixed feelings about living back home with your parents. and when you see her.” (summary) . . For example. A focusing summary is an intervention that brings the discussion to bear on the major issues and themes.” HELpEr: “Before we move on. Your mother called and made this appointment for you because you were arrested about a month ago for public intoxication. “How have things been going this week?” or “What would you like to talk about today?” When a client begins the session by reacting to a focusing summary. In the example that follows. reflections of feelings (ROFs). places the spotlight on the client’s responsibility for the prob- lem. Because she is an adult. Is this about right?” Brammer (1973) points out that a focusing summary at the beginning gets the client on track immediately. You have tried to get professional help for your daughter’s drug problem. a summary may help to focus the conversation before it begins.” Focusing summaries are not only to remind clients about their goals from previous sessions. the client may feel that it is necessary to go over an issue several times until full understanding is communicated. That’s what makes it especially frustrat- ing. If the helper does not summarize occasionally. he or she immediately begins talking about the key issues and goals. Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing 135 Focusing Summaries At the beginning of a session. One of the conditions of your probation is that you receive help for your drinking problem. and reminds the client of the goals. and she has rejected it. For example: “In the last few sessions. Your probation officer referred you to our agency. A good time for a signal summary is when the client seems to have come to the end of a story and pauses. your relationship is very superficial because you can’t talk about the drug issue without getting into a fight. This makes you feel helpless. it seems like we have been dealing with two major issues. and here is a situa- tion where there is little to do. cLiEnt: “So that’s about it . Contrast this with the traditional opening statements such as. let’s just summarize where we’ve been so far. (pause). They can even be used at the first session with a new client. So you’re here to do something about the problems you’ve been having with alcohol. When this kind of reflection is made. you want to get . and the other is your sense that you haven’t been able to reach your potential in your career. who may be unaware that the issue is resurfacing so often.” • “From everything we’ve talked about over these past few weeks. emotions. You may also have the oppor- tunity to see advanced practitioners identify these themes in recorded sessions. plans. The thematic summary is an advanced reflecting skill because it means that the helper has to be able to make connections among the content. You seem to want to end relationships when they begin to lose their initial excite- ment and romance. too.” • “As you have been talking. you are unhappy with the way you tend to become overly depend- ent on your friends.” (door opener) Thematic Summaries A theme is a pattern of content. Is this right?” It is difficult to practice using thematic summaries because it presumes that you have seen a client for some time and usually for more than one session. Here are two examples: • “Well. Now I guess I need to talk about how I can go on with my life under these circumstances. One of them is the anger you feel in a number of different close relationships. it seems like we’ve identified several things in this first session that we want to pursue. that themes are the helper’s constructions or interpretations.” HELpEr: “Okay. because if incorrect. a thematic summary can have the effect of making the client feel analyzed. you hesitate to make a commitment to a career or to a relationship or to take any important action because you are afraid you might let your parents down by failing. Here are some examples of thematic summaries: • “There seem to be two issues that keep coming up. it often provides new information to the client. In fact. the thematic summary tends to push clients to an even deeper level of understanding or exploration. let’s talk about that. Remem- ber. I seem to notice a pattern. and I’d like to check it out. but that’s the way it is. or meanings expressed in many client statements or even over many sessions. Rather than signaling a transition to a new topic.136 Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing cLiEnt: “Yes. it is placed here because it is possible you may notice these themes as you practice. First. Sometimes these themes are referred to as “core issues” because they represent problems that appear in a variety of circumstances. Even though identifying themes is an advanced skill. It is best to propose themes tentatively. over and over again. they should be used only when you have enough information to be fairly certain that you have identified a theme. feelings. one major issue seems to be that. 1987). The planning summary brings a sense of closure and ends the session on a hopeful note. and agreements made dur- ing the session. It takes time for important themes to emerge. You want to follow your own interests. Identification of themes is an intuitive process. Planning Summaries Planning summaries entail a review of the progress. The helper must think back on the whole of his or her experience with the client and try to cull the big issues. or meanings that the client returns to again and again (Carkhuff. With this in mind. you’d like to identify some goals for your career. That is something you and I can begin to work on right away.” “Uh-huh. but you are far from satisfied with your relationships with friends and family. Figure 6. although it is impossible to expect that every session will follow the same sequence. Although the helper summarizes here. The NLC is a framework for understanding the sequence of skills through a particular topic of discussion between client and helper. Following is an abbreviated example of helper responses to client statements that represent a complete nonjudgmental listening cycle. you have accom- plished your financial goals. we thought about your entering a coun- seling group at the local mental health center. On the one hand. Each skill is most frequently used at its assigned position on the circle. which was intro- duced in Chapter 4. What do you think?” THE NONJUDGMENTAL LISTENING CYCLE ENDS WITH SUMMARIZING Summarizing is the final step in the nonjudgmental listening cycle (NLC). You have said that this is because you are not very assertive.” “Can you tell me more about that?” 3. Open question: “Would you tell me more about the accident?” 2.” “Yes. The listening cycle is composed of basic skills or building blocks that you have already learned. Besides that. actually.3 A Complete Nonjudgmental Listening Cycle Moving from Open Question to Summary . it may take more than one such cycle before the helper is able to summa- rize. We’ll set up an assessment program and talk more about this over the next several weeks. It sounds as though this is the area we need to discuss in our next session. How does all this sound?” • “Let’s recap what we have talked about so far. The topic being discussed is symbolized by a circle and a suggested order of skills is listed clockwise around the circle. The session is condensed to illustrate the major components in sequence: 1. Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing 137 to know yourself better. The NLC provides the beginner with some ideas about when to use certain skills. Closed question (important facts): “How badly were you hurt?” Open Question (start) Summary Minimal Encourager Reflection of Meaning Minimal Encourager Reflection of Feeling Door Opener Reflection of Feeling Paraphrase FIGURE 6.3 shows this graphical representation of the complete nonjudgmental listening cycle. Minimal encouragers: “Okay. shooting. The building blocks provide a foundation for that relationship.2 The NLC and Using Summaries What Happens after the Nonjudgmental Listening Cycle? The nonjudgmental listening cycle never goes away. Reflection of meaning: “You’ve always been proud of the work that you do. a questioning cycle is a blind alley that is almost inevitable in your early training. then more advanced plays can be constructed. . and rebounding. there are several issues that continue to worry you. Summary: “Though you’re recovering on a physical level. and is even able to paraphrase the content. Earlier in the book we used a metaphor of learning a sport like basketball to illustrate the sequence of the NLC. After several such cycles.” 6. THE TRAP Closed questions will lead to short answers that do not allow you any breath- ing room to construct a paraphrase or reflection. the helper has fallen into a questioning spiral. because the helper is engaging the client’s intellect with questions. In the following example. Many helpers are anxious to learn the more advanced skills and chafe at the repetitive nature of practicing these building blocks. In fact. When these skills become second nature.” 7. the discussion does not deepen and the helper is surprised to find that they have not even scratched the surface of the topic. including how you might perform at your job and how other people will see you. Reflection of feeling: “You’re embarrassed about what has happened and a little afraid that people blame you.4. the helper starts well. It is to establish a therapeutic relationship with the client. Paraphrase: “So you had to be in the rehabilitation center for several weeks and you’re still unable to work. using an open question.” MyCounselingLab Video Exercise 6. it is the default position of any helper when a new topic is introduced.” 5. which is the most significant predictor of success. A questioning cycle is an unproductive spiral that occurs when the helper does not follow the NLC but automatically reverts to closed questions when there is a pause in the con- versation. The question focuses the client back on content. Think about the real purpose of the building blocks. Now that you have been unemployed for several months.138 Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing 4. the helper is tempted to give advice because he or she has understood essential facts and expects that the client is simply in need of direction. In the questioning cycle shown in Figure 6. it is hard to feel good about yourself. and the helper follows this with a series of questions or minimal encouragers because the client’s responses become briefer and briefer. A Questioning Cycle Typically Found Early in Training Because it takes time and experience to gain expertise in using the building block skills. But because the helper is unable to use reflecting skills yet. or when the client experiences a crisis. and the relationship makes change possible. when the client reports new information. The client answers back right away in short sentences. he or she relies on a closed question to keep things moving. Players at all levels drill on the basics of passing. I am a little afraid to see everybody”? Here the helper has a golden opportunity to reflect the client’s feelings of fear and embarrassment. but I am in no hurry to face people. too. I felt terrible for months. and there were the physical problems. he or she is better off using a paraphrase or open question as a delaying tactic. I don’t know when I can go back to my job. but I am in no hurry to face people. using a paraphrase or an open question. “What is it like being out of work for so long?” is not responsive to the client’s last statement. and I focus a lot on the pain in my legs. When the helper is struggling to understand but cannot make a quick response. Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing 139 Open Question (start) Closed Question Minimal Encourager Closed Question Door Opener Paraphrase Closed Question FIGURE 6. the helper falls back on questioning. “Yes. and that car hit some people on the sidewalk.” HELpEr: “Do you think you are getting better?” cLiEnt: “Yes. GETTING OUT OF THE TRAP One way of escaping from the questioning spiral is to respond to the client’s last statement directly. I am a little afraid to see everybody. This will .” HELpEr: “How badly were you hurt?” cLiEnt: “I spent 2 weeks in the hospital with a broken femur and a broken ankle. taking the client to a more superficial level.” cLiEnt: “It was horrible—what can I say? It was a financial problem. HELpEr: “Tell me more about the accident. I had to go to the rehab center for the month of May. Instead.” HELpEr: “What is it like being out of work for so long?” cLiEnt: “I am bored.” HELpEr: “Can you tell me more about the wreck itself?” cLiEnt: “I ran into another car.” HELpEr: “Are they giving you some medication for that?” Can you see that the helper’s fifth question.4 A Questioning Cycle Typically Found Early in Training Note the client does not stay on the topic because the helper’s questions do not respond to the client’s last statement. I’m still using a cane to walk. ” HELpEr: “You’re worried that some of your friends will reject you because of the injuries to the other people. feelings.140 Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing buy a little time as you search for a reflection of feeling or meaning. Reflecting meaning is the first building nents of a client’s message include content. I’m not walking yet without a cane. block skill described in this chapter on advanced re- and meanings. Here is an example of how responding to the client’s last statement using encouragers. she does not know how to respond and so uses an encourager to keep the client on track. but I am in no hurry to face people.” (paraphrase) cLiEnt: “Yes.” (summary) Notice that in the helper’s third and fourth statements. and you’re still unable to work. reflecting meaning. it doesn’t seem sensible. reflecting feeling.” HELpEr: “When you think about it. “I think that everyone blames me for what happened. I guess I would feel even worse if my own friends blamed me. Reflecting content and feelings are im.” (paraphrase and reflection of feeling) cLiEnt: “Sure.” (minimal encourager) cLiEnt: “I think that everyone blames me for what happened. and you are still a little unsure about how others will feel about the accident.” HELpEr: “So it sounds like sometimes you blame yourself for what has hap- pened. it is also vital to iden. More important. paraphrase. but for a client to deeply sense life experiences. you are still recovering from your accident. earth the important issues in the client’s story. HELpEr: “How badly were you hurt?” (closed question) cLiEnt: “I spent 2 weeks in the hospital with a broken femur and a broken ankle. flecting skills. Summary In previous chapters. I don’t know when I can go back to my job. culture. includ- tify and reflect the meanings behind the client’s ing the ultimate meanings technique and asking open . but all the same.” (reflection of meaning) cLiEnt: “Sometimes I think like that.” (door opener) cLiEnt: “Well. and understand the story. you feel guilty about what happened. This buys her time until the client makes the statement. Meanings consist of the worldview and portant tools for communicating to a client that you values that arise from upbringing.” HELpEr: “So you had to be in the rehabilitation center for several weeks. it worries you. we identified that the compo.” HELpEr: “Okay.” (reflection of feeling and paraphrase) cLiEnt: “I guess it is not rational.” HELpEr: “So. I am a little afraid to see everybody. and a summary—in that sequence—can deepen the client’s self-examination. family. There are a number of ways to un- understanding from the helper. as I understand it.” HELpEr: “Go on. experiences.” Now the helper can respond with a reflection of feeling plus a paraphrase. I had to go to the rehab center for the month of May. I don’t know what they are thinking. and then “Something I am not very proud of is . should give the helper understand the situation. . look at the helper’s responses and see • When you have established a good reflecting how many of them are accurate reflections of mean. helper. unique viewpoint from previous topics.” strive for reflection of feelings. Whenever “My ideas about divorce (or marriage) are . steps. or are you looking ahead to the helper can record any useful feedback on this what you are going to say? Think about the same sheet and take this record home for further client’s last statement. By analyzing the NLC in tran- Summarizing is the second building block skill scripts or in classroom practice. . This can get the ones. and you have heard so far. Summaries pull together the whether he or she is responding to the client’s state- content. Understand- feels that the helper has understood at a very deep ing the NLC can help new learners decide which skills level.” encouragers as you get the details. Summaries should consist of plumb the depths of what the client says. time. The helper should re. As the helper reflects.” to the client?” “Why is he or she telling me this?” “What is it that bothers the client so The helper is to use encouragers and open ques. and follows and make reflections of meaning in response then tie in what you know about his or her to the client’s story. the observer calls lead you to meaning. one by one. and the client knows you ing. but the main emphasis should the major issues. take a risk and play feedback on key meaning issues that were missed. . Exercises GROUP EXERCISES Exercise 1: Reflecting Meaning QUICK TIPS: REFLECTING MEANING If you are having difficulty identifying the Form groups of three with a client. feelings. feelings. get. . . and provide a basis for planning the next helper responses that go beyond the superficial. importance. The client. and then reflect meaning. Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing 141 questions about values. . and meaning behind the client’s story. your best hunch about some deeper Group members then change roles and continue until underlying meaning that the client has not each person has had a chance to take the role of the yet disclosed. . . At this stage. to use at various points. consider observer. This means that the helper must use intuition to session back on track. make a reflection of meaning. The client is to pick a topic that is likely to these tips: evoke some deeper meaning such as: • Use the following plan in your practice sessions: “My greatest ambition is . client said. After 5 minutes or client’s statements. Later. try to use summaries when you are ting at the implicit messages rather than the explicit stumped during your practice sessions.” Ask an open question to start. . view the “Quick Tips: Reflecting Meaning” section that • Think about the client’s background. If you stay with the examination (similar to Table 6. When the facts. use minimal “My biggest disappointment has been . “Why is this story important is .2). “Something I would like to improve about myself • Ask yourself. a helper can determine described in this chapter.” possible. Summarizing is the final step in meanings of a client’s story are reflected. he or she the nonjudgmental listening cycle (NLC). in particular. . signal a transition in be reflection of meaning. they will 10 attempts at reflection of meaning. ments with deepening responses or is falling into the Summaries serve four purposes: to focus the client on mistake of shifting topics by the overuse of questions. Reflections of meaning are the session. Together. identify themes. and meanings in a distilled form. but the main goal is to • Be patient! Wait until you have heard advance hunches about the personal meanings that lie enough of the story to understand its behind the client’s disclosures. extrapolating about two or three sentences that encapsulate what the underlying meanings. helper. the observer is to write • Are you responding to the last thing the down all helper responses on a sheet of paper. much about the event?” tions to keep things moving. . relationship. Helper's words as close to verbatim as possible (13 possible answers) Depth Example: You feel that by revealing his secret you were letting yourself down.2 Depth Scale Make additional copies of this sheet for practice sessions or use lined paper. place an upward pointing use opening. who evaluates (3) If the helper response reflects unacknowledged feel- them based on their thoroughness. c S T _________________________________________________________________________________________ c S T _________________________________________________________________________________________ c S T _________________________________________________________________________________________ c S T _________________________________________________________________________________________ c S T _________________________________________________________________________________________ c S T _________________________________________________________________________________________ c S T _________________________________________________________________________________________ c S T _________________________________________________________________________________________ c S T _________________________________________________________________________________________ c S T _________________________________________________________________________________________ c S T _________________________________________________________________________________________ c S T _________________________________________________________________________________________ c S T _________________________________________________________________________________________ c S T Tally: .” The other members of the group listen to the en. c S T Example: So. Conduct a practice session with helper. and after 12 minutes. or basically keeps the conversation going. the observer and the client Look back in this chapter to the scenario of Joan and consider the following questions and rate each helper Lynn. or meanings behind the story. and reflecting skills but does arrow c next to that line indicating that the response not summarize. The topic is “a brief history of my fam. are they judgmental. is an tire dialogue. After reading that dialogue again. or do they merely fail to unteers playing client and helper. supportive. content. bers read their summaries to the client. The observer writes down each of the Discussion 1: Planning and Focusing Summaries helper’s interventions as close to verbatim as possible. and meanings? Were the summaries place a downward pointing arrow T. Students form groups of five individuals with two vol. is a paraphrase. they each write encourager. do they change the subject. is more superficial. down a summary of the client’s history. write down a TABLE 6. it was an accident. (2) If the response by the helper is ily. feelings. is an open question. Group mem. The concept of depth ship has gelled and how much trust the client feels. invitational. SMALL GROUP DISCUSSIONS and observer. a tool for judging the of the session is likely related to how well the relation- overall depth of your session. client. refers to the helper’s ability to enable the client to ex- plore new feelings. Exercise 3: How Deep Was Your Session? where do the majority of your responses fall? The depth Table 6. Although there is no ratio that differentiates a deep session from a superficial session. values. Tally the num- distilled or were they too lengthy? ber of each kind of arrow. Did they capture ings or meanings or in any way moves the client deeper. place a sideways pointing arrow S next to that line.142 Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing Exercise 2: Using Summaries response: (1) Do the helper’s words lead the client to make a more superficial response.2 is the Depth Scale. After the session ends. c S T Example: I'm sure you didn't mean to hurt his feelings. The helper tries to respond to the client? If so. and the training group I am a burden to you. write down a focusing summary that you might • Use a summary when the client is moving too use to begin the next session. and I’m not going to be able to pay my bills sure what I will talk about. Each mem. Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing 143 brief planning summary and share it with your class.or four-line statement about 6 months. Then.” A good assumptions (why is this important?): response to the preceding problem might be. identifying next steps. I’ve been very de. Lately I’ve had thoughts of hitting my child. • At the end of a summary. so I dread anyone call- this month. Use the following summary. My wife and I don’t seem track. too. So. feeling. “Have I got that right?” or “Am I and belittles me. form groups of four. but she won’t . If a friend calls on the phone. That’s not all. feelings. and that a fictitious client might give as a statement of a things are a little better. But every day I go to the presenting problem. Another option is to ask one participant Your reflection of meaning (content. isn’t me. The planning summary could summarizing to signal the client to move on be at the end of the session. When I finish with a quick “checking question” such tell my daughter something. I tried to talk to my wife. “I am extremely depressed and have been for ber is to write down a three. to see eye to eye on how she should be raised.” takes turns giving a reflection of meaning using the Client’s underlying meanings or hinted. Barbie. I can’t decide what to eat. This will tend to get things back on have to yell and scream. feel. They should down. How long do you think this is going to last? to do?” When writing the example. and meanings expressed? only meanings in a client’s statement. In this exercise. What am I supposed ing. But she doesn’t mind me. person. as follows: “I am having trouble getting my In the morning. criteria to give each other feedback on the summaries: • Was the summary no longer than two or three sentences? WRITTEN EXERCISES • Did the summary essentially capture the major Exercise 1: Identifying Meanings points? • Did the summary include the key events.” The trainer or leader asks for ___________________________________________ feedback from the group concerning the accuracy of the reflection. it is often useful to Maybe we don’t agree on a lot of things. you are asked to separately identify ings. in practice. unspoken formula “You feel _______ because _______. “I am a 31-year-old construction worker. For this discussion. It should be written in the first refrigerator and look in. my wife rolls her eyes as. to reflect the meaning using the formula and the next meaning): participant to rephrase it in more natural terms. I be stuck. The trainer or leader take care of me. I am now taking medication. “You are feeling really discouraged because your best does ___________________________________________ not seem good enough. She is • Use a summary when the client appears to the light of my life. to the next topic. This children to mind me. ___________________________________________ ___________________________________________ QUICK TIPS: SUMMARIZING 2. contain a brief synopsis of the thoughts. students should Never has anything like this happened in my fam- remember to include enough information so that a ily. inflection or word emphasis would Discussion 2: Creating a Presenting Problem certainly change the meaning of these statements. I even feel like reads each one anonymously. and • Try to finish every session with a planning meanings expressed by the client. of course. • When you feel like asking a question. I try as hard as I can. I feel so bad that my daughter has to come and reflection of meaning is possible. I am not pressed. She has a life. I can’t decide what to wear. 1. Summaries should be quickly and you want to slow the session about two or three sentences in length. try mates in a small group. Take into account • Is there a hopeful tone to the planning summary? that there may be more than one possible answer be- cause. Barbie won’t do correct?” what I say. Your final response was brought up with a belt. ___________________________________________ meaning): ___________________________________________ ___________________________________________ JEnniFEr: “You probably know I’m failing ___________________________________________ social studies. He lets me do what I write a specific response. I am indicate how they could be improved. Don’t you think she should have?” but I just can’t sleep. go back and look over your responses and spanked.” weight. That’s all my mom talks about. “My main problem is that I am overweight. But my not going to need social studies. She and my dad are divorced. I were actually talking to the client. Look at the televi- sleep very well. But only when I will be a summary. Listening Cycle When I go to his house. And I want to lose weight. but she needs to learn to mind. age 15. I don’t necessarily think she has to be signment. Her main goal is to pass social assumptions: studies. I am husband doesn’t realize that I have tried everything. And his mother didn’t ing me what to do.” ___________________________________________ Your reflection of feeling: Your reflection of meaning (content. the social studies teacher. I want to pass even correct him. She is about to fail her social studies class. ___________________________________________ Everyone in the class is probably failing. Maybe if every- body would leave me alone. It’s really boring and I’m am supposed to go along with the crowd. has problems with motivation. unspoken attend summer school.144 Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing listen any better than my daughter does. but I know he doesn’t find me wait until I get out of high school attractive anymore. and you have agreed to help. But I can’t that. But why can’t I be treated like an adult? At Exercise 2: Constructing a Nonjudgmental home. Record your answer as if you want. people tell- Children can be so cruel. going to be a flight attendant. So I sleep in class sion and magazines. My Client’s underlying meanings or unspoken friends are having trouble with Mr. my _________________________________________ 7-year-old son and I went to the mall. I would go and live with him . assumptions: Robinson. that’s how I feel. But is a slim body all that is and can run my own life for a important? How about unconditional love? If I lost change. there is space for you to pressure me. a high school house or anywhere else because she won’t listen. embarrassed when I have to take her to my mom’s Background: Jennifer. ‘You have a big fat mom!’ JEnniFEr: “It’s like this all the time. I can’t He never says it. he doesn’t After each client statement. In front of everyone. feeling.” sophomore. I know hard as she wants me to. feeling. I am not studying as 3. and one of his classmates was there. what would I have to do next? Dress some particular way? He says he is concerned about my Your paraphrase: health. ___________________________________________ Identify an open question or door opener to start ___________________________________________ the interview: Your reflection of meaning (content. the _________________________________________ other kid said to my son. but do you believe that? Last week. Now. _________________________________________ meaning): _________________________________________ ___________________________________________ ___________________________________________ JEnniFEr: “Yeah. Everybody’s skinny! I guess I sometimes. requiring her to Client’s underlying meanings or hinted. After you have completed the as- needed it. my mom is always after me. Then take a look at the building ent and helper using the format shown in blocks that follow and rate your current level of mas- Table 6. I will really be _____ Reflecting meaning hard to live with. the two can be examined. Be sure you have permission from your client to record. I’ll ing blocks of the helping relationship. The next task is to Your summary: convert the recording to hard copy. encouragers. Rather than asking _________________________________________ questions. Review the feedback you have received dur- made and transcribe every word of both cli- ing group exercises. If they Now that you have read about and practiced the build- make me go to summer school. ments appear directly below your helping 1 = I understand the concept. that is. he changes _____ Paraphrasing the subject. reflecting meanings. fall back on paraphrasing. Alterna- You have now learned most of the building blocks tively.” make a record of your present skill level by recording a longer session (20–30 minutes). The Homework 1: First Transcript summer is when you’re supposed to go to the mall and the beach. Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing 145 but when I bring it up. con- duct and record a session based on a concern A Midcourse Checkup that he or she is willing to discuss. naming each of the _____ Eye contact skills that your response exemplifies. If they make me go to _____ Reflecting feelings summer school. and even silence until you are able to make a reflection. it is time to probably sleep in class. _________________________________________ JEnniFEr: “The main thing is I have got to pass this class ’cause I can’t handle the HOMEWORK whole summer in school again. Although you have prob. problem of a friend or acquaintance or fabri- ably not mastered all of them. The comments section is a place for . Use only _____ Door openers and minimal encouragers the names of the building blocks you have _____ Open and closed questions learned. Some- _____ Body position times students describe their responses rather _____ Attentive silence than categorizing them. It is important to _____ Voice tone identify the skills you are using to determine _____ Gestures and facial expressions their frequency and appropriateness. 4 = I can do it regularly. responses. meaning): You may also be doing fairly well with paraphrasing. 3 = I can do it occasionally. Try to be as honest as possible. a transcript. and summarizing. your fellow student may role-play the skills presented in this book. It is important that the client’s com- tery for each skill. If you are Your reflection of meaning (or part of the like most beginners.” Examine the pattern of your responses. _________________________________________ Your goal as a helper in this transcript is to dem- _________________________________________ onstrate your ability to move from cycles of question- ing and paraphrasing to the use of the higher skills of _________________________________________ reflecting feelings and meanings. so that the connection between 2 = I can identify it and give examples. They have no _____ Summarizing idea. SELF-ASSESSMENT Step 1 With a partner from your training group. Step 3 Listen to the recording or read the transcript and make comments. This will help you identify areas where more practice Step 2 Choose the best 15 minutes of the video you is needed. encounter in real life. it is time for a brief cate a problem he or she might someday review and checkup. _________________________________________ but you may well be at level 2 or 3 on reflecting feel- ings. your invitational skills are strong.3. facial expression. and nonjudgmental listener. you to reflect on your responses.” H2: “Really? Tell me more. I missed the boat. • Do I seem engaged with the client. Maybe next time I will get the around the house. Note that each helper and client response is numbered so that the instructor can refer to them. Try not to be judgmental. H3: “She doesn't have anything else to Closed question Whoops. I think it do?” might have been better to reflect the client's frustration. to open up? In the comments section. I need to do some work problem. or am I too passive? Homework 2: Alternative to the Transcript— • How many paraphrases and reflections of feel- Making a Video ing did I use? • Did I rely too much on questions? Make a video as described in Homework 1. Rather than re- acting on a purely emotional basis. I think I will try something else next time. Dostoyevsky says in Notes from the Under- we form the basis for a therapeutic relationship?” Build ground that there are things that we are afraid to tell on your strengths before focusing too much on your even to ourselves and that every decent person has weaknesses. try to think about JOURNAL STARTERS the following questions: “Did I help the client to go Reread the “Stop and Reflect: Secrets” section in this deeper into the problem?” “In the brief encounter. I have been having a problem with a nosy neighbor. They see mistakes in body position or facial expression.” Minimal encourager and Seems appropriate at this stage. statement or to my own thoughts? nesses. • How many reflections of meaning was I able to back from fellow students and your instructor on your attempt? progress. What reaction do you imagine? voice tone inviting? Do you think such confessions are helpful? . door opener C2: “Well. did chapter.” client to focus more on that. Can you mentally • Was I able to get the client to open up? identify one of these issues for yourself? Write a para- • Are any of my gestures distracting to the client? graph about your secret as if you were telling it to a • Are my body position. I need to work the neighbor. Instead of • Did I reflect soon enough? making a full transcript of the video. you may also wish • Do I appear relaxed? to reflect on how you might improve. identify strengths as well. include a short description of the client and the nature of the issue to be discussed. many students see themselves on • What are my natural strengths as a helper? video and do not like what they see. But she won't let me. it seems a little today?” trite. For example. One of the big. She is not owning the on the computer. Client and Helper Responses The Skill You Used Comments H1: “What would you like to talk about Open question Looking at this now. Here are some questions to ask yourself: several such secrets stored away. Get feed.146 Chapter 6 • Advanced Reflecting Skills: Reflecting Meaning and Summarizing TABLE 6. I I notice that the client is blaming can't get anything done.3 Transcript Example In your write-up. she comes over every day. C1: “Well. • Are my words responsive to the client’s last gest mistakes at this point is to notice only your weak. Do not just • Do I allow silence sometimes to urge the client note weaknesses. The process reflecting? of identifying skills can be a form of practice. watch it again and • Did I overuse minimal encouragers rather than classify each of your skills as you watch. When I disagreed with my mother. CHAPTER 7 Challenging Skills When Should We Use the Challenging Skills? Giving Feedback • Why Is Feedback Important? • How to Give Feedback Confrontation • What Is a Discrepancy? • Why Should Discrepancies Be Confronted? • Cognitive Dissonance and Confrontation: Why Confrontation Works • Types of Discrepancies and Some Examples • How to Confront • Steps to Confrontation • Common Problems in Confrontation and Their Antidotes • Final Cautions about Confrontation Other Ways of Challenging • Relationship Immediacy • Teaching the Client Self-Confrontation • Challenging Irrational Beliefs • Humor as Challenge Summary Exercises • Group Exercises • Small Group Discussions LEARNING OUTCOMES • Written Exercises • Self-Assessment By the end of this chapter. Once it happened to be a knife and I needed ten stitches in my leg. 7. They were always very demon- strative and loving.3 Recognize confrontations in the context of a helping session.4 Evaluate confrontations using the Helper Competency Scale. In his book Vital Lies. 7. she threw whatever was nearest at hand at me. you will be able to: • Homework • Journal Starters 7. Simple Truths. 7. Daniel Goleman (1998) relates the following story told by a woman at a dinner party: I am very close to my family.1 Respond to client statements with a confrontation that highlights the discrepancies in the story. A few years 147 .2 Identify inconsistencies in a client’s story. 1. the client will see you as someone who is critical. Similarly. in the help- ing professions. 1974). and thoughts. or as a friend. the helper is bringing up topics and inconsisten- cies that may be painful for the client. as a helper person. and actions. these two challenging skills. he or she is using a challenging skill. Helpers have a duty to point out discrepancies and not merely accept what is on the surface of the client’s story. my father tried to choke me when I began dating a boy he didn’t like. Whereas the invitational and reflecting skills are supportive and convince a client to open up. the client’s trust in the helper is reduced.148 Chapter 7 • Challenging Skills later. Blanchard. the client does not engage in very much self- examination. 16–17) Goleman claims this tale is a good example of how people deceive themselves. Challenging skills are reflections that identify the conflict in the story. 2007).1. For most helpers. Depending on the mixture you use. Because the client cannot face the fact that she was the victim of child abuse. Life is simpler that way. this step in the journey is a giant one. she changes the story to its exact opposite. feelings. In the preceding excerpt. It appears that good managers find ways to balance pushing and supporting. one of caring and concern. It is a human tendency to block out these voices and smooth over the competing ideas. but she also must have been aware of the other voices saying their behavior was abusive. as someone who is apathetic. The client has found a ref- uge. When the helper uses challenging skills. much of what we do can be described as a combination of challenge and support (Keen. yet when the helper is highly challenging. Supervisors in business situations can be roughly described as supportive or nonsupportive and challenging or not challenging. On the bottom half of the chart in Figure 7. When challenge is high. he or she is giving the client an honest reaction or pointing out warring factions in the client’s story and encouraging action. you can see that when a helper does not use enough challenging. Sometimes it becomes necessary for helpers to “dare” clients to examine the inconsistencies in their stories by giving them feedback and. and this strains their relationship. If a helper points out this inconsistency. by confronting discrepancies. Consider Figure 7. & Johnson. Another way of looking at challeng- ing skills is that clients have multiple voices or stories that need to be told. potentially arousing resent- ment and discomfort.1 are based on research in organizational settings that have identified managerial styles (Hersey. the helper is asking whether the client is not paying attention to some aspect of the story. at other times. Although there is an element of pushing on the part of the helper. The helper awakens the client to unrecognized or purposely ignored aspects of the story through the use of challenging skills. the client perceived her parents as caring. The ratio of challenge to support has an effect on the client’s willingness to explore his or her own thoughts. Invitational and reflecting skills do not necessar- ily encourage the client to dig deeper or follow through with plans and commitments. it must be seasoned with a liberal amount of support. but challenging skills do. Making clients aware of uncomfortable information motivates them to act to make changes in their circumstances. push the client to critically examine his or her choices. The ideas behind Figure 7. 1976) or “joining” and “kicking” (Minuchin. feedback and confrontation. This ratio also affects the cli- ent’s willingness to trust the helper and to discuss either deeper or more superficial topics. By challeng- ing. (pp. and the helper’s revelations kill off protective fantasies. They really are very concerned about me. motives. On the . feelings. which depicts the relationship between support and challenge. 1 Balancing Challenge and Support left-hand side of the figure. Chapter 7 • Challenging Skills 149 High Challenge Moderate Challenge and High Support Criticizing Helping Low High Support Support Ignoring Befriending Low Challenge FIGURE 7. the client is probably encouraged to maintain his or her current behavior. When challenging skills are used. blind spots. After several cycles. It is high-support conditions along with moderate levels of challenge that lead to the best conditions for change. they are better able to make decisions and to operate free of illusions and “vital lies. the helper listens attentively using the nonjudgmental listening cycle (NLC). it also becomes clear that without support. low-trust situations. so carefully con- structed by the helper. He or she may then use challenging skills to help clients function with more accurate information about them- selves. There is a fundamental shift from relationship building to a focus on the goals set by the client and helper. the helper begins to detect distortions.” Challenging is consistent with the primary goal of helping: to empower clients by encouraging them to explore their thoughts. Figure 7. the helper strives to understand the client’s unique worldview by getting the client to open up. is at risk. When there is high support and low chal- lenge (befriending). With heightened self-awareness. feelings. the client does not engage in self-examination. and inconsistencies. and behaviors and to take steps toward their dreams and goals. the aura of safety and support. nor does the client wish to discuss deeper issues because the trust level is so low. As a client tells the story. WHEN SHOULD WE USE THE CHALLENGING SKILLS? During the initial stages of the relationship. conveying to the client that the help- ing relationship is not a friendship but a business partnership during which the helper .1 suggests that the worst conditions for help- ing are high-challenge. For example. feeling that she is not capable of attending college when there is evidence to the contrary. Second. a client may underestimate her intelligence. including group work.” People usually come for help when they experience pain in their interper- sonal worlds. discusses how she hides her financial difficulties from her husband. a client talks about how much she values honesty but. or basic skills. we will focus on two building blocks. For example. 1971). GIVING FEEDBACK Why Is Feedback Important? Disclosing oneself to others and receiving feedback from others are the twin processes of promoting personal growth. 1990. and advanced reflecting skills that you have already learned are the primary methods helpers use to encourage client self-disclosure. Clients need accurate feedback in order to confront inconsistencies in their own attitudes and to know how they are affecting others. we tackle the skill of confrontation. thoughts. This tendency is called mind reading and is a common problem among couples. the challenging skill that is the art of pointing out inconsistencies and blind spots in the client’s story. . Most problems that people face are “people problems. feelings. and values are inconsistent. Unfortunately. couples counseling. Learning to receive feedback is the other key to self-awareness and growth. A client may act on assumptions without con- firming them. • They are not operating according to their own values. 2004). Our significant others may withhold feedback because they do not wish to jeopardize the relationship. used to chal- lenge clients and help them deal with problems more consciously. For example. For example. reflecting. We have discussed how the mere act of confiding in another person seems to have many health benefits (Pennebaker. a client may blame the boss at work but refuse to look at his own responsibility for the poor relationship or his own work performance.150 Chapter 7 • Challenging Skills may have to hold the client’s feet to the fire in order to attain the agreed-upon outcomes. Many of the terrible singers on talent shows have been encouraged by their closest friends and family members to participate. the cli- ent believes she must be perfect. and individual and family therapy.” • They are blaming others rather than examining themselves. In this chapter. • They are operating with mistaken ideas and irrational beliefs. we often receive conflicting messages about ourselves from other people because even family members and close friends may be afraid to give us honest feedback. making statements such as the following: “I could tell by the way he acted that he did not want to date me anymore. • They are not working on the goals that they participated in setting. The skill of giving effective feedback is one that has wide application in helping. The first of these is giving feedback: providing information and your honest reaction to the client. and the ability to be “transparent” to others has also been linked with mental health (Jourard. The invitational. • They misinterpret the actions of others. • Their behavior. at the same time. Clients need to be challenged when: • They are operating on misinformation about the self. who may be giving feedback to each other in group exercises. On the other hand.” we are more likely to listen nondefensively. These are also good rules for trainees. To evaluate a client’s progress toward the goals Example: “As I see it. you have now been successful in overcoming your anxiety by facing the situations you have been avoiding.” 2. the sole purpose is to help the client.” Feedback may be rejected by clients because “the truth hurts. PET: Parent Effectiveness Training (1975. Feedback helps people grow when they are receiving constructive. How to Give Feedback In the helping relationship. Here are some suggestions about how to give effective feedback in a way that others may accept. the client’s most romantic ideas. When a person starts a conversation by saying. but I experience your behavior as pas- sive when you look away and avoid eye contact. Feedback from a professional—unlike that from family and friends—does not take into consideration the needs of the helper or concern itself with whether or not this will produce a strain on the relationship. Irvin Yalom (2000) compares the responsibility to give accurate feedback to the job of an execu- tioner because it is the helper’s duty to point out the holes and flaws in. 1. 2000). When a pro- fessional helper gives feedback.” 3.” because it is incor- rect in the client’s eyes.” “I notice that you don’t seem to have any friends. and some- times to kill. the helper has both the opportunity and the responsibility to deliver honest feedback even if it is uncomfortable to do and for the client to receive. Thus.” “I am hurt that you did not seem to acknowledge my birthday. To indicate how the client’s behavior affects the helper Example: “You say you want to be assertive. To supply a client with information based on the helper’s observation Example: “I notice that you never seem to talk about your father. Therefore. it is critical to deliver feedback in ways that benefit the client. Therefore. or because it is too harsh. specific information about themselves. Chapter 7 • Challenging Skills 151 Rosen and Tesser (1970) call this unwillingness to transmit bad news the “mum” effect. giving feedback means supplying information to a client about what you see. we are often operating with incorrect or inadequate information. feel. helpers endeavor to present feedback in ways that will make it more palatable. For example. Use I-messages. consider the following pieces of feedback: “I am uncomfortable when you talk that way about women. “This is my viewpoint. or suspect about him or her. Thomas Gordon described the process of delivering feedback as “I-mes- sages. Helpers only give feedback when clients ask for it or when clients need information to progress.” Most feedback statements delivered by helpers are I-messages because using the word I conveys that the helper is expressing his or her own perspective.” . In his classic book about raising children. in effect. They give feedback for three purposes: 1. client defenses rear up like impenetrable walls. Is that all right?” 5. concrete. your report has been late. and you need to wear a more formal shirt.” Good feedback: “I think you should improve your appearance at work. Poor feedback: “You asked someone out for a date. For exam- ple. you left the copy machine on again last night. It is hard to see how one can change one’s character and so such general remarks are easy to reject. You look disheveled. Poor feedback: “I think you should improve your appearance at work. 2006.” Good feedback: “For the past 3 months. “I would like to give you some feedback on something I have noticed. but you did not work on the other part of the assignment. It is easy to assume that clients are aware of their strengths and that we should focus only on their foibles. When too much feedback is given. Identifying strengths is part of “positive psychology” and focusing on positive character traits engenders hope (Lopez & Kerr. We tend to give more feedback to uncover unknown weaknesses rather than to point out assets. and a T-shirt really is not appropriate.” Good feedback: “I got the impression last time that talking about your father was difficult for you and you seemed to steer away from that topic. clients need to know what is going right. More often. Give only one or two pieces of feedback at a time. Poor feedback (boss to subordinate): “You are a procrastinator. Try focusing on the positive aspects first and bringing up the negatives later.” (only mentioning the negative) . You do not have to dilute the feedback.152 Chapter 7 • Challenging Skills 2. Be specific. Always ask permission before giving feedback. Maybe it is because you think you deserted him when he was ill.” 3. Let’s talk about that.” (I-message with specific content) 4. Poor feedback: “You’re bugging me. find an acceptable route to get the client to think about what is being reported. Poor feedback: “You are avoiding that issue with your father. Ward & Reuter. and what resources the client has to bring to the problem (see Wong’s [2006] strength-centered therapy and Ward & Reuter’s [2011] strength- centered counseling). Sometimes feedback about touchy subjects is accepted more easily if it is offered tentatively. what is working. Do not give people feedback on their personality traits or something they cannot change. For example: “You say that people at work are angry about your behavior. By the way.” Good feedback: “I find it annoying when you whistle during my favorite music. Would you like some feedback?” Or. where you were to confront your friend about her behavior. rather. your pants are wrinkled.” 7. Am I right about this?” 6. 2011). and nonjudgmental. and you forgot to call Dodie back. Do not forget to give feedback that emphasizes the client’s strengths. rarely allowing anyone else to control the conversation. Take a look at the X and the large dot shown in Figure 7. You may know that the optic nerve attaches to the back of the eyeball. Where it connects. I’m picking up that you have made real progress. What assignments might you give the client to make her more aware of this tendency? .2 Blind Spot The physical blind spot is only an analogy of the psychological phenomenon. the other eye takes over and corrects for this tiny blind spot and we never know that it exists. identify one or two other situations where the client might get this kind of feedback. Stare directly at the X on the left side of the page. Suppose I had merely told you about the blind spot? Which information is the most powerful in convincing you of its existence? • How can we help clients have experiences of their psychological blind spots rather than merely telling them? • Suppose you gave the client some feedback that you were 98% sure was true and accurate. Next. FIGURE 7.” 8. Use a follow-up question to determine whether the feedback was received and how it was accepted. What is your reaction to that feedback?” STOP AND REFLECT There is a parallel in our own optic system that can demonstrate the existence of blind spots or holes in our view of the world. there is a small gap in the picture your brain sees. it alerts us to the fact that our knowledge about the world and ourselves is not complete. Because we are unaware of these hidden parts of ourselves. Because we have two eyes. it takes some convincing before we believe what is revealed. write down a nonjudgmental feedback statement exactly as you would deliver it. In her interactions with you and with other personnel.2. you learned about your blind spot through actual experience. Close your left eye and slowly move the book straight toward your face. Con- sider the following questions: • In this experiment. and the client’s response was to dismiss it completely. you notice that she talks constantly. at least from a physiological viewpoint. Helper: “A minute ago. Even though it was a little scary. First. At about 12 inches. Chapter 7 • Challenging Skills 153 Good feedback: “Based on what you’ve said today. I pointed out that you have spent the last few weeks talking only about your ex-husband. Now hold this book with your right hand and stretch it out to arm’s length. the dot on the right side disappears. Still. How do you think you might react? How could you get the client to consider it further without damaging the relationship? • Suppose that a client feels rejected in her personal relationships. you asked two people for a date and one of them said yes. feelings. a mixed message. and the cli- ent is motivated to resolve them. sharing relationship. Albert Ellis. They use confrontations but qualify them as “double-sided reflections. words. helpers are careful to acknowledge the client’s point of view while pointing out the conflict. In fact. Some early group therapy meth- ods for treating substance abuse (the Synanon approach. which has been successfully practiced and researched in addictions pro- grams. and behaviors. For example: • A client says that she wants an equal. 1993). Confrontation creates emotional arousal and can lead clients to develop important insights and motivate them to change their behavior. or repressed. This information has added support to a theoretical approach called motivational interview- ing (MI). • A client says that she loves her job. or a conflict among a client’s thoughts.1 and Miller. 177). As a result of confrontation. • A client states that he wants to improve his marriage. But I am not going to give up going with my friends for a beer or two. or nonverbal messages. There is nothing wrong with that. behaviors. even with substance abusers.” . a con- sistent highly confrontational therapist style is not as effective as a moderately con- frontational one (see Figure 7. client awareness of inconsistencies is stimulated. but she complains about it constantly. Albert Ellis used loud voice tones or even curse words to intensify confrontations. • A client is intelligent and tenacious but is convinced he will not do well in school. However. it is an educational process that brings infor- mation to the client’s attention that has been previously unknown. liked showing clients the gap between their beliefs and rationality by directly exposing them to the “nuttiness” of their ideas. Straight Inc. In fact. Benefield. What Is a Discrepancy? A discrepancy is an inconsistency.) used personal attacks and abusive confrontation to create client movement in dealing with deeply ingrained behavior patterns. most well-known therapeutic systems use confrontation to some degree. the founder of rational emotive behavior therapy. but he forgets to go to mar- riage counseling sessions. & Tonigan. there is little evidence to support the use of such strong confrontation. The Gestalt thera- pist Fritz Perls confronted clients about incongruities in their nonverbal and verbal behavior (which he labeled “phony”). disregarded. In MI. The most powerful confrontation urges the client to resolve the inconsisten- cies. Why Should Discrepancies Be Confronted? Ivey and Simek-Downing (1980) say that “the resolution or synthesis of incongruities may be said to be a central goal of all theoretical orientations” (p. every problem contains discrepancies. but she only dates dom- ineering men. In essence. it appears that. In fact.” For example: Client: “Everybody wants me to stop drinking. Confronta- tions point out discrepancies in client beliefs.154 Chapter 7 • Challenging Skills CONFRONTATION Confrontation is the second challenging skill we will address in this chapter. and behaviors. and are less pushy as they provide support. they use confrontation more frequently. 1988). 1992). When people experience inconsistencies in their thoughts. Consider also the case of Donna. The researchers found that the students whose awareness of the risks had been heightened were more motivated and had higher rates of smoking cessation than those in comparable treatments. Fink. The conflict between smoking behavior and putting oneself at risk creates cognitive dissonance. Let us take the example of quitting smoking. She needs the job to help her mother. and they are motivated to reduce the tension. then. & Brandon. To use anything stronger could create a rupture in the helper/ client relationship. a 25-year-old woman who describes her job as good-paying but also as repetitive and boring. One study of college students who smoked asked them to view an online program about the effects of smoking (Simmons. As a consequence. this cre- ates tension. . It appears. Smokers may reduce the dissonance in a number of ways: to either ignore or misinterpret the facts about health risks or else tell themselves that they are “addicted” and therefore quit- ting is not under their control (self-handicapping strategy. Hays. Confrontation is an advanced reflecting skill that should be developed after the early helping building blocks of invitational and reflect- ing skills have been firmly established. that as helpers gain expe- rience. Either way. doctoral-level counselors demonstrated less dom- inance and verbosity than student helpers. At the same time. feelings. and attitudes consistent (Festinger. In this chapter. the helper acknowledges the client’s statement that he wants to continue to drink for social reasons and at the same time does not pull any punches by reminding the client of the problems alcohol has caused him. 2013). The helper’s agreeing with part of the client’s statement softens the blow of the confrontation. Research confirms that highly trained (doc- toral) counselors used confrontation more often than students (Tracey. Malone. Jenks. 1957). Smokers are aware of the health risks but also continue smoking.” In this double-sided reflection. Chapter 7 • Challenging Skills 155 Helper: (Referring to things the client has said in the past) “Although you often talk about the many problems that alcohol has caused in your life. you just can’t see quitting and distancing yourself from your drinking friends. smokers are pushing the risks out of awareness. which is the very thing that keeps the client in treatment and engaged with the helper. They were then asked to make a video recording of their own negative experiences with smoking and then they watched their recording. we urge you to consider how to raise inconsistencies in a client’s mind without alienating him or her. Heightening of awareness led to motivation. we can either convince ourselves that the incongruity is unimportant or else change one of the incompatible elements. Small. Cognitive Dissonance and Confrontation: Why Confrontation Works Do you remember the concept of cognitive dissonance from your first Introduction to Psychology class? Cognitive dissonance theory states that we are motivated to keep cognitions such as values. beliefs. talk less. & Herman. making it moderately challenging. Heckman. the distortion masks the fact that Donna does really want to go to college and the lack of intellectual stimulation does bother her. In this case. 2011. In the case of Donna. 1990). the client not only will reject the message but also may be less willing to explore feelings and to trust the helper (Hill et al. the client’s verbal messages. Many times. When helpers con- front people with these discrepancies. Pittman. Zanna & Cooper. and even investigate options to use her mind. but now the client is acutely aware of both sides of the conflict again and becomes moti- vated to change (Elliott & Devine. clients use defense mechanisms to escape disso- nance. The client’s frozen position has provided some security. 1994). Zanna. which is normally kept out of awareness by his or her defenses. 1975. it is possible to make decisions that are more reality-based and personally satisfying (Claiborn.. Strong & Zeman. Thus. This creates dissonance. Kiesler and Pallak (1976) reviewed dissonance studies and found a link between dissonance and physiological arousal (Cooper. 1978. 1986. Donna wants to go to college because she is not intellectually challenged in her present position. anxiety often resurfaces but so does awareness of choices. therapists tend to use confrontations sparingly because doing so is strong medicine. She deals with the tension caused by these conflicting thoughts by telling others and herself that education and intellectual challenge are not really important. Donna may realize that there may be nontraditional and incremental ways of taking classes she has not considered. It seems that clients actually change their attitudes in order to reduce the arousal caused when the helper makes the client aware of the two incompatible elements. 2000. we must remember that clients do not really like it because it produces negative emo- tions (Harmon-Jones. rather than making choices based on thinking and planning. and the client’s behavior. The confrontation causes anxiety because the client then becomes aware of this split. 2010). . If the helper’s confrontation is too power- ful and the client’s emotional arousal is too great. the helper might encourage Donna to become more aware of her need to be intellectually stimulated and ask her to talk about it. Hill et al. Norcross. but first she must be confronted with her ten- dency to push the inconsistency out of awareness. Although we may use confrontation to bring buried elements into consciousness. the client’s previous experiences. The examples that follow are simply meant to help sensitize you to the fact that discrepancies in a client’s story can take many forms. It is not important to memo- rize each of the types of possible discrepancies. Olson & Claiborn. For her.156 Chapter 7 • Challenging Skills who is struggling to survive on Social Security. 1988). 1983. Types of Discrepancies and Some Examples There are five elements of a client’s story that can come into conflict: the client’s worldview or beliefs. 1982.. & Taves. and they should combine it with a liberal helping of support. explore it. 1974). going to college may not be possible but pretending that her desire does not exist is creating a giant “blind spot” in her life. the client’s nonverbal messages. 1988). We all use such defense mechanisms to distort reality so that we can reduce anxiety. but the costs are too great. or else they risk causing a rupture in the relationship (Barkham & Shapiro. Croyle & Cooper. Without blind spots and defense mechanisms. I am confused. you are thinking that being together full time will make things better. But it’s not really helping. You know. too.” Helper: “If I understand you.” Helper: “Okay. You say that you want to give up cocaine. isn’t one of the problems that when- ever you spend any length of time together.” Helper: “From what you told me before. But if we moved in together. Every time I see one of my old friends.” Helper: “I’m confused. on the one hand. and yet you also say that you feel inadequate in her eyes and talk about a career change!” (confrontation) . Chapter 7 • Challenging Skills 157 Incongruity between Verbal and Nonverbal Messages Client: “It’s been hell. Sometimes he loves me. This whole thing. If I want to get ahead at work. They are really smart. you say that it doesn’t bother you. You say you are not smart enough and yet you are almost finished with your degree. I am almost finished with my degree but I didn’t sail through like they did.” (confrontation) Incongruity between Values and How the Client Behaves Client: “My son is the most important thing in the world to me. It doesn’t bother me. but somehow you’ve let other things get in the way. But I am not as smart as my classmates.” Helper: “Okay. I often think about starting a new career.” (confrontation) Incongruity between Beliefs and Experiences Client: “I do the best I can. I have to put in the hours. and yet I can tell by what you’ve said that it has been very painful for you. I need some recreation. you say that your relationship with your son means a lot to you. sometimes he hates me. I’m back into it again. my girlfriend and I have been having a lot of problems lately. But I just don’t have time to see him every week.” (con- frontation) Incongruity between What the Client Says and How the Client Behaves Client: “I’ve been going to Cocaine Anonymous as I said I would. I think things would improve. and yet you continue to see your old drug friends.” (confrontation) Incongruity between Experiences and Plans Client: “Sure. I should be making a lot more than I do. But I always feel that she looks down on me because of it. And I am a hard worker. That bothers me.” Helper: “Your laughing and smiling make me think the problem is not serious. It’s almost funny [laughs]. you fight even more? Yet.” (confrontation or “double-sided reflection”) Incongruity between Two Verbal Messages Client: “My wife makes twice as much money as I do. apa.org/index. experience.org/iMIS15/AAMFT/Content/Legal_Ethics/code_of_ethics. Strong confrontation. But a few of these issues point to ethical issues as well.socialworkers. believe. is a technique that should be discussed with a supervisor before it is applied. Using confrontation as a way to vent your frustration would not be ethical. Confrontation is an excellent exam- ple of a technique with important cultural and developmental implications. Others have recommended a gentle approach in using confronta- tion with African American and Asian American clients (Ivey. or show nonverbally) _____ but you also (think. some guidelines were given for its most effective use. value.counseling.org/pubs/code/default. Most ethical codes point to considering the cultural. Schectman and Yanov (2001) found that confrontation was not effective with children in groups in Israel. or show nonver- bally) ________.aspx National Association of Social Workers http://www. and spiritual background of a client before applying a technique such as confrontation. but your nonverbals said _____. plan. behave. For example. value. Helpers may feel frustrated when the client is not progressing quickly enough. The codes of ethics do not specifically identify confronta- tion. behave.php How to Confront The helper’s confrontational statement is a reflection that usually uses the following for- mula: “You (think.” “You believe _____.” “You said _____.nationalhumanservices.org/knowledge-center/ethics American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct http://www. say. plan. For more information. 2. consult the following codes of ethics on association websites: American Counseling Association’s 2014 Code of Ethics http://www.” (verbal versus nonverbal) Example: “You said you were happy. but the needs of the clients must take precedence over those of the helpers. 1994). but I don’t see that in your face.” (negative beliefs about oneself versus strengths) .158 Chapter 7 • Challenging Skills ETHICAL ALERT In our discussion of confrontation. Consider the following: 1.asp American Association for Marriage and Family Therapy https://www.aamft. religious. experience. believe.org/ethics/code/index. It is unethical according to the codes of helping professionals to use a technique that you are unfamiliar with unless you are under the supervision of someone who is adept in its use. but you possess _____. say. but there are guidelines for use of emotionally arousing techniques and the training you should receive before using them. being a potent method. Lazarus (1982) discusses how this technique backfired with some Native American children in a school counseling setting.aspx National Organization for Human Services (NOHS) http://www. 3. actions. This chart may help remind you of the formulas that you have learned. The following . Chapter 7 • Challenging Skills 159 Example: “You say that you believe you aren’t very strong or tough. have you earned the right to confront (Egan. but you spend nearly 60 hours at work each week. but you acted _____. but you also say _____. but the tenacity I saw when you dealt with the Veterans Administration does not seem to fit with that belief.” (plans or beliefs versus past experiences) Example: “You plan to try to become more socially active. verbal vs. In Table 7. In other words. on the other hand. this formula will help remind you to look for the conflicting aspects of a client’s story. you might find it helpful to memorize the following phrase: “On the one hand. each of the major building blocks is described along with its purpose. but your past experiences tell you _____.1 Practice in Identifying Discrepancies MyCounselingLab Video Exercise 7. when to use it. _____. take time to understand the issue and listen carefully. Although you do not wish to overuse this statement with clients. It also shows how confrontation follows the relationship-building invitational. values vs.” (verbal versus actions) Example: “You said you were excited about coming to counseling. Ask yourself whether the timing is right or whether a confrontation will prematurely place stress on the relationship. and advanced reflecting skills. nonverbal. etc. but there is a part of you that says you’ll be rejected like before.). 1977)? Step 2 Present the confrontation in a way that the client will most likely accept it. actions. but you haven’t been making your appointments.” (verbal versus verbal) Example: “Sometimes you say you are happy with your job. but you act _____.1. make your confrontations moderately challenging.1 When Worlds Collide Steps to Confrontation Step 1 First.” “You plan to do _____. opening.” “You said _____.” “You say _____.” (values versus actions) Example: “You obviously value your family.” “You value _____. In other words.” As you begin to identify discrepancies and present them to a client. reflecting. and a suggested formula. and other times you threaten to quit. _____. Move through the NLC to fully understand the client’s message and reflect feelings and meaning.” This formula allows you to plug in any two discrepant elements without having to name which elements are in conflict (verbal vs. MyCounselingLab Application Exercise 7. making sure the rela- tionship is well established before confronting. it’s not going too well. say.160 Chapter 7 • Challenging Skills TABLE 7.” Jyoti: “Sounds like it’s hard for you to pay attention to the strengths you have and the gains you’ve made this year. or show nonverbally) _______. plan.” Jyoti: “Okay. experience. plan. But I still have a long way to go. believe.’” (reflection of feeling) olivier: “Yeah. experience. and the meaning Confrontation (CON) Discrepancies in the story When the relationship is On the one hand. I’m confused.” (confrontation of cli- ent’s negative view of self and strengths) olivier: “I guess so. In a way. obviously I am not going to make it. We’ve talked about the fact that you’ve become more organized and gotten along better with your teachers. you strong enough (think. Formulas. Jyoti (Helper): “You say that this hasn’t been a good school year for you and you are thinking about dropping your Advanced Placement class. and Timing Building Block What It Reflects When to Use It Formula Paraphrase (P) Most important events When you are trying None and thoughts to understand what is happening or what the client is thinking Reflection of Feeling (ROF) Client feelings As soon as you sense You feel ___ when ______. value. you’re discouraged because you are getting a ‘B.” (paraphrase) olivier (Client): “Yeah.” Jyoti: “Well. the feelings. _____. On the one hand you say it’s been a terrible year but at the same time a lot of good things have happened this year. behave. behave. but on the other hand.1 Building Block Skills. or show nonverbally) _____. believe. if I understand it right. you (think. the emotions behind the content Reflection of Meaning The meaning When you have You feel ____ because (ROM) understood the content. You’re doing better than passing in your AP class but you don’t want to recognize that. say. you seem to prefer to focus on what you’re not . value. example shows a helper using open questioning and reflection of feeling to gen- tly usher in confrontation and reduce the negative impact. the helper must be ready to follow up with additional explora- tion. Chapter 7 • Challenging Skills 161 achieving.” Helper: (Following up) “What I said before was that on the one hand you can’t stand people who are not honest and I was wondering if you are little bit scared of broaching that issue.” . many confrontations “bounce off” because the client is not ready to look at the discrepancy or because the confrontation either is worded too strongly or is too vague. He gains some insight into his situation. it makes me mad. But there are some other people in the office that agree with me and so I have support. Michele.” Client: “Yes.” (confrontation of client’s avoidance of strengths and focus on weakness) olivier: “I’m afraid I would slack off if I patted myself on the back all the time. RESPONDING WHEN THE CLIENT DENIES THE TRUTH OF THE CONFRONTATION OR SHRUGS IT OFF Antidote: Follow up on the confrontation. MyCounselingLab Application Exercise 7. Jyoti’s second confrontation seems to be more acceptable to the client. For example: Client: “When I first met my co-worker. If you want to see the effec- tiveness of your confrontation. the helper should try another tack. Because clients often respond to confrontation either by denial or by super- ficial agreement. the aim of the confrontation is to examine both sides of the client’s view of the problem. I was excited about her because she seemed so nice but I soon caught on that she was just a fake. but she doesn’t listen to what anyone says and besides she has applied for a transfer and maybe that will solve the problem. I guess I just can’t stand that in a person. Here are three common problems in confrontation as well as some suggested ways of dealing with them (antidotes). another confrontation. examine the client’s response in a transcript. Did it push the client to examine the deeper issue? Unfortunately. or clarification. Step 4 Follow up the confrontation by rephrasing or retreating. When the client does not accept or rejects the confrontation outright. That is what deepens the conver- sation.” Step 3 Observe the client’s response to the confrontation. In this case. 2010).” Helper: “So you don’t like the fact that she talks about you behind your back but you can’t seem to be honest with her either. She talks about me behind my back and although I never say anything. The helper notes this and repeats her confrontation in a slightly different way.2 Practice Using the Helper Competency Scale (HCS) to Evaluate Confrontations Common Problems in Confrontation and Their Antidotes A good confrontation is one that the client responds to thoughtfully and that furthers the dialogue between helper and client (Strong & Zeman. In short. the client does not fully accept Jyoti’s first confrontation. rather than increase awareness and . Do you think it’s possible to have friends and be sober?” (asking client to resolve the dilemma) THE CLIENT APPEARS TO FULLY ACCEPT THE CONFRONTATION.” Final Cautions about Confrontation One writer called confrontations the “thermonuclear weapons” of helping. drug-using friends. would you be willing to think about this? Go to your next Cocaine Anonymous meeting and ask one or two people about this. But it’s not really helping. At such times. What do you do next? Sometimes the helper freezes because he or she is momentarily caught off guard by the client’s acceptance. the helper sug- gests that the client get ideas from fellow support group members. The dialogue shows how the client partially accepts the confrontation. I guess recovering addicts have new friends that don’t use. Every time I see one of my old friends.” Client: “All right. Client: “I’ve been going to Cocaine Anonymous as I said I would.” Helper: “I’m confused.” Helper: “So on the one hand you know that your friends are the greatest risk fac- tor for using again but on the other hand the idea of being alone is scary. But how you do that?” Helper: “I’m not an expert on this. But some people who have been off cocaine for a while must be familiar with this problem. the helper is encour- aged to focus the discussion on the areas of agreement and press for a resolution of the conflict. They are pow- erful. But what am I supposed to do? Stay by myself all the time? That I am not willing to do. You say that you want to give up cocaine. another problem can arise. She’s been sober for a year now. and their force can help or harm. Confrontation may arouse negative emotions and the defenses of the client or damage self-esteem.162 Chapter 7 • Challenging Skills RESPONDING WHEN THE CLIENT ACCEPTS ONE PART OF THE CONFRONTATION WHILE REJECTING ANOTHER PART Antidote: Having the client disagree with some of the confrontation but accept part of it can clarify this issue and lead to further dialogue. and the client and counselor then begin a deeper dialogue. The following is based on our previous example in which a helper confronted a client (1) who stated that he wanted to give up cocaine and (2) who continued to as- sociate with his old. In the following example. Client: “I don’t know. Then let me know what they have to say. and yet you continue to see your old drug friends. And I’ll talk to my friend Michelle. It seems like it might be fairly common. I’m back into it again. NOW WHAT? When the client accepts the confrontation. Antidote: The answer to this problem is to encourage the client to engage in some activity that helps resolve the two sides of the problem: something that reinforces the acceptance the client has identified. Between now and when we next meet.” (confrontation) Client: “I do want to stop using. The helper expresses his or her feelings in a way that does not overload or burden the client. or troubling issues and focusing the conver- sation in that direction. Chapter 7 • Challenging Skills 163 motivate action. we mentioned that the timing of the confrontation could be important. Relationship Immediacy When you meet someone for the first time. Relationship immediacy is a comment by the helper about what is happening in the relationship right now. such as the weather. It has been my experience that frequent and premature confrontations based on very little information tend to erode the credibility of the helper and thereby damage the relationship. strong challenges should not be made until the NLC has been firmly established. Relationship immediacy (Kiesler. Although the force of the confrontation should not be watered down with qualifiers. It is easier to discuss issues that are positive and uplifting rather than those that are negative or depressing. Obviously. However.2 Regrets OTHER WAYS OF CHALLENGING Besides pointing out discrepancies using confrontation. In general. and using humor. Among these are relationship immediacy. challenging irrational beliefs. the time for confrontation is when the client/helper relationship is well established and the client trusts the helper’s motives. The relationship can be a laboratory where the client can learn about his or her effect on others. MyCounselingLab Video Exercise 7. rather than talking about what is going on between us right now. 1988) is a technique that helpers use to give clients here-and-now feedback about their effect on another person—the helper. irrational. We hope that you will mentally note that they fall in the category of challenging skills and that supervision is necessary as you learn to use them. Immediacy statements by the helper should have three characteristics: 1. think about what issues are the most difficult to discuss. confrontation must be presented in a way that does not shame the client by saying “Gotcha!” We are aiming to deliver moderately confrontational statements with the client’s best interests at heart. The helper describes the client’s behavior or the helping relationship issue in non- judgmental terms. By the same token. The helper uses the word I in the statement to indicate that this is the helper’s per- spective. teaching the client self- confrontation. Earlier. 3. It is also easier to talk about issues that concern neither of us. it is sometimes difficult for the helper to bring up issues affecting the helper or the relationship between helper and client. These are more advanced skills but we mention them here because you will likely run into them early in your training through films or reading. . Tim- ing means knowing when confrontation will do the most good. It is easier to talk about past problems and previous relationships rather than present issues and relationships. 2. there are other methods for getting clients to pay attention to discrepant. the ability to give honest feedback and discuss the helper/client relationship openly gives it a special meaning that separates it from other social interactions. we seem to end up in a struggle and the issue gets dropped. It can be used to address or prevent ruptures by asking the client to honestly assess the quality of the therapeutic bond. I don’t feel listened to either. One way to do self-confrontation is for the client to write down everything that he or she considers to be a conflict in life. What is your reading on that?” Alternatively.164 Chapter 7 • Challenging Skills These three characteristics are illustrated in the following helper statement: (1) “I am aware that (2) when I make a suggestion. whenever she had car trouble.” If given as a writing assignment. the helper can ask the client to reflect on the relationship as it has progressed up to that point. It should only be used if it seems that the relationship issues between client and helper relate to the client’s goals or if the therapeutic relationship is strained and needs to be repaired. Lyddon. 1990. But the method can be applied more simply as a research project that the client conducts on himself or herself with the assistance of a helper. My experience is that the sessions are much more fun and productive. I have found that our relationship seems to have changed. I’m behaving just like your father. which she was having trouble deciphering. “You tell me that other people say you don’t listen to you. For example. 2006). (3) I am a little concerned about this. After a month of therapy. the client might be asked to respond to questions such as: “What is it that I don’t really want to do?” “What would it say about me if I changed in the ways people want me to?” “In what ways am I lying to myself?” . but I really don’t want to go to college. & Hermans. and handed it to the thera- pist who began reading it.” or “My parents want me to get better grades. As I am sitting here. It challenges the client to focus on the helper’s impressions of the therapeutic relationship. For example. but she has made it clear I am only a friend. “Over the past few weeks. she brought in her auto insurance policy. Can we talk about that?” In this vein. Fiddelaers. For example. “Look. Relationship immediacy is also an invitation to examine the client/helper relationship conflict as a microcosm of the client’s difficulties.” Helpers use relationship immediacy because the client’s interactions with the helper are probably similar to the client’s interactions with significant others. a skill that could provide lasting benefit when the helping relation- ship is over. What do you think?” Teaching the Client Self-Confrontation Although it is good to have the input of others. After a moment.” Relationship immediacy is “you-me” talk. Relationship immediacy can be of the “here-and-now” variety such as. a cli- ent might talk incessantly. she turned it over to him. the therapist laughed and exclaimed. I feel a lot of tension between us because we brought up the alcohol issue. Using an immedi- acy challenge. Relationship immediacy can enhance intimacy in a relationship because it acknowledges the mutual bond and gives the client liberty to also look at his or her feelings toward the helper. the helper might say. “I am in love with this woman. such as the one just presented. it may be more useful to have the client learn to self-confront. not leaving room for the helper to respond. Self-confrontation has been studied as a complex assessment and research tool (Hermans. “Right now. Yowell. Murray (1986) cites the example of a young woman who came to therapy because she felt she was overly dependent on her father. de Groot. It is one of the best ways of dealing with so-called resistance and transference reactions. & Nauta. For example. present.” 2. Challenging beliefs involves making the client aware of their irrational nature and teaching them to dispute these disturbing thoughts when they arise. Finally. but not the end of the world?” 3. No one gets helped there. although the helper highlights the irrational ideas in session. 1. This is the worst school. Overgeneralizing—“always” or “never” attitudes: “I went to one AA meeting and all they did was drink coffee and smoke cigarettes.” More rational challenge: “So. Is it really true that you get nothing from a meeting like this?” . client and helper identify a plan to solve the dilemmas. The organization is crazy. but this will give you a feel for the general categories. it’s uncomfortable for you to wait. Low frustration tolerance (“I can’t control myself”): “I can’t stop myself from calling my ex-girlfriend.” More rational challenge: “I wonder about this idea that it is the responsibility of other people to get you registered and help you when you didn’t even request assistance. and I get myself into big credit card debt. and future and helps the client explore the issues collaboratively. right? But is it really true that waiting is impossible or is it just annoying?” 4. Chapter 7 • Challenging Skills 165 “What possibilities in my life am I not paying attention to?” “What conclusions am I drawing about life that have no evidence to support them?” The helper then guides the discussion of these issues in the past. Shoulding and musting: “I must be the best in my class. Thus.” “I should have learned this by now. Blaming: “No one even tried to help me. Ellis has longer lists of common irrational beliefs. it is a tragedy. not mine. Challenging Irrational Beliefs Some cognitive therapists challenge clients’ strongly held beliefs when these beliefs are responsible for clients’ emotional suffering.” “I can’t wait to buy things when they are on sale.” More rational challenge: “Have you ever tried saying. Isn’t it pos- sible that there were some positive aspects of the meeting? Tell me why you think you must look at this in black and white. It’s their fault that I wasn’t able to register for classes.” 5. and it is awful. ‘I would like to be the best in my class’ without laying a ‘must’ or ‘should’ on yourself? I think it is those words that cause you to feel so upset when you can’t reach perfection.” More rational challenge: “I’d like to take issue with this idea that attending one AA meeting gives you enough information to make this blanket statement.” More rational challenge: “Isn’t it more accurate to say that it’s unpleasant. Following is a short list of irrational beliefs adapted from Ellis and Velten (1992). Together client and helper try to identify key themes in the client’s life that come from this discussion. a catastrophe. Awfulizing: “When I don’t get it right the first time. The client learns to confront his or her erroneous beliefs. dis- puting and replacing irrational thoughts is ultimately a form of self-confrontation. This is still an area I am trying to improve. at first. there is no substitute for knowing your client and having the kind of relationship where you can talk about ruptures when they occur. That is. I reas- sured her that after the requests from talk shows were rebuffed. She laughed with me and admitted that her fears were overblown as usual. that. especially through exaggeration. It can possibly be a needless distraction. rumors would be spreading like wildfire.” “Respect your family and don’t discuss concerns or problems outside the family circle. one of the most angry and difficult client populations. This has facilitated my developing rapport with clients and getting to the point in a relationship where they can accept confrontation. of course. of course. I was able to get away with this because I knew the client well. open. and willing to confront oth- ers.” These were the values and expectations instilled in me by my parents. not interrupt. and she did not perceive me as laughing at her. regardless of age or status. For someone who is assertive. Once. lawyers. at first.” “Respect your elders and don’t talk back to them. “Respect your parents and do as they say. would have been very disrespectful. I responded by agreeing that although she lived in a city of one million people. There would be newspaper headlines and. my job was to facilitate a group for court- ordered drunk drivers. . Respect is a core value in Chinese culture. My cultural style of passive acceptance has helped me develop unconditional accept- ance regardless of differences. Again. For someone like me who was taught to listen. But humor can also be a way of mak- ing a confrontation. and agree with others. It takes a great deal of skill to challenge a client’s beliefs in a way that does not alienate him or her personally. it was a daunting task. Frequently. It has taken quite a while for me to over- come this reluctance to be what my culture would consider “disrespectful” and to develop the necessary skills as a counselor to be assertive in confronting others. The goal is for both client and helper to gang up on the irrational beliefs while maintaining a good working relationship. especially older people and those in higher positions. When I first began working as a counselor. Humor as Challenge Humor can be one way of relating to clients and teaching them to view situations in a dif- ferent way. It could belittle the client or convey that you think his or her concerns are unimportant. Interrupting them. When doctors. everyone would be looking at her and treating her differently. as a divorced woman. the primary precaution of using humor as confrontation. and teachers were in the group and expressed opinions contrary to my curriculum. this would be a difficult job. in Chinese eyes. it was nearly impossible for me.” “Respect your teachers and don’t question or challenge them. to disagree with them. Chinese cultural values and beliefs have been both helpful and challenging to me as an emerging helper. You can imagine the challenges I had to face. especially my mother. television news. a client told me about her fears that.166 Chapter 7 • Challenging Skills You can probably see how confronting a person’s beliefs can feel like a very strong intervention. Both stories and humor seem to bypass the client’s defenses. she would be able to resume her private life once again. CULTURE CHECK The following is a story by Cindy Yee Fong about how she was brought up and how her family and cultural values helped her become a nonjudgmental listener and also presented a challenge when she was forced to confront her clients. She was born in China and believed strongly in these rules. there were older clients in the group who tended to “ramble on” in their dis- cussions. Clients tend to accept humorous stories because they are not seen as preachy or mean. Chapter 7 • Challenging Skills 167 • Cindy Yee Fong indicates that respect is one of the core values in Chinese culture. Videos of facilitate growth with challenging skills. that so much time has been spent on confrontation is There are two main ways that a helper can that it is the stuff of therapeutic legends. using an accepting environment in which the client’s story I-messages. yet kindly and with respect for the client’s ble. . Summary Much of the material in previous chapters has been recurring tendency to give up before achieving a devoted to learning how to use the nonjudgmental goal. worldview. when the helper vides honestly to the client to help the client. First. Which do you think will be the most difficult for you? How might you increase your comfort with these topics? • Would you find it more difficult to confront someone of a different ethnic or racial back- ground. Confrontation is an Paradoxically. your contract with the client implies that you will give honest feedback despite your personal discomfort. actions. Feedback is data the helper pro. informing a client that his or her personal hygiene is poor. the story also has inconsist. and the client feels a strong push from the helper. discussing whether the client is having an affair. and only when the relation- example of feedback is making the client aware of a ship is firmly established. encies and conflicts. However. including humor tween his or her values. Think about some specific situations that will create discomfort for you such as refusing an expensive gift from a client. The problems the client is experiencing serious challenge to the client’s version of the story. keeping the peace. Moderately challenging confrontations and may feel that the helper has abandoned his or are less likely to rupture the relationship. or else the client would not be Compared with feedback. the social rule that says to keep feedback to yourself. Inconsistencies are at the root of client problems be. may be due to incompatible ideas and motivations. The helper brings these to resolve them. The beginning helper is advised to use through feedback. the famous therapists show them making startling con- helper can provide the client with information frontations. and disclos- ing weaknesses? Was family business to be kept within the family? Do you think any of your own core values may have an effect on your willingness either to talk with clients about their deepest issues or to confront certain individuals? • One of the most common difficulties for most of us is overcoming the “mum” effect. talking about sexual problems. we gave some guidelines for listening cycle and adopting the attitudes that create good feedback that included being specific. someone older or younger than you. and identifying irrational beliefs. what cultural or family values would you describe as “core”? • What were your family’s values about contradicting others. confrontation sparingly and softly. methods to challenge the client. someone who has a high-status profession. In this chapter. or asking whether the client is being honest with you. An really knows the client. and words. feedback. this places a strain on the therapeutic art because one must point out these discrepancies relationship because the client becomes uncomforta. or someone of the same or opposite sex? How do you plan to overcome these limitations? Discuss with a small group some strategies for overcoming some of these roadblocks to feedback and confrontation. thoughts and feelings that ments in the client’s story and asking the client to they have pushed down. One reason her supporting role. clearly. blames the helper for entering unsafe territory. The helper can use confrontation as a the surface by using challenging skills and tries to reflection of the underlying conflicts or use other make the client more aware of the discrepancies be. confrontation is a seeking help. Thinking back on your own upbringing. dealing with tardiness. and asking for permission before giving can come out. As a helper. Confrontation involves identifying discrepant ele- cause they are blind spots. that you regret. discussion on a topic such as “What are the most impor.168 Chapter 7 • Challenging Skills Exercises GROUP EXERCISES with inner. and nonjudgmental. who will assume to the words of their counterparts in the inner group. • Give only one or two pieces of feedback at a x time. • Do not give people feedback on their tant personal characteristics of a helper?” or “What do personality traits or something they cannot you see yourself doing. 5 years from now?” Members need not take turns but • Be specific. client. For 10– 15 min. The problem might be the result of: the amount of time the person talks and how much he or she discloses. Finally. circle partners. • Sometimes feedback about touchy subjects is o x o accepted more easily if it is offered tentatively. to assume each of the three roles.3). any feedback that was especially accurate you do not feel good about. concrete. Following the feedback in dyads. and observer. Each member of the interpersonal style? outer circle is paired with an inner-circle member. the groups break down continues. The same number of you surprised by the accuracy of the feedback on your participants forms an outer circle. • Ask permission before giving feedback. not just his or her weaknesses. The outer-circle members sit behind the inner circle and across from the members they are paired with so they can observe them (see Figure 7. personally and professionally. Outer-circle members give feedback to inner-circle members about interpersonal style. If time permits. Four or five people sit in chairs facing each difficult. Arrows show partners FIGURE 7. each member should have the opportunity into dyads of the inner-circle members and their outer. • Conflict about whether or not to be honest in a fer their counterparts feedback using the “Quick Tips: relationship. As the exercise At the end of the discussion. x • Give feedback that also emphasizes the client’s strengths. or or helpful. inner-circle members identify. QUICK TIPS: GIVING FEEDBACK utes. Which role was more people. talkative? The outer-circle members of. • Conflict about a job or whether to relocate warm. the exercise can be repeated that you wish you could change . the inner-circle members engage in a leaderless • Use I-messages. In this situation was the person open. just hold an open discussion. outer-circle members are instructed to carefully observe nonverbals and listen Break into groups of three trainees. The Client’s Role Interpersonal style means the verbal and non- Discuss a problem that is causing an internal conflict verbal ways that a person communicates and includes or moral dilemma.and outer-circle members changing places.3 Fishbowl Activity Diagram Exercise 2: Confrontation During the discussion. Feedback should take about friend she depends on you too much 5 minutes. being the giver or receiver of feedback? Were other to form an inner circle. the roles of helper. change. for example. quiet. whether to tell a Giving Feedback” section. a class discussion can Exercise 1: Feedback—The Fishbowl Activity be held in which members compare their experiences This exercise works best with groups of eight to ten of giving and receiving feedback. o x o • Use a follow-up question to determine x = inner circle whether feedback was received and how it o = outer circle was accepted. for • Conflict about something you have done that their partners. After the tation. CQ for closed frontation and delivers it verbally to the client. “What makes this a dilemma?” or. suggestions described in Group Exercise 2). not be a problem if there were no discrepancy. “Am I on target?” Often the client will correct you and clarify the discrepancy. As 2. QUICK TIPS: CONFRONTATION 7. What seems to be a discrepancy may be a 9. 4. or fully accept your identification of presented as observations rather than accusations? the discrepancy? Follow up denial and Were they presented nonjudgmentally? Helper and partial acceptance with invitational and observer can also attempt to recall the client’s reac- reflecting skills to help resolve the tion to the confrontation and see whether the dos- dilemma. discrepancies. using a question such as.” feedback to the helper concerning the effectiveness • Note the impact of your confrontation on of the confrontations and the degree of discomfort the client. the group discusses which . one member (the client) describes Write down verbatim the helper’s responses and then a problem situation to the group (choose from the evaluate the helper on his or her ability to use confron. OQ for open question. • If you are having trouble identifying 11. client has spent a few minutes describing the situ- phrase. SMALL GROUP DISCUSSIONS Discussion 1: Collaborating to Identify Effective Confrontations The Observer’s Role In groups of four. ing the client’s responses. • Wait until you have heard the client’s whole 8. each remaining member writes down a con- tion of meaning. were the confrontations accept. Use Observer Name: _____ Helper Name: _____ the NLC to get the basics of the client’s story. identify discrepancies by pointing 3. Code the helper’s responses using P for para. Follow- encouragers. and then encourage the client to resolve the inconsistencies. story before you identify discrepancies. ______. on the other based on the Feedback Checklist. Do not include client responds to each confrontation in turn. partially they caused. Does he or she deny. Do not spend too much time on setting up the relationship. in 1. Ask yourself. The client gives hand. age was too strong or too weak for the client to • After you have identified a discrepancy. 6. The question. Helper Statement Coding Although this is critical in real helping situations. ROM for reflec. this exercise the main purpose is to practice identify- ing discrepancies and delivering them to a client. situation. ation. “On the one hand. them out. Chapter 7 • Challenging Skills 169 The Helper’s Role Feedback Checklist: Confrontation Review the “Quick Tips: Confrontation” section. “What are the two sides to the client’s problem that make this Postexercise Discussion situation so bothersome?” Use the formula The observer shares feedback with the helper. 5. ROF for reflection of feelings. ______. try accept. remember that there would 12. and CON for confrontation. soon as possible. For example. minor point once you know more about the 10. inconsistent and limited knowledge. Imagine what conflicts you might be that need improvement and present strengths. Try to identify the reflections of meaning (ROM). During their last encoun- • Near Expectations/Developing toward Compe- ter.e. and profes- pany is very excited about hiring her because of sional disposition(s) and behavior(s). Looking at both the clients and the you reach competency (a score of 4 or better). which would be most difficult for you to actu- ally confront? Helper Competency Scale (HCS) 1. of the following building blocks. strates harmful use of the specified skill(s) ment as she can and would like a new because the skill is performed in a way that challenge. responsibilities there are unlikely to improve. The client is very religious and is very judgmen- strong (i. These are the most hand. At age 22. skills. He comes for help • Meets Expectations/Demonstrates Competen- because he has become “addicted” to Internet cies (4) = the helper or trainee demonstrates pornography. She plans to continue in the “score” column on the left. members trade roles and continue until each has had a turn Using the HCS as client. When you of 3 or less on any skill suggests that you need to iden- have written your answers. The client states that she has just been offered a dispositions in the specified helping skill(s). The client is a 17-year-old high school student or encourage the client’s disclosure. using the formula “On the one confrontations (CON) you used. or focuses in an alternative school. fails to invite 5. A score experiencing if you were in that situation. closed questions (CQ). but her pay and helping skill(s). Following are five client situations. romantic relationship. It is important to get a these situations. go through Exercise 1: Identifying Discrepancies and count the number of open questions (OQ). First. the conflict is implied rather than picture of your present skill level so you can see areas actually stated. Instructions: By this point in the book. based on rubric descriptions. SELF-ASSESSMENT ceptable to the client. issues. and record rating to drop out of school. tencies (5) = the helper or trainee demonstrates 2. and 4. After this discussion. the helper should be able to demonstrate most indicated she must have a high school diploma. In a 20. even though her boss has session. • Exceeds Expectations/Demonstrates Compe- She smiles as she talks about this. Evaluate your session using WRITTEN EXERCISES the Helper Competency Scale below. She has worked at her • Below Expectations/Insufficient/Unacceptable current company on weekends and during the (2) = the helper or trainee demonstrates an summer since she was 17. and improved her poor grades to Bs and Cs. summaries (SUM). consistent and proficient ability in the speci- 3..to 30-minute working at her job. . exceeding the expectations of a tal about nonbelievers. An 18-year-old client describes how sad she is that Scale Evaluation Guidelines: she has to leave her parents and go off to college. she “exploded” because he did not attend her tencies (3) = the helper or trainee demonstrates wedding.170 Chapter 7 • Challenging Skills confrontations seem to be the most effective and ac.” In some of important building block skills. he has only a beginning professional helper) specified helping few friends and has never had a long-standing skills in this category. She is discouraged and has decided skills. harms the therapeutic relationship. _____. is very important to him. • Harmful (1) = the helper or trainee demon- She feels that she has made as much advance. The client says that he loves his sister and that she fied helping skill(s). you should have a recording or transcript of a helper/client session lasting at least 20 minutes. her years of experience. reflections of feelings (ROF). She has worked hard the client away from his or her goals. meet with a small group tify the problem you are having and then practice until and discuss them. and discrepancy in each. She says that she excess or deficit in the use of the specified feels the owner relies on her. abil- job as a manager at a new company. on the other hand. She failed her high school equivalency examination Directions: Evaluate the helper or trainee’s helping by 1 point. The com- ity to facilitate therapeutic conditions. _____. or does not use are minimal enough. helping session. and closed ended questions mostly closed with an emphasis questions for and may use questions. Helper Competency Scale (HCS) Near Exceeds Meets Expectations/ Below Expectations/ Expectations/ Developing Expectations/ Demonstrates Demonstrates toward Insufficient/ Building Block Specific Helping Skills Competencies Competencies Competencies Unacceptable Harmful Score Helping Skill(s) and Descriptors (5) (4) (3) (2) (1) Nonverbal Skills Includes body Demonstrates Demonstrates Demonstrates Demonstrates Body language is position. reflecting skills interventions session. of helping reflecting skills. distance communication that nonverbal in his or her communication from client. Uses intervention. leaving encouragers. sparingly. effective nonverbal effective inconsistency limited nonverbal not inviting. once. tone. for prolonged questions at Closed questions periods. majority of skills. relationship. use of silence. Questions Use of appropriate Demonstrates Demonstrates Demonstrates Uses open. Encouragers Includes minimal Demonstrates Demonstrates Relies too much Uses too many Instead of encouragers and appropriate use of appropriate use on encouragers encouragers reflecting. are used only when needed. posture. the client to fill in the silence too often. helping session. into the helping skills for the communication etc. Relies on questions open and closed appropriate use of appropriate use inconsistency ended questions as the primary questioning open-ended and of open-ended in using open. on open-ended the majority of closed questions May ask two questions. closed questions. eye contact. voice invites the client communication nonverbal skills. door openers such encouragers that of encouragers but occasionally instead of 70% or more as “Tell me more allow the client to for the majority moves to moving to of the helper’s about…” open up. 171 . Reflecting Reflection of feelings Reflections of Reflections Helper rarely Feelings are Absence of Reflection of feeling are regular. i.172 Helper Competency Scale (HCS) (Continued) Near Exceeds Meets Expectations/ Below Expectations/ Expectations/ Developing Expectations/ Demonstrates Demonstrates toward Insufficient/ Building Block Specific Helping Skills Competencies Competencies Competencies Unacceptable Harmful Score Helping Skill(s) and Descriptors (5) (4) (3) (2) (1) Reflecting Basic reflection Demonstrates Uses paraphrase Paraphrases Paraphrases Paraphrases Paraphrasing of content— appropriate use consistently are brief and are inaccurate are judgmental paraphrasing of paraphrasing to reflect the inaccurate. But utilizes beliefs. accurate and sad. focus. Focus is Paraphrases may way of reacting aspects of the paraphrases frequently on have the wrong to client story. Interspersed with distilled fashion. as a primary important More used. undershooting or overshooting. inconsistent in opening. rarely reflected reflection of Feelings accurate. and rarely or absent. upset. . Advanced Advanced reflection Accurately reflects Accurately Unable to Does not move Reflection of Reflecting of meaning including meaning several reflects meaning reflect meaning the client deeper meaning and Meaning values and core times during the at least once during the by reflecting deeper questions beliefs (taking session. and paraphrasing. and regular and Accuracy of and are either feelings or are frequently include a accurate. reflections is generally inaccurate. level) describe “why” the questions to get issue is important to at meaning. him or her. on values. inconsistent inaccurate or with some too general.. other people. Consistently during the session. reflecting skills. or some not.e. The helper is other invitational. of feeling are reflects feeling. paraphrase. client’s story in a are needed. helping to a deeper urging the client to session. core absent. signal understanding. Mullen. contain explicit or plans session to focus the session to signal or summaries veiled advice. 2015. discussion. a supportive fashion at least once during the session. thus do not inconsistencies and verbalizing but does not balance support discrepancies in inconsistencies explicitly reflect and challenge. _______: Total Score (out of a possible 40 points) *Number of: OQ___ CQ___ P___ ROF___ ROM___ CON____ *Count the number of each building block skill in the transcript or video. Helper Competency Scale (HCS) (Continued) Near Exceeds Meets Expectations/ Below Expectations/ Expectations/ Developing Expectations/ Demonstrates Demonstrates toward Insufficient/ Building Block Specific Helping Skills Competencies Competencies Competencies Unacceptable Harmful Score Helping Skill(s) and Descriptors (5) (4) (3) (2) (1) Advanced Summarizing Uses summaries Uses summaries Uses summary Summaries Summaries are Reflecting content.91 (p < . the client’s words and discrepancies discrepancies. and record here for comparison with other sessions. feelings. Swank. The skills portion of the CCS-R showed an interrater reliability of . and focus the reflections of plan for the future. and the session to plan for the that point. future. & Blount. Confrontation Challenging client Demonstrates Demonstrates Uses other Absence of Confrontations to recognize the ability to the ability methods of confrontations of are harsh or and evaluate challenge clients to challenge confrontation any kind in the judgmental and inconsistencies through verbalizing clients through such as humor session. words and/ Balance of challenge or actions in and support. Note: The HCS is based on the Counselor Competencies Scale by the University of Central Florida faculty and the Counselor Competencies Scale–Revised (CCS-R): see Lambie. discussion. are not accurate understanding. this session.001). and future at the end of the during the of the session. and/or actions in a in the client’s supportive fashion. 173 . during pauses and at least twice only at the end totally absent in judgmental or Summarizing behaviors. you may write about. It may have been about a weak. In a single page. and per- ceptions in order to gain the love of another. identify an incongruity or discrepancy about a job well done or some aspect of your appearance in your own life that you are willing to talk about. What made the feedback positive? Finally. needed now to resolve the discrepancy? Do you think this method of self-confrontation would work for an JOURNAL STARTERS adult client? What about an adolescent? Carl Rogers said that the greatest harm one can do to Homework 2: Receiving Feedback the self is to deny one’s own thoughts. of ways that you have used defense mechanisms to re. How important do you think it is for a helper to con- petent? Did you try to protect yourself by denying or front clients when they are not being true to themselves? . a have you ever had an experience where you received no discrepancy you have noticed in another person. feelings. Can you think of an example of when you you have received. Alter. were not true to yourself in order to stay in the good ness in your appearance. negative.174 Chapter 7 • Challenging Skills HOMEWORK discounting the feedback? Did you learn anything con- structive from the negative feedback? Homework 1: Identifying Discrepancies Now think about a time when you received some through Self-Confrontation positive feedback on a personal strength. a job evaluation. or personality. Reflect on Think about a particularly difficult piece of feedback Rogers’s idea. natively. or just make you feel incom. How deeply does What effect do you think a lack of feedback would have this discrepancy affect your (or the other person’s) life? on a person’s behavior in the long run? Of the three Do all problems contain discrepancies? Can you think kinds of feedback mentioned here—positive. How did you sponded to a confrontation that highlighted the discrep- respond emotionally to the feedback? Did it make you ancy between your actions and what you truly believed? angry. and none—which helped you the most? How might you duce dissonance or other methods of self-deception to apply your reactions to your future dealings with clients? decrease your discomfort? What action steps would be Summarize your reactions in two or three paragraphs. Write feedback after expending considerable time and effort? down the two sides of the dilemma. or perhaps graces of others? How do you think you might have re- even feedback you received in this class. hurt your feelings. for example. in a disguised fashion. Behavioral Assessment • C. we have been looking at creating a therapeutic Clarifying Goals relationship using the nonjudgmental learning cycle (NLC) and The Technique of Using Questions to challenging skills to produce a supportive environment that also Identify a Goal • Questions That Help Make the Goal pushes the client to be aware of all aspects of the problem. Family History • 3. Cultural and Religious/Spiritual Background • 4. you will be able to: • Goals Should Be Simple and Specific • Goals Should Be Stated Positively 8. • Goals Should Be Important to the Client 8.3 Identify well-formed behavioral objectives. Resources for Identifying and Up to this point.2 Recognize questions that clarify a client issue and the technique • Goals Should Be Collaboration between of boiling down the problem in a helper/client dialogue. It illustrates that the next • Questions That Help Turn a Problem into stages are assessment and goal setting. Developmental Issues • 2. You will likely take an entire a Goal • Questions to Determine a Goal’s course devoted to assessment and so the major focus in this chapter Importance will only be to highlight its importance and connect it to goal setting. Physical Challenges and Strengths Categorizing Clients and Their Problems • Organizing the Flood of Information: Making a Diagnosis Goal-Setting Skills • Where Do I Go from Here? Set Goals! • Why Must We Set Goals? • When to Set Goals LEARNING OUTCOMES What Are the Characteristics of Constructive Goals? By the end of this chapter. Figure 8. Helper and Client • Goals Should Be Realistic 8. Affective Assessment • B. CHAPTER 8 Assessment and Goal Setting Why Assessment? • Assessment Is a Critical Part of Helping • Reasons to Spend Time in the Assessment Stage Two Informal Methods of Assessment That Every Helper Uses: Observation and Questioning • Observation • Questioning Conducting an Intake Interview: What to Assess? • A. 175 . Cognitive Assessment • 1.1 More Specific shows the road map of the helping process.1 Identify the key areas of assessment in an intake form. I recommend that the helper set aside time for an initial assessment during the second stage of the helping process (Figure 8. Exercises • Group Exercises • Small Group Discussions WHY ASSESSMENT? • Written Exercises • Self-Assessment Assessment means gathering information about a client and his or • Homework her problems. you will not be able to set realistic goals. START Relationship Building HERE Assessment Goal Setting Intervention and Action Evaluation and Reflection STOP FIGURE 8. Helpers collect information in a variety of ways. Informal assessment encompasses all the other ways a helper learns about a client. Formal assessment may occur at a specific time in the helping relationship. In this book.1).176 Chapter 8 • Assessment and Goal Setting • Questions to Enhance Collaboration on Both of these activities provide the basis for deciding which Goal Setting techniques you will choose to help the client in the intervention and • Questions That Help Confirm That the action stage.1 Road Map of the Helping Process . • Journal Starters beginning with the first contact as the helper observes the client’s behavior and listens to the story. but infor- mal assessment is an ongoing process. If you do not understand the client and the client’s Goal Is Realistic problems. Formal assessment methods include testing and filling out questionnaires and forms. including observing and questioning. then you may choose the wrong interventions to try and Problem achieve them. If you have fuzzy The Technique of Boiling Down the goals. Let us look first at assessment and the crucial role it Summary plays in setting achievable goals with the client. Therefore. Assessment Is a Critical Part of Helping Sometimes you will hear that gathering a lot of historical information about a client is not worthwhile. More important. & Fretz. I might have sent him away without treatment. I talked separately to his 28-year-old son. It is very common. which might include test- ing. who had waited patiently outside. with the only assessment activities being the collection of basic demographics. The second and possibly a third session are spent in more in-depth assessment before moving on to a goal-setting phase. They leave the first session believ- ing that they have made a start on solving problems. instead of feeling dissected by tests and probing questions. You must know your customer thoroughly (Gelso. Just because a client is well groomed and comes from a prominent family does . and so they ignore history and personality data. Imagine how you would feel if you went for a doctor’s appointment and were asked only to fill out forms. so using a structured form for assessment is advised. they give much more informa- tion during the formal assessment period that follows. I might have saved some time. does not always lead to such spec- tacular embarrassment. contrib- ute blood samples. asking them to come in early or stay later than the session can be an effective way of collecting information about their background and current functioning. When clients have been invited to tell their stories. The client had simply filled in the gaps of his history with very convincing fiction. It is important to listen to what clients leave out and where they minimize or deny. Nutt Williams. Key data need to be collected at the first interview. I couldn’t understand why he had con- sulted me. and answer questions. It is true that some helpers do spend an inordinate amount of time gathering background information and administering tests. as he was very convincing. but were not allowed to talk about the reason for your visit. He had led an interesting life before retiring about 2 years before we met. 1993). Lukas. Conducting superficial assessments. about 10% of the time may be devoted to assessment. Chapter 8 • Assessment and Goal Setting 177 Because each client’s situation is unique. The son told me his father had been a physician in Texas and 5 years ago developed a syndrome. a severe brain disorder with a deteriorating course. by failing to collect critical data. for helpers to accept the client’s story without a critical thought. Once I interviewed a 65-year-old man who had been a shoe salesman in Cleveland. however. If I had tested the client’s memory or talked to his son first. if a client is seen for 10 sessions. As a courtesy. one takes the chance of making a serious mistake. observation of the client’s behavior. He reported no real difficulties. it is easy to forget to ask specific questions. Also. Still. and. and whatever else you can glean from the client’s story. Even the most astute helper can make drastic mistakes. though. On the other hand. Certain theories emphasize the present and the future rather than the past. That incident taught me that it is best to get as much infor- mation about a client as possible and information from a variety of sources. For clients who can read and write. it is impossible to predict how much time to give to each stage of the helping process. 2014. a rule of thumb is to spend one session primarily in relationship building. had I relied on the client as the sole source of information. but there are several ways to handle this. Beginning a relationship with formal assessment can be a mistake because the initial moments of any human encounter are so important. which was thought to be Alzheimer’s disease. the diagnostic bible.m. we discovered that her angry outbursts all happened between 1 p. When a client arrives for treatment. on days when she had not eaten lunch.178 Chapter 8 • Assessment and Goal Setting not mean that he or she should not be asked about drug abuse or suicidal thoughts. which in turn helped in her relationships and her work. After some reflection and homework by the client. Reasons to Spend Time in the Assessment Stage ASSESSMENT HELPS YOU DETERMINE WHETHER THE CLIENT IS A GOOD CANDIDATE FOR THE HELP YOU CAN PROVIDE Therapeutic help from a trained professional is not the best treatment for everyone. 2009). be moti- vated to change. and be able to attend sessions and understand what is going on (see Truant. occupational. A physician helped the client to deal with a problem of low blood sugar. chemotherapy. ASSESSMENT HELPS CLIENTS DISCOVER EVENTS RELATED TO THE PROBLEM A woman came to a community clinic asking for help in dealing with problems at work. ASSESSMENT GIVES CRUCIAL INFORMATION TO PLAN USEFUL AND REALISTIC GOALS The main purpose of assessment is to gather information that will be useful in planning the goals that will guide the helper and the client. recognizes that misdiagnosis can occur when the helper is not familiar with a client’s cultural background and interprets symptoms within his or her own cul- tural context (Alarcón. the helper must throw the net broadly enough to make sure nothing crucial escapes.” Clients with fewer verbal skills might benefit from art or music therapy. Thus. in a shelter. the first thought should be: Is this the right place for this client? For example.m. counselors are only available one day each week. psychological. ASSESSMENT HELPS US UNDERSTAND THE IMPACT OF THE CLIENT’S ENVIRONMENT ON HIS OR HER MENTAL HEALTH For example. As far as breadth is concerned. The next section indicates how assessment can provide the helper with critical information about the client for his or her best treatment. the existence of mental disorders. and social history as well as current functioning. or alone? Does the client suffer isolation because he or she does not speak the dominant language or belongs to a religious minority? If the client is a child. but she had never connected this with her behavior on the job. and the “presenting prob- lem” or specific issue that acted as a catalyst for the client’s decision to seek help. There may be better avenues of help for the client than “talk therapy. what is happening at . Assessment must have both breadth and depth. in our university clinic. The client must have the capacity to form a relationship. That is why many treatment facilities use a standardized assessment or psychosocial intake form that requires details about the client’s medical. The client knew that she became grumpy when she was hungry. Depth refers to focusing on specific issues such as suicide. She recog- nized that her job was stressful. and 2 p. and support group alterna- tives. We refer those who are not to a more intensive treatment center. we need to assess clients to make sure that they are stable enough to get along on their own between sessions. and her extreme irritability diminished. is the client living with family. 1999). online learning. but she found that she was unusually irritable with her co-workers and wanted to work on that problem. There are also educational. Our prejudices and worldview color our definition of pathology. Even the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association. TABLE 8. Although it is not possible to always accurately predict violent behavior. The behavior of people from different cultural groups may be judged as being more pathological than of those who share our own background. seeing no meaning to keep living? Anger: Is the client’s mood angry or hostile? Is he or she feeling vengeful toward someone? Trapped: Does the client feel there is no way out of the present situation and that he or she is better off dead? Hopelessness: Does the client have a negative view of the future and feel that he or she is a lost cause or beyond help? Withdrawal: Has the client withdrawn from family. especially by collecting a thor- ough history. A systematic assessment helps us be less manipulated by these strong social influences and more objective because we are recording the answers to standard questions rather than merely relying on our own impressions.) School counselors are recognizing the need to assess for violent behavior in the aftermath of school shootings and in the wake of renewed interest in bullying (Bernes & Bardick. and a client who is exhibiting any of these symptoms (especially ideation) should be further evaluated. & Lebrón-Striker. friends. 2007.1. IS PATH WARM (see below) is an acronym that was developed by the American Association of Suicidology (2006) to gauge suicidal risk (see Juhnke. Felix. 2011). or encouraged by a teacher? ASSESSMENT HELPS US RECOGNIZE THE UNIQUENESS OF INDIVIDUALS We all have the tendency to generalize and stereotype. 2011). such as driving at high speed or taking other chances? Mood: Is the client experiencing drastic mood swings? Is the client feeling depressed? . 2007. values. It must be remembered that these are guidelines based on risk factors and that there is no foolproof method of determining how suicidal a client might be. Sharkey. a history of self-inflicted injury or harm to others can cue us to examine the client’s situation more thoroughly and take precautions (see Granello & Granello. & Tanigawa. Granello. Then. & Granello. Assessment can also be useful in helping clients recognize their unique personality.1 Is Path Warm? When you suspect suicide. or write about a desire to self-destruct or to purchase the means to do so? Does the client show an intention to carry out the plan? Substance Abuse: Is the client intoxicated or has he or she been abusing alcohol or other drugs? Purposelessness: Is the client adrift. Ideation: Does the client think. the rule of thumb is to err on the side of caution. ASSESSMENT UNCOVERS THE POTENTIAL FOR VIOLENCE Assessment can identify indi- viduals who are at risk for violence toward self or others. rejected by classmates. we may make assumptions about them through our own cultural lens. take it seriously and get immediate help. 2010). However. talk. Chapter 8 • Assessment and Goal Setting 179 school every day that might be affecting the problem? Is the child bullied. Granello. you should ask the client directly about his or her thoughts about hurting himself or herself. and other supportive people? Anxiety: Is the client experiencing anxiety that interferes with sleep and daily functioning? Recklessness: Does the client engage in risky behaviors. and interests (Armstrong & Rounds. 2007). Juhnke. Unless we ask clients about family and cultural background issues. (See also Table 8. Green. without a sense of meaning and purpose in life. Ward & Reuter. . 2010. 1992). and spiritual resources (Myers & Sweeney.2 shows a simple assess- ment device called a time line. you will be better able to identify an effective plan. 2011). Strength-based assessment is. & Ryser. 1996). social. ASSESSMENT HELPS CLIENTS BECOME AWARE OF IMPORTANT PROBLEMS Frequently. chances are that you have not considered assessment as a critical part of that process. A wellness philosophy also emphasizes strengths. & Duncan. 1967). 2005. If you know when and where your client has panic attacks.180 Chapter 8 • Assessment and Goal Setting Rafael Age 12 Age 15 Age 21 Age 23 Age 25 Parents Met Future Married Son Divorced Divorced Wife Born FIGURE 8. 2004. Lopez & Sny- der. Strength-based assessment instruments such as the Behavio- ral and Emotional Rating Scale (Epstein. painful issues are pushed out of awareness or remain unrecognized until brought to the surface through assessment procedures (Granello. in part. Kiselica & Englar-Carlson. Harniss. Yet how do you know which techniques to use? The answer is derived from two sources of knowledge: information about your client and information about the client’s problems. the results can be an eye-opener. Rafael was asked to fill in the boxes with critical life events in sequential order. Wüsten. Pearson. emotional. occupa- tional. His choice of key interpersonal events gave a glimpse of his world- view and his major concerns. for example. Witmer & Sweeney. ASSESSMENT HELPS THE HELPER CHOOSE WHICH TECHNIQUES TO USE When you think about learning helping techniques. ASSESSMENT CAN HIGHLIGHT STRENGTHS. it is difficult to discuss helping techniques without thinking about how we choose which methods to use with which clients for what particular problem (Paul. Hubble. If you know that your client is very religious. Zinbarg. & Wampold. Another emphasis for assessment is to base it on a wellness philosophy. Thus. you will be able to select techniques that the client will embrace. mental. 2009. 1999) have been developed in recent years in response to this need. but its holistic point of view advocates evaluation of clients’ physical. 2010. 2010). The next section covers the basic techniques of assessment that are appropriate to use at all stages of treatment to gain knowledge about clients. Many alcohol treatment centers take thorough histories and use motivational interviewing as a beginning step in breaking down the alcoholic’s denial system (Miller & Rose. a reaction to medical models based on pathology. When clients are asked to list and discuss the problems that alcohol has caused. A common example of this is substance abuse. 2009). cognitive. Epstein.2 Time Line Assessment ASSESSMENT REVEALS CRITICAL HISTORICAL DATA Figure 8. NOT JUST WEAKNESSES AND PATHOLOGY More and more helpers are using assessment tools that identify client strengths and competencies (Flükiger. It is also being recognized that build- ing on client strengths enhances client self-esteem and helps client and helper use time more effectively (Miller. She explained that living on an island means that travel is more restricted. both formal and informal. Chapter 8 • Assessment and Goal Setting 181 TWO INFORMAL METHODS OF ASSESSMENT THAT EVERY HELPER USES: OBSERVATION AND QUESTIONING By using the informal assessment techniques of observation and questioning. and experiences color what we observe. some helpers can catch signs of alcohol abuse from a client’s hand tremors. may seem inconsequen- tial to someone else. When we heard these explanations. Most of the assessment methods we use. Flip or Flop. my companions and I met a large group of Japanese tourists taking hundreds of pictures of a Dutch windmill. after she noticed a lump on his thyroid. she indicated that pic- tures are a way of sharing experiences with family and friends back home. which has since been successfully treated. Our family backgrounds and culture shape what we remember and pay attention to. Freeing our- selves entirely from this conditioning is nearly impossible. Ryan Read. Observation Yogi Berra once said. finger swelling. It turned our Tarek had thyroid cancer. I have tried to take special care in recording and reflecting on my observations when a client is culturally different. Experienced helpers are able to detect patterns in clients from a number of small clues that. concerted effort. revisit this section and reflect on what you may be bringing to the picture you are painting. on the surface. For example. “You can observe a lot just by watching. excessive and annoying. observation can be just as crucial in the helping professions. amusing. Tarek El Moussa. we can also become students of every culture we encounter. For example. Even more important. who may expect and eagerly await a slide show. my colleagues and I were embarrassed by our cultural encapsu- lation. on the one hand. and we began to see the behavior in a completely different light. and changes in the nose. and off-island vacations are relatively rare for most people in Japan. CULTURE CHECK Assumptions in Assessment Our own cultural biases. worldview. it is a way for the tourists to relive that moment. assumptions. In the following sections.” His statement underlines the fact that observation is something of a lost art. Although it is enlightening to be a visitor to another culture. jaundiced and dry red skin. Since then. Clients often carry the clues to their problems on their faces and in the way they walk and speak. Recently. rely on our own cultural concepts about mental health and values. In addition. In conjunction with experience and training. It also emphasizes that observation is not a passive process. on a trip to Europe. a registered nurse. the helper is able to screen for major problems and determine whether the help he or she has to offer fits the client’s needs. We need to be aware of how we interpret what we observe in our clients. but we can become more aware of our own limited cultural vision. We see clients through our own cultural lens and judge their behavior according to our standards. . We found this to be. When you have the chance to record your observations and assessments of real clients. was watching her favorite show. I began talking with the Japanese tour guide about this. but a conscious. Ryan e-mailed the show’s host. and on the other. remember that your impressions come through your own cultural point of view. Fritz Perls. General Appearance. Note all aspects of a client’s speaking voice. Is the client clean? Does the client exhibit body odor and a general disregard for personal hygiene? Even if the client shows concern for cleanliness. or prostheses? Gait means the person’s manner of walking. or legs. or lack of social awareness? Do cultural differences in grooming account for the client’s appearance? If the client is a child. fore- head. tension. or depression? Build refers to the body habitus. and is it appropriate to the occasion? Does the cli- ent wear jewelry? A lot of jewelry? Does the client wear appropriate amounts of makeup? Does the client wear glasses or a hearing aid? Does the client’s clothing suggest a different cultural background? Grooming. p. Does the client wear expensive. perhaps suggesting disorderliness. it is sometimes useful to note initial holistic impressions. Build. stylish. Does the client’s voice annoy or soothe? Is the client’s tone slow and monotonous or excessively labile (variable)? Does the client have an accent of any kind? Does the client’s voice reflect alcohol abuse or smoking? Is the client’s speech hurried or forced? Does the client have a speech impedi- ment of any kind? Does the client speak without listening? Client’s Clothing. well-coordinated. seduc- tive. devoid of any emotion? Does the client maintain direct eye contact or avoid it? Do the eyes fill with tears? Does the client smile or laugh during the session? Is the brow wrinkled? Could the client’s facial expressions be due to cultural injunctions about eye contact or posture in the presence of an authority figure like the helper? Other Bodily Movements. One important way in which people express themselves is through their hand movements.182 Chapter 8 • Assessment and Goal Setting WHAT TO OBSERVE Speech. or thin? Are there any unusual physical characteristics. and mouth. A client may show anxiety by twisting tissue or by tap- ping restlessly with fingers. or is the client’s posture indicative of a more long-term state of anxiety. is there a disorganized appearance to the hair and clothing. toes. such as excessive acne. Does the client’s manner of walking reflect an emotional state. 1959.)? Is clothing inappropriate for the weather (several layers on a hot day). 83). conservative.” “The client appeared to be very precise and neat and seemed to carefully consider all . and Gait. what does grooming suggest about family environment? Posture. which may become less noticeable as treat- ment progresses—for example. the founder of Gestalt therapy. or outmoded clothing? Is there anything odd or unusual about it? Does the client reflect a particular style (artistic. depression. such as depression or anxiety? Does the client’s walk seem to indicate confidence or low self-esteem? Is the client tentative and cautious in finding a seat? Facial Expressions. Is the client physically attractive? Is the client obese. etc. “The client appeared much older than his stated age. or are the client’s expressions flat. old. Facial expressions include movements of the eyes. lips. In recording an assessment of the client. Do the client’s feelings show. What is the client’s posture during the session? What is the position of the shoulders and head? Does the client sit in a rigid or a slouched position or with head in hands? Does the client’s posture reflect the present emotional state. was fond of making clients aware of how bodily movements expressed their inner con- flicts and impulses (Perls. muscular. physical disabilities. become more abrasive and the cycle continues. before he took LSD) hypothesized that we react automati- cally and unconsciously to the communications of others. We tend to instinctively react in a positive. Questioning Previously we cautioned not to ask too many questions as it tends to disrupt the bond- ing between client and helper. Timothy Leary (1957. but they can be very important in the helping relationship and in the client’s social world. and allowing the client to elaborate on his or her construction of the problem. Are you judging the client based on your own upbringing? Feelings of the Helper. Similarly. instead. it is just that they are used too often by beginning helpers and at the wrong time. as the helper/client relationship develops. It requires detaching and not reacting to the client’s overtures but. questions are necessary because they expedite taking personal and sexual histories. Following are some assessment questions frequently asked by helpers early in the assessment stage in order to identify important aspects of the client’s concerns: “How can I help you?” “Where would you like to begin?” “What prompted you to make today’s appointment?” “Has something happened in the last few days or weeks that persuaded you that help was needed?” . drawing the fam- ily tree (genogram). in turn. It is not that questions are inherently bad. If the helper finds himself or herself becoming annoyed with the client. 1973) occur outside of awareness and are rarely dis- cussed. Questions can also be used to gain valuable information and to focus the client on the agreed-upon goals. We call these assessment questions. questions can even be therapeutic devices to spur the client’s thinking or stimulate action. although sometimes they give insight into the impression the client is trying to make. They serve an “orienting” function in that they tell the client what is important (Tomm.” Many of these holistic impressions can be stereotypes. However. rather than taking the neces- sary time to understand the client and provide an atmosphere of openness and trust. the helper then uses the second basic assessment technique of questioning. we instinctively respond in a negative way to individuals who are combative or aloof. 1988). 1998). Our reaction. When used artfully. In fact. They. friendly manner to individuals whom we find attractive and friendly. the helper can learn to use his or her personal feelings as an assessment instrument. During the assessment stage. Questioning is an art (Goldberg. the most common mistake for beginning helpers is relying on questions in the relationship-building stage. in turn. These interpersonal reflexes (Shannon & Guerney. thinking about how others in the client’s world must feel about the client and recording this information. 1998). Chapter 8 • Assessment and Goal Setting 183 of his statements before speaking.” “I had the feeling that the client was a super sales- man. is it possible that most of the client’s social contacts might have the same response? What would moti- vate the client to push people away? Is the client even aware of his or her effect on oth- ers? According to Ernst Beier (Beier & Young. triggers the other person’s next response. Basing his observations on Harry Stack Sullivan’s theo- ries. 184 Chapter 8 • Assessment and Goal Setting “What is it that you want to stop doing or do less of?” “What is it that you want to begin to do or do more of?” Next is a different sort of question that pushes clients to dig deeper and challenges them to act. (2) family history. If a client has a regular exercise regime. excesses. they can attempt to re-create those states. for short. The format we are suggesting is an inventory of the client’s (A) affective or emotional issues and status. ranging from smoking to sexual addiction. and duration of these negative emotions in order to plan effective treatment. grief. relaxation. and strengths. In addition. Clients also have “positive addictions” or healthy habits that should be noted. A form is a good training device because it ensures that you have not missed the big problems. frequency. that you are not capable of being a good father?” CONDUCTING AN INTAKE INTERVIEW: WHAT TO ASSESS? One way of getting started in the assessment process is to systematically record your impressions about a client on some kind of standard form. and (C) thinking or cognitions. depression. (3) cultural and reli- gious/spiritual background. Let us take a brief look at each of the seven elements and why it is critical to collect these data on each client during a screening or intake interview. Behavioral Assessment Many people are seeking assistance for excessive behaviors. They are seek- ing relief from anxiety. B. Cognitive Assessment Cognition includes the client’s thinking. Others need help in learning and increasing new behaviors such as social skills. and meanings (the client’s worldview). and C. meditates. the helper assesses the intensity. or is very organized. These three items will be referred to as A. It is similarly important to identify the client’s positive affective states. Whether these are disabling or merely uncomfortable conditions. you can make your own form on a blank sheet of paper and record the informa- tion under the categories ABC-1234 using the book to help you address each area. you are asked to record data about the client’s (1) developmental level. “What effect do you think your depression has on your spouse?” “What would your life be like if the problem were solved?” “What does that do to the relationship between you and your stepmother?” “Where did that idea come from. or time management. When you practice in class. (B) behavior deficits. and anger. We call these challenging questions. They differ from assessment questions in that their purpose is not to gather information but to expand the client’s thinking. C. these behaviors can be identified and encouraged. A. For example. B. and (4) physical challenges and strengths. Affective Assessment Clients come for help because of overwhelming and confused emotions. communication. If clients can identify the times when they feel satisfied and happy. images. a client may be engaging in negative thinking and negative imagery about . Helpers frequently also assist older people who are trying to create new lives following the death of a spouse. By uncovering this in an intake interview. 1. Developmental Issues Helpers must have a basic knowledge of human development as major theorists such as Pia- get. In short. to know older people. The helper who works with college students deals with alcohol and drug abuse. it is particu- larly important to touch on drug and alcohol abuse. the helper can help the client find specific constructive thoughts and images as an antidote. However. freedom. and substance abuse. and relationships with parents and siblings. 2014). COLLEGE STUDENTS College students are characterized by their focus on issues of self- esteem. deteriorating health. problems with parents. School functioning for children is analogous to occupa- tional functioning for adults and is an indicator of overall adjustment. CHILDREN There are many specialized assessment and helping techniques that are spe- cific to children (Sattler. Chapter 8 • Assessment and Goal Setting 185 an upcoming event. There are some octo- genarians who are physically and intellectually younger than their chronological ages. pregnancy. and anger are just beneath the surface of their words. interview parents. people are grouped according to the common age-related categories of children. any specific learning problems. The discussion is meant to urge you to consider critical developmental issues. suicide attempts. homicide. separation from their family of origin. it is also important to remember that each person is unique. the helper records intellectual deficits and strengths. especially where money is concerned. who need to let go of past experiences. Erikson. Then assessment and helping tech- niques can be modified to deal with life-stage differences. In this section of the intake form. regrets. When assessing adolescent problems. Loevinger. sexual behavior. or who have disappointing family relationships. These areas must be care- fully addressed in the assessment stage. eating disorders. suicide. it may be important to get a sense of the time they grew up in because it affected their perspective on life and is the basis for their view of the future. adolescents. In this section. grandparents. and Kohlberg have described it. These two events shaped their thinking and worldview. and siblings. and older people. college students. thoughts about lost oppor- tunities. or head injuries. The descriptions of these life stages are generalizations about groups of people. OLDER PEOPLE Understanding the problems of older people requires consideration of their unique histories. intense love relationships and their dismal after- math. To understand a child’s family and his or her relationship with parents. and their strong need to form close bonds with others. Contact the teacher for insight into a child’s behavior toward adults and peers. Issues of trust and betrayal. ADOLESCENTS Adolescents are challenging but also intriguing and rewarding to work with. some 9-year-olds demonstrate an unusual amount of intellectual and emotional maturity. delusions or hallucinations. dangerous behavior. . and sexually transmitted diseases. autonomy. The oldest people today lived through the Great Depression and World War II. Helpers who work with older people deal with issues of loss. It instilled in them a cautious approach to life. and fears associated with loneliness. Most adolescent deaths are due not to medical problems but to automobile accidents. head- aches. anxiety. race. you may simply want to question clients concerning important stressors in their family now and in the past. 2014.186 Chapter 8 • Assessment and Goal Setting 2. social. In addition. substance abuse. may be the cause of a client’s headaches. as it may shed light on the client’s current concerns. physical challenges include medical diagnoses. It is irresponsible and unethical to treat someone for these .) • How much does the client identify with his or her cultural or ethnic background? • According to the client. a brain tumor or other serious problem. and what is normal and good all come from our original family groups. For example. weight gain or loss. and psychological effects. Levy. A family history of depression. Taking the time to get a sense of the client’s family will be rewarded by insights into the forces that have shaped the client’s worldview. Following are some additional questions that stimulate thinking about the degree of a client’s cultural identity and its impact on the helping process: • What is the client’s cultural/ethnic identity? • What is the client’s religion or spiritual orientation? How closely does he or she fol- low that belief? (See Leighton. too. Cultural and Religious/Spiritual Background Besides identifying a client’s ethnicity. and drug and alcohol use and abuse. Family History Our family histories provide a deep insight into who we are. it is important to understand the cli- ent’s acculturation. or sex- ual abuse is valuable information. & Breitholtz. Symptoms of depression. are based on our own families. 1999). A helper can go wrong by trying to work on a symptom that turns out to be the result of a treatable medical condition (Pollak. Our ideas about normal family functioning. 3. two children in a bicultural family may feel close to one parent’s culture but not the other’s. A client’s acculturation is the degree to which he or she personally identifies with a particular culture. parental roles. irritability. For example. or class. Physical Challenges and Strengths For our purposes. Our ideas of gender roles. sexual disorders. a girl whose parents are Russian Jews but who was born in the United States might conceivably have a minimal relationship to her family’s culture and religion. All these may have physical. physical abilities and dis- abilities. MEDICAL DIAGNOSES A number of physical disorders have psychological effects. rather than stress. and fatigue suggest that the client should receive a thorough medical checkup as part of the helping process. how is seeking help from a helper viewed within his or her culture? • How can the client’s goals and problems be viewed in a way that is compatible with his or her cultural background? • How does the client’s upbringing regarding appropriate gender roles relate to the presenting problems? • Is the client’s culture a source of pride or shame? 4. Focus on the client’s physical assets and abilities in this category. suicide. what it means to be a spouse and parent. In the absence of a genogram. The visual nature of a genogram makes it an efficient way to under- stand a client’s family history. or our families of origin. anxiety disorders. and how this way of getting around affects that person socially and professionally. how?” “How much do you drink or use each day?” “Have you ever had a blackout or amnesia while using?” “Has your substance abuse changed any of your close relationships or affected your work?” “Looking back at your family tree. one way to start a discussion and gain important information is by asking direct questions or by asking the client to fill out a questionnaire or rating scale (see Evans. be sure to note positive health and wellness behaviors such as good diet and physical exercise. Heart conditions. Conley. TABLE 8. helpers should refer clients for medical evaluation. 2015). Table 8. PHYSICAL ABILITIES AND DISABILITIES The term physical disabilities suggests that there are normal-functioning people and people with disabilities. which relatives have had a substance abuse problem?” “Have you ever felt the need to cut back on your use of substances?” MyCounselingLab Application Exercise 8.2 Some Key Interview Questions for Substance Abuse “Do any of your friends and family think you have a substance abuse problem?” “Have you ever been arrested for driving under the influence?” “Have you ever been physically injured or had an accident while drinking or using?” “Have you ever broken any bones as an adult? If so. and thinking. Prescrip- tion and nonprescription drug taking must also be recorded because the mental. Sajatovic & Ramirez. Even medically required medication can affect school or work functioning and family relationships. & Young. Chapter 8 • Assessment and Goal Setting 187 symptoms until medical causes have been ruled out. Perhaps the term should be physical differ-abilities. because abilities are probably better described on a continuum rather than within an abled/disabled dichotomy.2 contains a list of additional questions that you might use to follow up on suspected substance abuse. DRUG AND ALCOHOL USE AND ABUSE Alcohol and other drug use is difficult to assess because clients consciously and unconsciously minimize the amount they report. On the other side of the coin. diabetes. Not all challenges to physical ability are as obvious as a prosthesis or wheelchair. and it is important to explore with a client the impact of the disease on his or her overall functioning (Barden. arthritis. how he or she functions. When in doubt. 1998.1 The ABC-1234 Assessment . emotional. It is not as important to know that a person is in a wheelchair as it is to know how he or she sees himself or herself in relation to other people. multiple sclerosis. and behavioral effects of certain drugs can make other issues worse. Also. When substance abuse is identified. behavior. and myriad other problems have an effect on mood. 2012). assess what the person can do. It is helpful to know the normal psychological effects of common diseases. many helpers try to treat this first because con- tinued substance abuse undermines clients’ progress on other issues. Because clients may not want to bring up substance abuse. it may be confusing to know which sources to tap and how to manage the incoming data. from what the client supplies (verbal descriptions. 2014). Figure 8. In addition to observation and questioning and conducting an intake interview.3 also shows how the client’s problems or diagnoses are placed on a treatment planning list. and similar instruments to gather data about clients and their problems (Gelso et al. the treatment plan is constructed in conjunction with the client. Besides formal testing. it is the helper’s job to consult with the client and place them in order of priority. These courses will provide you with a more complete background. The helper selects methods and techniques to treat each problem on the list. which is discussed next in the chapter. Johnstone & Dallos. it is important that you recognize that all assessment tools are attempts to simplify the process by placing clients or their problems in categories. However. GOAL-SETTING SKILLS Where Do I Go from Here? Set Goals! At this point in training. we continue this chapter by examining the next stage on the road map of the helping process: goal setting.3 shows the downward flow of information from the seven sources entering a funnel that narrows as the data are examined and organized into categories. from medical history. recordings. something like an in-basket to be sorted out during the goal- setting stage of the helping process. Because there is so much information that can be collected. Diagnosis is identifying the overriding issues or problems that seem to encompass a large number of the client’s complaints. Having looked first at the many facets of assessment and its crucial role in setting achievable goals with the client. It should not focus solely on mental disorders but should also sum- marize all of his or her problems (Hohenshil. Figure 8. you will take a course in evaluation and assessment or tests and measurements and probably one on diagnosis. most of which have been covered in this chapter. These methods might include referral to a physician. at this point.188 Chapter 8 • Assessment and Goal Setting CATEGORIZING CLIENTS AND THEIR PROBLEMS Organizing the Flood of Information: Making a Diagnosis Through the combined use of formal and informal assessments. or any other method that the helper suggests. As you learn to be a helper. helpers are in a better position to service their clients’ needs. a typical client’s in-box might contain marital problems. Typically. and from the legal system. drawings. and I understand something about the client’s problems and background. many students make the following statement: “I seem to be able to empathize with the client through the nonjudgmental listening cycle. Once the client’s prob- lems are identified. 2014). For example. from information provided by friends and family. who signs an agreement to be treated according to the plan. Diagnosis is the simplifying process we use to organize the results of our examination. assertive- ness training. from other agencies. noting those issues that will take precedence and those that will be placed at the bottom of the box.. questionnaires. journals. but where do I go from here?” . and genograms). professionals use paper-and-pencil tests. which become the focus of the client/helper discussions. Key information comes from things the helper observes. career confusion. and low self- esteem. 1996. group therapy. there are six other important sources of information to consider. ask questions. The best answer to the question “Where do I go from here?” is “Set goals!” When you have set goals. Sorting. the helper is tempted to give the client advice. Chapter 8 • Assessment and Goal Setting 189 Information from the legal system Formal testing Information from family and friends Data supplied by the client Information from social service agencies Observations by the helper Medical history Data Collection C A B D Diagnosing or Identifying Major Issues In-Basket C A B D Placing Problems in Priority Order Out-Basket Matching Problems Problems Appropriate Treatment with Treatments Interventions C 1 A 2 B 3 D 4 FIGURE 8.3 Process of Gathering. or introduce a new technique of some kind. it will be easier for you to identify . he or she has exhausted the client’s story and explored the client’s distress. More than ever. and Matching Problems with Interventions in the Assessment Stage The helper feels that after a session or two. but the helper does not believe that he or she has really helped. 4 Breaking the Problem into Parcels and Working on One Part . Hope begins to dawn because the client now views what was an amorphous mass of trouble as a set of solvable prob- lems. goals get us to make a commitment. goals help us know when the helping relationship should end. 2013). 1990). Moreover. If one can achieve a small goal. 1991). When every session begins with a review of goals. Thus. is diminished (Frank & Frank. If you commit to a goal. then discouragement. you are digging deeply in the same place. & Nordahl. but we must also decrease client demoralization and ignite hope. never sticking with something but trying many different options. To use an analogy. Sometimes helpers answer this question by The Problem The Problem Solving this piece is our goal FIGURE 8. goal setting separates the tangled mass of a problem into manageable units. the client is much more likely to think about those goals and to work on them between sessions (Matre. the intangible cloud of problems has been broken into manageable segments. If these goals are mutu- ally formed. Finally. Why Must We Set Goals? If we are to really help the client. Identifying and achieving goals help the client gain confidence even if the objectives are rather modest. not only must we understand his or her problems. and you will eventually hit water. Partners are much more likely to make contributions than patients. Through this process. Steve de Shazer says that one of the most important questions a helper can ask is. Once a few goals have been identified.4 shows the client’s difficulties as they first appear in the opening sessions and later after the assessment and goal-setting stages. the biggest enemy of change. “How will we know when we are done?” (de Shazer. the client will feel that he or she is part of the team and a partner in the therapeutic project. Figure 8. Besides decreasing demoralization and clarifying the issues. I believe that every helping session should focus on the client’s goals. helping has a focus and the client begins to see the light at the end of the tunnel. Jensen. frequently clients have started digging a number of dry holes in their life.190 Chapter 8 • Assessment and Goal Setting compatible techniques and the plan will make sense to the client. Dahl. Chapter 8 • Assessment and Goal Setting 191 using a time-limited approach. Setting a date for termination of the relationship motivates helper and client to work quickly to solve problems. The best measure of whether the work is done is to deter- mine whether the treatment goals have been reached. as shown in Figure 8. When to Set Goals It is possible to begin setting goals prematurely when you have neither the client’s trust nor a clear understanding of the problems. most of the helper’s activities are based on the invi- tational. such as substance abuse. Assessment Outcome Evaluation Relationship Building Goal Setting and Termination Intervention and Action FIGURE 8. In this part of the chapter.5. if we have formulated goals at the beginning of the helping relation- ship. or is in a nonsupportive environment. we will look at two skills that help us arrive at usable goals: (1) using questions to identify a goal and (2) boiling down the problem. As was men- tioned earlier. could seriously under- mine the therapeutic plans. In addition. the helper does not narrow the field of discussion. the helper gets informa- tion about the client. client and helper will have a shared vision throughout the relationship and will know when it is time to end.5 The Therapeutic Relationship Is Central to Goal Setting . allowing the client to discontinue the helping process unilaterally makes the process seem haphazard as the relationship just peters out. One of the reasons that time limits help is that the threat of termination tends to focus the mind. We have said that helping progresses through five basic stages. Early in the relationship. where the client attends for a certain amount of time or attends a specific number of sessions. In the assessment stage. and challenging skills. and the environment. is being influenced by others. hidden areas of a client’s life might not come to light without a thorough look at the client’s history. but dares the client to go deeper and broader and disclose more about a number of topics. the goals might turn out to be irrelevant or the efforts ineffective if the client is not moti- vated. The problem with the time-limited approach is that we terminate the relationship regardless of success or failure. Without this knowledge. reflecting. On the other hand. the client’s problems. These secrets. Many college counseling centers limit clients to 6 or 10 sessions. which invite the client to open up and engage in self-examination within the confiding relationship. you will be learning about when to set goals and how to know whether the goals you and your client devise are constructive. The preferred time to set goals is after the helper has established a relationship with the client and conducted a thorough assessment. Alternately. At the initial relationship-building stage. some helpers prefer to focus on the process of helping. When goals are clearly understood by client and helper. 1982). 1999. reflecting. clear. & Buchanan. For one reason or another. For this reason. at least four other favorable outcomes accrue from negotiating spe- cific goal statements with your clients: 1. “I don’t really know what’s wrong. In other words. WHAT ARE THE CHARACTERISTICS OF CONSTRUCTIVE GOALS? This section is an argument for selecting goals that are simple and specific. rather than establishing landmarks of progress. Having clear goals may be more challenging but is more likely to lead to progress than having fuzzy goals or having no goals at all (Mackrill. 1978). 2011. they make better progress (Borelli & Mermelstein. and easily restated goal sounds more like this: “I want to be able to be more assertive with my friends and co-workers. and challenging skills encourage clients to open up and assessment provides crucial data. it’s just that I am uneasy with everything. Clients then begin to feel that they have a han- dle on how to begin making changes. Their goals when stated are vague and elusive (Rule. stated posi- tively (reflecting the presence of something rather than the absence of something). the skills of the goal-setting stage are methods for narrowing down the information into a few specific tasks and goals. such as the acquisition of skills.192 Chapter 8 • Assessment and Goal Setting Although invitational. and realistic. or substance abuse treatment. Many clients have problems imagining or envisioning success. “I haven’t been feeling right for about a year. are considered to be more useful than goals that are only focused on eliminating a negative behavior. goals that are stated positively. Goals Should Be Simple and Specific Sometimes clients have difficulty in selecting clear projects to work on. collaboratively developed. It is not only clients who have trouble setting goals. but eventually it narrows to focus on certain particular areas.” A specific. couples counseling. This book argues that help- ing has changed radically in recent decades. impor- tant to the client. 1994.” or. . 1996). letting the client deal with issues as they arise. Hart. Smith. For example. Sometimes it is only during the goal-setting process that the helper realizes that the client needs some special- ized assistance such as sex therapy. The client who is clear about goals will be able to work on them in and out of session. Nearly all helping is now brief. Thinking about and imagining specific. Besides these general advantages. 2. the helper can deter- mine whether he or she possesses the requisite skills to continue with the help- ing relationship or whether a referral is needed. Focusing on specific issues allows helpers to make the best use of therapeutic time. Ponte-Allan & Giles. Goal setting is the stage where the helper begins to change the focus of the sessions from the introduction of new topics and assessment to the identification of the most crucial issues to be addressed in later sessions. Hauenstein. positive outcomes have the effect of focusing the client’s resources and energies and increasing hope. help- ing begins with wide-ranging discussions.” When clients have clear goals. Specific goals make the direction of the helping process clear to the client. at least one of these with a woman. To be able to return an 1a. Target Behaviors (Described in Frequency. and Interventions Goal Objective Intervention 1.To join a yoga class and talk to 2b. objectives. AND INTERVENTIONS One way to make goals more specific is to break them down into subgoals or objectives. To call my sisters once each 3a. To visit my mother one 3b. The interven- tions you choose are the techniques selected to achieve the objectives. Chapter 8 • Assessment and Goal Setting 193 3. OBJECTIVES. They specify the client’s current behavior (baseline) and the target or goal behaviors that indicate suc- cess. Role-playing in session to go for coffee and talk 2b. Here is an example of how you can develop a behavioral objective: Client’s Stated Goal (Client’s Description of the Goal): The client would like to increase comfort and decrease anxiety in social situations. Duration. In Table 8. and they are necessary for his employment. To be able to say “no” to two 1b. Practice art of small talk one person after class in session 3. To make more friends 2a. Role-playing and imagery unwanted item to the store as practice in session 1b.3 shows that objectives are really just more specific goals. and third-party payers want helpers to link goals. and interventions. Identifying specific goals provides a rational basis for selecting treatment strategies that agencies. Both clients and helpers have a clearer idea whether progress is being made and can determine when termination is imminent. and supervisors can understand. Table 8. and examine and positive things change the negative self-talk . The client’s job entails attend- ing several social functions each week. GOALS. third-party providers. hospitals. measurable. To be more assertive 1a. To ask one person this week 2a. Specific goals enable helpers to determine how successful helping has been for the client. Helper will send e-mail with my family week reminder 3b. Many agencies. and Intensity): The client would like to be able to attend a social gathering. schools. hold two or more conversa- tions (frequency). Behavioral objectives are concrete. Discuss the visit during time each week and talk about each session. Objectives.3 Goals. these three terms are shown with examples. Discuss the elements of people this week when someone assertiveness in session and asks me something I can’t do or give homework assignment don’t want to do (except my boss) 2. 4.3. BEHAVIORAL OBJECTIVES As we have indicated. To improve relationships 3a. and observable. stay for a period of more than TABLE 8. Many workplaces also require that helpers make these objectives behavioral. one of the characteristics of effective goals is that they are simple and specific. Specific goals reassure others that the outcomes of helping will result in measurable changes. Even when helping goals are not behavioral. and maintain a subjective distress level (SUDS) of 3 or 4. When goals are stated as negatives. setting a goal to lead a happy life without alcohol allows us to consider what things we would like to have in our lives.194 Chapter 8 • Assessment and Goal Setting 1 hour (duration). Whether goals are described quantitatively or not. It seems like a small difference. what people we would like to interact with. MyCounselingLab Application Exercise 8. we should eventually focus on where we want to go.2 Identifying Well-formed Behavioral Objectives in a Case Example ARE BEHAVIORAL OBJECTIVES THE ONLY WAY TO BE SIMPLE AND SPECIFIC? Various agencies seek to verify goal attainment in other ways. improving one’s relationship with a family member could be the goal but the specific objective might be. I would like to be able to politely stop her when she starts trying to give me advice.” we are still focusing on drinking! Instead. 2014). 2013). If you think about it. specific goals make it easier for both helper and client to identify when helping is on the right track. 1989). they can still be simple and concrete (Goodyear & Bradley. and so on. (The SUDS level is the client’s feelings of discomfort in the situation and is measured on a 10-point scale of intensity. Here is a list of client problems and then the goals that a client might pursue to address these problems. For example. Proctor & Hargate.) Baseline (Current Level of Target Behaviors): The client states that he can cur- rently remain at a party for only about 15 minutes before he has to leave. it is easier to see the steps needed to attain it (O’Hanlon & Weiner-Davis. reduce arguing. including client feedback forms.” AA’s goal is to help people lead happy lives without alcohol. stop feeling anxious in social situations. simple. Another way of looking at this is that the helper should try to turn problems into goals. I have heard it said that the goal of Alcoholics Anonymous is not “stopping drinking. Busse. if we focus all our attention on “not drinking. Many helpers will be required to set behavioral objec- tives at their place of work because agencies use the numbers to quantify success. stop drinking. but it would be much better to develop a list of goals than a list of problems. and self-ratings by the client (Brady. duration. but has not recently talked to a woman in this setting. Behavioral objectives have advantages in that they specify exactly what must be achieved in the helping process. . Goals Should Be Stated Positively Frequently you will hear clients say they want to get over depression. He can hold a brief conversation with a male co-worker. Otherwise we spend too much time mapping the prison and too little time planning our escape. He currently experiences a SUDS level of 8 or 9 during social conversations with any woman. & Lopez. or intensity but it is simple and specific. “Well. they have less power to influence and motivate us. and many other possible futures. with 10 being the most uncomfortable and 1 being mildly uncomfortable. When a clear vision of success is formulated. client satisfaction.” As you can see this goal is not described in terms of frequency. For example. stop binging on food. Although we must be willing to understand what problems brought a client for help. 1986. 1978. Trame. or student judiciary boards to solve problems that the client has little or no interest in solving. I will be able to recognize nervousness as a normal reaction and give myself positive messages to help me cope with these feelings. The third-party problem is evident in the example of a client who has been referred by a probation officer following an incestuous relationship. and neither may feel personally involved or motivated to achieve the aims. 2009). I use the example of incest because it seems so clear that this client has a prob- lem that needs to be treated. . 2014). Young & Robert.. 2002. Uken. 2011). However. Schöttke. 1986. At this point. 1984. principals. the incest victim. the evidence is clear that when helpers and clients reach consensus and collaborate on goal achievement. It seems obvious that clients will work harder when they are focusing on a goal that really matters to them. The client is divorced now and has had no contact with his teenage daughter. and this happens even when working with young clients (Rupani et al. the likelihood of success in these conditions is low. Clearly. 2014. 1992. & Sembill. Feelings of hopelessness I will pay attention to signs of hope and recognize positive emotions when they arise. He is not willing to rehash the incestuous relationship and is resentful of the helper’s intrusions. In cases where the court orders treatment for a particular problem. & Sebold. Still. Lee. Goals Should Be Important to the Client Clients will be successful when they are pursuing goals that are important to them (Barbrack & Maher. Goals Should Be Collaboration between Helper and Client Although helping should focus on what is important to the client. families. neither client nor helper has participated in the goal- setting process. The probation officer wants the client treated for sexual dys- function to ensure that this kind of thing does not happen again. Nervousness I will be able to calm myself in anxiety-provoking situations by relaxing. I will be able to ignore negative thoughts and dispute them so that feelings of hopelessness are prevented. Strong. Tjeltveit. 1984. the cli- ent’s concerns center on forming new relationships and dealing with family members’ rejec- tion. and yet we have little hope of making a difference if the client is not a partner in the process (Ritchie. 1984. Chapter 8 • Assessment and Goal Setting 195 Client Problem Changed to a Goal Shyness I will be able to meet people and operate comfortably in social situations. Miller & Rollnick. 2014). 2007. Low self-esteem I will be able to develop a list of positive mental sentences and encourage myself when needed. the client with this kind of problem may open up later and deal with the problem. This means that helper and client have developed a joint project upon which they both agree. By enhancing the helper/client relationship and working on goals important to the client. many peo- ple are referred by friends. Hart. courts. Bruce. Goal setting that involves the client has ethical advantages as well because we are doing not only what we think is best for the client but also what the client wants to do (Brace. Evans. the chances of success are greatly enhanced (Tryon & Winograd. 2006). Consider the following client statements and possible helper responses: Example 1: HigH ScHool Student: “I don’t like science or math. For one thing. Perhaps we need to look at both of these things a little closer. My aptitudes in those areas are not very good. and that is something we can work on.196 Chapter 8 • Assessment and Goal Setting agreement upon goals is not a one-time event. you say you’re having trouble being with only one person. Some- times the client has insufficient information about the self or about the issue. the client wants to accomplish two incompatible aims. 2011). I want to be a doctor because I need to have a good salary and I want to be respected as a professional. I still have a problem with being faithful to one person. She’s living with someone else right now. I don’t want to bring up this other relationship. a client recently said. it may be necessary for the helper to express doubts about the goal. When Myra and I come in for marriage counseling. we could make it work. she is showing no inter- est in getting back together.” One method of dealing with unrealistic goals is to confront the client with the discrepancy. At other times. “I want to be better paid at my job.” Helper: “It sounds like you want the status and the money that being a physician might bring. The excite- ment and romance is something that is missing in my mar- riage. For example. but you are not sure you have the ability or the interest needed for the training. Throughout the helping process.” Example 2: client: “I want to get my girlfriend back. the best practice is to continually seek information from your client about his or her progress and the current relevance of the goals (Tryon & Winograd. and. So I have decided to keep it a secret. I can’t hurt Myra or the kids by letting it come out in the open. Goals Should Be Realistic The helper’s expertise is important in defining goals when a client has unrealistic aims. She hates me because I was dating other people behind her back while we were going out.” Helper: “I’m not sure that reuniting with your ex-girlfriend is a realis- tic goal. In some cases.” Example 3: client: “I want to stay married and enjoy the safety and security of the married relationship. and she won’t even return my calls.” . Another way is to invite him or her to explore the goal and collect information to see whether the goal is really possible. but I know if I got her back. But there is someone else that I am seeing right now. and I am not very good at them. but I don’t want to work harder or give up my free time. Myra and I have a problem with communication. accord- ing to the national exams. second. Chapter 8 • Assessment and Goal Setting 197 Helper: “I would like to help. & Phillips. the helper uses challenging skills and helps the client gain self- knowledge or information about the problem that will help him or her set better goals. & MacLeod. and asking physi- cians directly about how important it is to enjoy and do well in math and science. 1. The Self-Development Project List–90 (Braaten.” Using a template. Peterson. 2005). This is a system for generating goals by using the clients’ own words. a. the emotions involved. positive goals. 4. The Child Psychotherapy Treatment Planner by Jongsma. A number of books are available that can help you find reasonable goals for all sorts of problems (e. refining them. the effect on others.” When a client is operating with faulty information or is engaging in self-deception. Pascual-Leone. and other categories. & Todd. Singh. in the case of the student who wants to be a physician. measurable objectives. b. Goals. Measures That Help in Finding and Monitoring Goals for Counseling and Psychotherapy. & Kroner-Herwig. Salmela-Aro. Harrington. we next discuss two goal-setting skills that helpers can develop to promote effective goals: using questions to identify a goal and boiling down the problem. Identifying and Measuring Positive Life Goals.. Personal Projects Analysis (Little. 2004). the helper might suggest the client gain experience and knowledge of medicine in several ways. RESOURCES FOR IDENTIFYING AND CLARIFYING GOALS Before leaving this discussion about the characteristics of goals. 2015). Jacobi. For example. Mack. a. Spicer. c. Boddana. and prioritizing them. let us mention some tools that you might use if you were having difficulty identifying goals. including volunteering in a hospital. low self-esteem. 2.brianrlittle. Salmela-Aro. 2000). Holtforth. 1992). 2007.g. 1989). These resources have a common purpose: to assist clients and helpers in evaluating and choosing clear.com/Topics/research/personal-projects-analysis/ 3. b. looking at the courses medical schools offer. Books. and school refusal. & Shapiro. Personal projects analysis is a fascinating system for analyzing and selecting one’s own personal goals. For more information see: http://www. McInnis. and interventions are identified for each cli- ent problem. Simplified Personal Questionnaire Procedure (Elliott. Bern Inventory of Treatment Goals (Berking. fire setting. but I don’t believe you can improve your marital relationship while you are carrying on a secret affair. 1997). and Bruce (2014) lists a variety of problems that the helper might have identified during assessment. These goals may range from “being a better husband” to “improving my score on a video game. Now that we have identified the aspects of constructive goals. & Yeryomenko. Simplified Target Complaints Measure (Deane. including depression. as in the preceding cases. you select goals that you want to work on and then evaluate them based on their importance to you. . A measure to elicit positive future goals and plans (see Vincent. what would be some of the things you would first notice that let you know the problem had disappeared?” (the miracle question. The helper can use these questions to change the focus away from the problem to a future without the problem. Instead of the helper setting the goals. what would you be doing that you are not doing now?” • “When you say things are not going well. O’Hanlon & Weiner- Davis. what level of stress would represent an improvement to you?” • “I understand that you want to be ‘happy. Using questions to identify a goal helps to make vague goals clearer and is the first goal-setting skill covered in this chapter. specifically what things are you talking about?” • “You say you want things to be better in your relationship with your husband. Questions can be used to reveal or uncover an underlying goal. and ensure the goal is realistic. find out how important the goal is to the client. How would you like to see your- self exactly?” • “Once you said that you live in the past. turn a problem into a goal. Where would you like to live?” • “If we were going to make a small dent in this problem. enhance collaboration on setting goals. make a goal more spe- cific.’ but if you were happy. . Unfortunately.198 Chapter 8 • Assessment and Goal Setting THE TECHNIQUE OF USING QUESTIONS TO IDENTIFY A GOAL During the goal-setting stage. Then when you reach the goal-setting stage of the helping process. • “What activities would help you reduce stress?” • “How often would you like to engage in stress-reducing activities?” • “How long would you like to meditate?” • “If your stress level at work is a 10 now. most helpers start questioning clients much earlier than at the goal-setting stage. You cannot set appropriate goals until after the client has told his or her tale and you fully understand the context. helpers can use questions to home in on the problem. Specifically what would you like to be better?” • “You have said that you want higher self-esteem. it is usually best to get the client to specify what he or she wants to achieve. The client is usually the best judge of what the next step should be. questions can help you get closer to what is really bother- ing the client. Keep in mind that the end goal of questioning is to arrive at a clear and concise goal. what would it be?” Can you see that these are reactions to vague client statements such as “I want to have better self-esteem”? The helper’s response of “How would you like to see yourself exactly?” requires the client to construct a clearer image of the future. 1989). Questions That Help Make the Goal More Specific The following questions can help clients become more specific about both their goals and their objectives. Questions That Help Turn a Problem into a Goal These questions are useful when the client is clear that there is a problem but has not yet identified a goal. • “If a miracle occurred while you were asleep and during the night your problem just vanished. Everything here has dete- riorated. and what would you be doing?” (Beck & Hoppock. Do you think so?” • “Can you put the goals we have agreed upon into words so we both are on the same page?” • “How do you think we could work together as a team on your goals?” • “Now that we have set some goals. Where would it be? With whom would you be working. Think about this for a moment and design your own job. Here are some questions that helpers use to affirm that both parties are part of the goal contract. If you were not arguing. • “I believe that it very important for both of us to be of the same mind when it comes to the goals we set. what would you like to be doing?” • “If the problem were solved. I need to start over. The message is. what would you be feeling. what difference would it make in your life?” • “How likely are you to talk yourself out of trying to accomplish this goal?” • “Is this your goal. client: “So what I really want to do is move to Texas.” • “How likely are you to follow through with this goal?” • “How important is this goal to you?” • “If we accomplished this goal.” • “I believe we both agree on the goals now. Chapter 8 • Assessment and Goal Setting 199 • “You say that you and your husband argue constantly.” Helper: “So is the real problem that you don’t think you have any direction in life right now and you think any change might help?” client: “I don’t have anything to hang on to right now. what kinds of things would you be doing to get your work in on time?” • “Suppose I gave you a job with all the money.” Helper: “Do you think that moving to Texas will give you something to look for- ward to?” . “We need to set goals that make a difference in your life. benefits. and resources you required. or thinking that you are not now?” • “If you were not procrastinating. what additions or corrections do you have to the goals we have agreed on?” Questions That Help Confirm That the Goal Is Realistic Consider the following dialogue where the helper quizzes the client as to whether the solution he has chosen is realistic. I don’t have a job. or is it something other people want you to accomplish?” Questions to Enhance Collaboration on Goal Setting We have said that collaboration leads to goal attainment. no friends. doing. That is our best chance for success. no real relationship. 1998) Questions to Determine a Goal’s Importance Hidden in each of the following questions about a goal’s importance is an embedded message from the helper to the client. At last count. a goal being realis- tic. having dinner at the White House. Holtz set 107 personal goals. It is this last criterion. Ever since my mother died. which included meeting the pope. Is moving to Texas a realistic solution to the problems the client is facing? Rather than giving the client advice or being judgmental. has said. What would make the most dif- ference in your life right now?” client: “I need to find a job with a future or go back to school for a different career. Is the goal specific? Is it simple enough for an 8-year-old to understand? b. STOP AND REFLECT There is a saying among career. An area of learning I would like to master or a formal degree program I would like to complete: 5. . How motivated are you to accomplish the goal? d. A way I would like to improve myself: Next evaluate each of the goals that you have identified according to the following criteria: a. That’s why I came for help in the first place. stated positively. We have said that goals should be simple and specific. Now. he had accomplished 102 of his goals. The kind of friendship or intimate relationship I would like to develop: 4.and life-planning counselors that if you do not know where you are going. think about your own life and write down a goal under each heading that you would like to accomplish in the next 5 to 10 years: 1. other factors besides our own plans will intervene. I just want to know what kind of goal makes the most sense. then make sure you do something every day to realize one of your dreams. that the helper is asking about. It was something to latch on to.” Helper: “Would you say that the thing you need to do is find a direction in life more than just moving to Texas?” client: “Yes. Texas just sounded nice.” Helper: “I am not trying to talk you out of moving to Texas. A job I would like to have: 2. Is the goal stated in positive terms? c. and realistic. I need to have some kind of future. At age 27. The meaning is that if we do not set goals for our lives. winning a national champion- ship. A project I would like to be involved in: 3. and coaching at Notre Dame. A well-known football coach. Is the goal realistic considering your abilities? . You are going to encounter adversity but you will also . sat- isfying bites out of life” (1998). . “Write down everything you hope to achieve in life. I don’t seem to have anyone to guide me. the helper asks questions to make sure the client’s goal matches the proposed solution. Lou Holtz. A hobby or interest I would like to develop: 6. take big. the client has identified a solution to the problem of not having a direction in life. you will arrive somewhere else. being on the Tonight show.200 Chapter 8 • Assessment and Goal Setting client: “I guess that’s it. important to the client.” In this dialogue. The helper uses questions to make sure that this goal is in keeping with what the client really wants. THE TECHNIQUE OF BOILING DOWN THE PROBLEM Earlier. the helper must choose areas to develop and others to set aside for the moment. For example. the sec- ond goal-setting skill covered in this chapter. List the steps you must go through to accomplish this goal. clients need to narrow down the list of issues and focus on one or two to begin with. Helper: “So let me pull this together a little. and in the middle of all this upset. • As you look at the steps that you have identified. people. “Well. does the goal seem more manageable or more difficult now that it has been broken down into parts? • Discuss this exercise with a friend who knows you well. This process of eliminating some and focusing on others is particularly useful in crisis situa- tions. specific sentence or two. First. My life is going nowhere.” tricia: “That’s about it.” This metaphor worked well to signal that a more specific focus was needed. Chapter 8 • Assessment and Goal Setting 201 • Choose one of the goals that appears to meet some or all of the preceding criteria and rewrite it in a simple. The man you have been dating for a year has called it quits. now let’s track down one or two of them. One therapist used to say to clients. in my work on a crisis hotline for 5 years I realized that clients were so oppressed by the weight of multiple problems that they could not see a way out. and right now everyone needs me to be strong. Meanwhile your mother’s illness worries you. agreed upon collaboratively.” . Just sorting the work into “piles” or cutting the job into “pieces” reduces client anxiety and offers fresh hope. More often. and realistic. and then specific issues are iden- tified and evaluated. they present tangled stories of feelings. I’m living at home. The steps in boiling down the problem are as follows: Step 1: Summarizing and Enumerating All the Issues. You’re living at home and feel embarrassed because you think that you should be out on your own. stated positively. your teenage sister is causing turmoil in the home. Ask him or her to evaluate the goal as to how realistic it is and how clearly it is stated. Finally. Most of us are aware of the experience of motivation and relief that accompanies making a to-do list when we feel overwhelmed. though. we identified some of the characteristics of constructive goals. we’ve chased a lot of rabbits out of the bush. They found that just identifying the most crucial difficulty provided immediate relief and gave them hope that their other issues could also be attacked. clients do not normally arrive with clearly defined goals. As you might expect. The helper uses summaries. This is the accomplished by boiling down the problem. the list is narrowed to a couple of the most critical. At some point. and events that spiral in different directions. You’re feeling overwhelmed because everything has happened at once. Goals should be simple and specific. important to the client. and paraphrasing to determine agreement on the overall content of the session to this point. reflecting skills. Similarly. the client is encouraged to open up. Boiling down the problem is also a metaphor for this process. ” .202 Chapter 8 • Assessment and Goal Setting Step 2: Asking the Client to Identify the Most Crucial Problems. Helper: “I realize that all these issues—your mother’s health. The main thing is how I can deal with my angry and depressed feelings all the time. I am bored and angry and alone. sitting there waiting for him to call. In this activity. I have an appointment with the community college to do some career coun- seling. As you think about the future. you want to look at the future a little bit. getting over your boyfriend. I would be able to concentrate at work. I need to focus on myself for a little while. too. and I’ve got to think about how I am going to make it through the next few months without my boyfriend. thereby narrowing down the number of issues to be addressed. and becoming financially able to have your own place—are important issues to you. unfortu- nately. I need help in thinking about where I am going in my career so I can earn enough to live on. At the same time. and we have discussed that topic pretty thoroughly. What would you be doing then that you are not doing now? What would you be feeling and thinking?” tricia: “I would be going out with my friends and enjoying life again.” Step 4: Changing the Problem to a Goal. which do you think are the most critical and are ones that we can deal with in these sessions?” tricia: “There is nothing I can do about my mother’s illness. and. You want to explore some career ideas. Of these. the helper uses a mental checklist to evaluate client goals and advocates for those that are: • Simple and specific • Important to the client • Mutually agreed upon by helper and client • Realistic Helper: “So it sounds like one of the emergency issues is to help you find some ways to take care of yourself emotionally so that you can cope with your loss. either.” tricia: “I know I can get some help with the career thing. one of the criteria for constructive goals. I feel like a baby. What will the problem look like when it is solved? This step helps us make sure that the goal is stated positively. Next the helper uses one or more closed questions to ask the client to evaluate which prob- lems are the most critical. your sister’s prob- lems. there is not much I can do about my sister. I wonder if you can envision your life when this is no longer a problem.” Step 3: Selecting the Focal Problem. I wouldn’t be thinking about him all the time. the helper encourages the client to think about success. But I want to get on my feet financially and emotionally. In this step. Helper: “You have told me that you are in a lot of distress about losing your boyfriend. ” MyCounselingLab Video Exercise 8. ask questions. and become aware of cli- tion begins the moment a client calls or walks through ent strengths and unique attributes.1 Identifying Well-formed Behavioral Objectives in a Case Example Summary This chapter addresses two stops on the road map of related to the problem that he or she may never have the helping process—assessment and goal setting. This tively between helper and client.” Helper: “Would you mind restating the goals as we talked about them so that I am sure we are both operating with the same understanding?” tricia: “Okay. set collabora- the flood of information from multiple sources. the problem. It won’t be easy.” Boiling down the problem is the step- Assessment helps both client and helper. Helper: “Let’s see if I can restate the goals: You would like to go out with friends and enjoy life again. We observe. Assess.” tricia: “Sure!” Step 5: Making Sure Client and Helper Are Clear and in Agreement. In order process involves listing problems and then organizing to reach workable goals. and realistic. In addition. the door. so that the agreement is clear. The helper uses assessment data to plan useful achieve the client’s goals. appropriate goals: They should be simple and specific. we also discuss the stage of goal receive medical data and reports from social service setting and provide the following guidelines about agencies.” Helper: “Like you said. identify the best treatment for the the client and his or her problems in order to develop client’s particular problem. and In this chapter. important to the client. it won’t be easy. Here the helper summarizes the mutually agreed-upon goals. This is the process of treatment of using questions to identify a goal and “boiling down planning. but I am confident that you can make this happen. Are we on the right track though? Are these your goals?” tricia: “Yes. but it is not that easy. I am going to find a way to have fun again and spend time with friends again. .” Helper: “I agree. the helper may ask the client to state them aloud or write them down. clients often need encouragement and a message from the helper that the goals are reachable. We may even interrogate family and friends. review tests. One of the pressures from the beginning is to organize positively stated. At this point. Is that about right?” tricia: “Yes. instead of spending so much time rumi- nating about your ex-boyfriend. identified or recognize issues that were previously hid- Both precede the selection of specific techniques to den. Gathering informa. ent is suicidal or dangerous. Chapter 8 • Assessment and Goal Setting 203 Helper: “So these are the goals that you would like to work toward. by-step process for deconstructing a larger problem ment helps the client discover events that may be and targeting its most important aspects. we presented the techniques them in priority order. Let’s talk some more about how you can actually go about making this happen. We need information about and realistic goals. determine whether the cli- a uniquely tailored treatment plan. the commission of a crime. an. A second observer ance that what you say will not be passed on to any. the client and observer identify and To complete this exercise in a short period of time. Be. After the exercise. (see “Instructions to Observer 2” below) writes down the one else. and a third as the observer. Collecting write down any of the helper’s interventions that seem information about another person requires a reassur. ___________________________________________ 2. to help the client in setting the goal. one student acts as the helper. such an integral part of the helping process. ___________________________________________ 1. specific feedback to the helper on the following issues: 1. • What important areas do you think are missing Then give the helper feedback on how closely the that you would have liked to explore? goal matches the following characteristics. potential danger to self or others. What other suggestions do you have for the helper Part II: Instructions to Observer 2 in terms of the quality of the interview? Write down your understanding of the goal finally Within your group. We have they will know when it is time to end the helping rela- tried to argue that goals provide structure for helper tionship.204 Chapter 8 • Assessment and Goal Setting Not all helpers agree that goal setting should be ageable. will guide and motivate them. Still. The helper swers to key questions. one are authentic even if the problem itself is concocted. The activity involves a help- other as the client. States vary slightly Part I: Instructions to Observer 1 on what must be revealed but giving your fellow stu. Did the helper find the key problems? If not. questions: Read this to the client and helper to determine whether your articulation of the goal is accurate. Is the goal: • How long did it take to complete the interview? • Did the client react negatively to answering so • Simple and specific? many questions? If so. her real identity so that the other aspects of the intake While client and helper are engaged in goal setting. to understand the basics of the problem. They are also creating a vision of success that and that identifying goals makes problems seem man. Was the helper able to intersperse questioning and 2. observer (see “Instructions to Observer 1” below) can An ethical alert is necessary at this juncture. When helper and client agree upon the goals. agree on a problem that the client is hoping to work the helper and client should spend only a small portion on or that is fabricated for this exercise. how might this be • Positively stated? (the presence of something handled better? versus the absence of something) . discuss the following arrived at by client and helper. between helper and client. fore the interview. and reflecting skills—just enough to enable the helper ories of the interview (ABC-1234) and think about an. the helper that help the client boil down the goal to a tect you and others. er and client and one or two observers. ___________________________________________ was too businesslike or too familiar? 4. Exercises GROUP EXERCISES Exercise 2: Boiling Down the Problem The purpose of this exercise is to practice the process Exercise 1: Practice Interviewing of boiling down the problem to a workable agreement In groups of three. or abuse of a child or elder. Record what you believe are the key statements by dent this warning will be good practice and will pro. why 5. The client should retain his or should then jump immediately into a discussion of goals. the client gives workable contract. you must warn even a fellow classmate final goal verbatim and facilitates a discussion about how that you would have to report to your instructor any closely the goal matches the ideal characteristics. ___________________________________________ not? 3. ___________________________________________ listening? Or did the client find that the interview 3. The client of the interview (perhaps 5 minutes) on the invitational should take a moment to look over the general categ. “You said your child’s behavior pathological depending on the person’s gender? Are is ‘just awful. In a group of four or five. He loses his temper with his wife. 1984). Chapter 8 • Assessment and Goal Setting 205 • One that the client is motivated to achieve? about and experiences with a higher power.’ Can you tell me which behav.aservic. Kitchener. SMALL GROUP DISCUSSIONS Discussion 4: Ethical Issues in Setting Goals There is an ethical principle that suggests we should Discussion 1: Religious and Spiritual Beliefs respect a client’s autonomy or ability to decide for Religion is the social body associated with a set of himself or herself what treatment to receive and what beliefs whereas spirituality is an individual’s beliefs choices to make (Brace. This • Set collaboratively? chapter recommends asking clients about their reli- • Realistic? gious and spiritual beliefs. To do so. and Religious Values fully explained the problem. “Are we in agreement then. age 11. and his grades have dropped to “Ds. that this will be our approach to achieving your goals?” 1. “Will the goal you have set re. How comfortable would you Exercise 3: Using Questions to Identify a Goal feel assessing this area—even if you were an atheist or not religious or spiritual? How would you approach Step 1 Form a group of at least seven students. specific. Mike wants to learn anger management and con- flict resolution skills. “What kind of interactions with process. Step 4 The entire group discusses whether these ques. Use the guide- Set Collaboratively between Helper and lines given earlier in the chapter. out of his chair at inappropriate times. 1992. Jack says ally solve the problem?” that he does not want to get into so much trouble Step 3 The helper then asks these questions to the in class and he wants to get at least “B” grades at client in order. minor issues. women generally seen as unhealthier than men? In iors you are talking about?” your group. Ethical. Jack. “How motivated are you to achieve this goal?’ In a small group. her would you like to be having?” Discussion 3: Constructing Behavioral Important to the Client Objectives For example. spiritual competencies on the website of ASERVIC. and challenging skills where possible. Mike came to see his helper due to problems man- flow of the conversation. this exercise because they are not part of the 2. the action pauses. important. react to this suggestion. how important would it helper uses invitational. see whether you can set one behav- ioral objective for each of these clients. in Counseling (www. Step 2 Each of the remaining members of the group is assigned to write down two questions that Discussion 2: Gender Issues in Assessment will help to refine the goal in each of the following categories: Conduct a classroom discussion on gender issues in assessment. They may seem disjointed in school. His wife is considering separation.org). and realistic goal. is doing poorly in school. discuss the importance of including a Stated Positively discussion of gender-role issues in the assessment For example. How does the interpretation of data vary Simple and Specific based on gender? Are some behaviors seen as more For example. reflecting. advanced be to discuss spirituality? For more information see the reflecting.” He has difficulty Realistic paying attention for long periods and often gets For example. you may Client have to invent some additional details. aging his anger. often yelling at her during disagreements over tions helped to move the client to some clear. The clergy? If you were a client. when the client has Association for Spiritual. positive. The a client who is antireligious or simply nonreligious? exercise begins with a helper and a client hold- Under what circumstances would you refer a client to ing a session about the client’s problem. the After about 8–10 minutes. Some . think about your It is important to reduce assessment data to a set of major practice sessions as well as your answers to the issues. Interviewing and recording information help by the legal system or those in authority. Indicate how well you think you are able to nar- Arrange them in the order that you would address them row the client’s story to simpler goals or “boil in an out-basket list. One guide for treatment planning down” the problem. On a scale from 1 to 10 (1 = just beginning and WRITTEN EXERCISES 10 = mastery). into treatment by a judge for a particular problem such as alcoholism or domestic violence? What is the ethical thing to do in such situations? Self-Assessment 2: Goal Setting 1.aids. c. What if the person is ordered you might gain additional experience or training. actions you are willing and able to take. and shelter must be dealt with before higher needs such as belongingness. . the skills of this chapter. The client indicates he feels lonely and isolated since his divorce one year ago. The client has been experiencing mild Include all feedback even if it does not relate to depression. In-Basket 1 2 3 4 5 6 7 8 9 10 a. low students or instructors and write it down.) affect the way people look at them? What challeng- 1. Observing an affected person? Looking at the various websites. Recall feedback from fel- been attending support group meetings.org or www. Using standardized tests small group. which is then placed on a problem list or in-basket exercises in this chapter. Just beginning Mastery clothing. Consider the following issues in a client’s in-basket. indicate how to set goals for the client. When a list has been compiled. The client has difficulty with his supervisor and 5. What limita- In reviewing my assessment skills. In your 4. the help- er arranges the issues in order of importance and places 1 2 3 4 5 6 7 8 9 10 the list in an out-basket. Which skills are you finding to be the most difficult is considering changing jobs. is to think about Maslow’s hierarchy of needs. 2. Identify two steps you can take to help you ing and would like to consider a career in this improve your skills further. 4. to understand and practice? e. When answering. State two things you feel that you were able to b. and self-actualization.206 Chapter 8 • Assessment and Goal Setting helpers believe that no one should be forced to receive 3.gov are good places to start). discuss whether the helper has the right For those items that you checked. f.kidshealth. Items arranged in the out-basket Just beginning Mastery list represent a treatment plan or goals placed in priority order. Just beginning Mastery wife. Identify concrete area. The client is a recovering alcoholic but has not improve upon this week. indicate how well you think you Exercise 1: In-Basket–Out-Basket have developed the skill of using questions to identify a goal. d.3). Maslow 1 2 3 4 5 6 7 8 9 10 suggested that basic physiological issues such as food. The client has an interest in drawing and paint- 6. (see Figure 8. Now rate yourself on your ability to write construc- tive goals. 3. Using questions appropriately es would this present socially and professionally for 2. love. HOMEWORK Homework 1: HIV-Positive Client SELF-ASSESSMENT Search the Internet for reputable resources for dealing Self-Assessment 1: Assessment with people who are HIV positive (www. I feel I need more tions do such people experience? What mythologies work on: (Check all that apply. The client wishes to develop a better relation- ship with his two children who live with his ex. Defend your choices in a sentence or two. These may range from encounters with a high school guidance counselor to an intake inter- Do a brief research study on the symptoms of de- view at the college counseling center to a College pression in children. ing with someone who tested positive for HIV? What issues might you expect him or her to bring to the JOURNAL STARTERS helping session? 1. (2) asking the client to identify the thinking. the helper. Consider a personal problem that is currently trou- goal. and Internet Board Examination (GRE. and (5) making lem is gone? Comment on this exercise. you will be doing differently. Think back on assessment experiences in your Homework 2: Assessment of Children own life. books. SAT). Do you sure that the client and helper are clear and in agree. Chapter 8 • Assessment and Goal Setting 207 what must a helper know about current treatment. Respond to the question “How will I helper whereby the client is helped through the five know when the problem is gone?” Reflect on what steps of boiling down the problem: (1) summariz. What is different about the way that children decisions have you made based on testing or express and experience depression? What treatments assessment results? What decisions have others are available? made about you based on testing? Discuss any negative or positive experiences. what you will be ing all the issues. one clients? aspect that takes practice is changing a problem to a 2. test. stated by the client and the goal as reformulated by ing. How do these Homework 3: Changing a Problem to a Goal affect your views and feelings about testing When you are learning to boil down a problem. What important sources. Create two short dialogues between client and bling you. (3) selecting the focal problem. and prevention? How would you feel about work. and what others will notice that is differ- most crucial problems. think it might be helpful in goal setting for a client ment. Use articles. ent about you. After each dialogue. How will you feel when the prob- (4) changing the problem to a goal. identify the problem as to imagine a future without the problem? . CHAPTER 9 Change Techniques. and gratitude. 208 .3 Identify the steps for teaching clients countering.4 Formulate homework plans for clients based on case studies. thought stopping. 9.1 Use the REPLAN system for treatment planning in a case • Journal Starters example. you will be able to: • Self-Assessment • Homework 9. 9. Part I What Are Change Techniques? REPLAN and the Common Therapeutic Factors • Understanding the Factors or Major Components of the REPLAN Model • How the REPLAN System Helps You Plan Treatment • Using the Common Therapeutic Factors • Steps in Treatment Planning Using the REPLAN Model Enhancing Efficacy and Self-Esteem • Sources of Low Self-Esteem • Silencing the Internal Critic: The Technique of Countering Practicing New Behaviors • Role-Playing • Giving Homework Assignments as Practice Lowering and Raising Emotional Arousal • Reducing Negative Emotions • Reducing Anxiety and Stress • Raising Emotional Arousal and Facilitating Expression • Creating Positive Emotions Summary Exercises LEARNING OUTCOMES • Group Exercises • Small Group Discussions By the end of this chapter. meditation.2 Understand and practice the steps for performing the following techniques: role-playing and relaxation training. 9. then do an assess- ment. Only after these things have been accomplished are you able to identify the tools necessary for a successful outcome. But if you want to utilize techniques from other theories. the techniques you select will most likely be associated with that theory. Where should you start? If you are comfortable working with a particular theory. and a treatment plan has been devel- oped. is there a method of reviewing a variety of sources to then choose what is best for the client without being haphazard? START Relationship Building HERE Assessment Goal Setting Intervention and Action Evaluation and Reflection STOP FIGURE 9. Figure 9.1 shows the next stop on the road map of the helping process: intervention and action. selection of an intervention is not the initial thing that you do in the helping process. This is when appropriate change techniques are implemented. First you develop a relationship. Each of these categories has smaller building blocks. But there are literally thousands of techniques. challenging. Chapter 9 • Change Techniques. opening.1 Road Map of the Helping Process: Intervention and Action . reflecting. and then select goals. helper and client turn to the business of accomplishing the agreed-upon goals. So. collaborative relationship is established. Part I 209 WHAT ARE CHANGE TECHNIQUES? We have thus far focused on the helping skills that involve inviting. and goal setting. When the honest. you must find a way to incorporate them in a rational and systematic way. As the road map indicates. Change techniques are helping skills employed during the intervention and action phase that are designed to create movement and growth toward the achievement of the client’s goals. There are two ways to make a quilt. hoping they will fit when the quilt is done. transference. and thought stopping to silence the internal critic. and culture that can influence his or her reaction to the helper and to the helping process. family. but changing a client’s long-held beliefs about the self is a challenge. the helper looks to the six common therapeutic factors that we discussed in Chapter 2 as a way of fulfilling the client’s goals. which is a way of remembering them when we think about planning the course of helping. This theory suggests that all the methods that helpers use are actually evoking the healing potential in one or more of these common factors. This is not a trial-and-error method that starts when a helper hears about a new technique and just starts experimenting with it. countertransference. Together. they form the acronym REPLAN. or you start with a pattern and find the pieces that fit into your design. religion. we refer to each of the factors by a let- ter. Nearly all helpers agree that improved self-esteem is a desired goal. called the REPLAN system. you will learn the change techniques of countering. Instead. These are the big things or macro skills that all helpers use. Either you pick up the pieces nearest to you and sew them together. Part I One metaphor for analyzing your selection of techniques comes from quilt making. and this provides you with a rational way to home in on the special techniques that might be effective for your client. Not only must the helper provide a therapeutic atmosphere. Differences. a form of positive self-talk. In this chapter. The concept of common therapeutic factors is useful simply because it provides a way of organizing the techniques you are learning and because it will help you to think about the purpose of the techniques you are choos- ing. according to this method.210 Chapter 9 • Change Techniques. The REPLAN method of treatment planning recommends that the helper reflect upon the background of the client and the client’s problems and initially choose the common therapeutic factors to employ before identifying a specific technique. Enhancing the helper/client bond involves both the helper’s use of the nonjudgmental listening cycle (NLC) and the client’s willingness and ability to enter the relationship. E 5 ENHANCING EFFICACY AND SELF-ESTEEM There are techniques to improve a client’s confidence in his or her abilities and also aid in dealing with an underlying lack of self- worth. but he or she must also take into account the client’s unique background. and misunderstandings can cause ruptures in the therapeutic alliance. Understanding the Factors or Major Components of the REPLAN Model R 5 MAINTAINING A STRONG HELPER/CLIENT RELATIONSHIP The therapeutic alliance was discussed in Chapter 2 and in later chapters when you learned invitational and reflecting skills. a common therapeutic factor is a common or underlying element that explains why many different techniques seem to be effective. For the sake of convenience. It begins with the agreed-upon goals chosen by helper and client and leads to selecting methods and tech- niques that are aimed at those goals. The whole range of helping skills and techniques can be linked to one or more of these six factors. . Creating a design at the very beginning is the systematic kind of treatment planning we recommend in this book. which must be repaired. REPLAN AND THE COMMON THERAPEUTIC FACTORS As we discussed in Chapter 2. How the REPLAN System Helps You Plan Treatment There are many different methods for treatment planning. L 5 LOWERING AND RAISING EMOTIONAL AROUSAL Clients are often struggling to quell strong emotions and to express hidden feelings. N 5 PROVIDING NEW LEARNING EXPERIENCES Also in the next chapter. Antony & Barlow. Finally. you will learn the quieting techniques of deep muscle relaxa- tion and meditation and the change technique of gratitude to increase positive emotions. 2013). The major techniques you will learn in this category are giving advice (which is often misused). The REPLAN system does not conflict with making a DSM diagnosis or using theo- retically oriented models. Even before a helper is entrenched in a particular theoretical viewpoint. you receive a certain treatment. you will learn the change techniques of role-playing and giving homework assignments to help clients practice new behaviors. if you have major depression. psychodynamic. But clients also need to build a bank account of positive emotions to counteract negative feelings and broaden their coping repertoires. you receive another. clients may learn communication techniques to improve the couple relationship. In this chapter. For example. there is good reason to think that an integrative approach to treatment planning is useful. and getting clients to see their problems from a more con- structive perspective. Therefore. In this model. if you have obsessive-compulsive disorder. Part I 211 P 5 PRACTICING NEW BEHAVIORS Just like playing the piano. The techniques one eventually chooses may come from the person-centered. Here you will learn the change technique of encouragement as well as the use of questions to motivate change. For example. This is the medical methodology that begins by assessing the client and arriving at a diagnosis. . directly teaching social skills. particularly early in training. Adlerian. accurate diagnosis is crucial because it determines treatment (cf. As indicated earlier in the book. Frances. brainstorming. Chapter 9 • Change Techniques. I believe it is critical that to take into account whether or not a technique is backed with some kind of supporting evidence. using REPLAN. or behavioral theories. treatment strategies must be tailored to the client’s goals and unique characteristics rather than to a specific diagnosis. In this chapter. HOPE. but it does assert that even clients with the same diagnosis may need different treatments. A great deal of what helpers do involves stimulating new learning and creativity by provoking insight. Most people are familiar with the diagnostic treatment planning method. gestalt. giving information. but they need to practice both within sessions and between sessions so that the new skills are firmly established. we look at the vast category of change techniques that give clients insight and information. Many practice techniques are available to strengthen fragile new learning. 2010. The diagnosis then becomes the basis for determining what treatment the client will receive. AND MOTIVATION The next chapter addresses how a helper can motivate a demoralized client. many newly acquired skills need practice. many clinicians construct treatment plans based on the theory to which they subscribe. Alternatively. A 5 ACTIVATING CLIENT EXPECTATIONS. and reframing. Such evidence might be research. he or she can utilize the techniques of different theories with a systematic framework as a guide. Replanning occurs frequently during the helping process because client goals shift as some problems are resolved and new insights on old problems emerge. Use the common therapeutic factors (maintaining a strong helper/client relation- ship. Cleek. Wofsy. This approach has the benefit of focusing clients on a few goals at a time. Teachman. and motivation. Once an overall treatment plan has been constructed. as a result of assessment. activating client expectations. The approach is not incompatible with long-term therapy. the helper generates a list of potential techniques by asking two questions: 1. we stated that the first step in treatment planning is to make a list of problems collaboratively with the client. This makes it a brief treatment model. 2006). lowering and raising emotional arousal. and providing new learning experiences) to generate a list of possible treatment strategies or techniques to achieve the goals. The REPLAN system is distinguishable from other forms of treatment planning because it focuses on relatively few client goals. Using the Common Therapeutic Factors This brings us to how the six common therapeutic factors can help us structure a gen- eral treatment plan. & Mundy. 3. enhancing efficacy and self-esteem. & O’Hearn. 2003). Take a look back at Figure 8. and then identify techniques to address these problems (Woody. every 6 weeks. practicing new behaviors.3 where the process of placing prob- lems in priority order and matching them with treatments is shown graphically. choose one or more problems to focus on. but it approaches client prob- lems as distinct goals that must be regularly evaluated and replanned. But how do we match them with treatments? The REPLAN model’s spelling out of the common therapeutic factors in a certain order provides a framework for the big aims of helping. say.g. & Garofalo. using strategies associated with one or two common therapeutic factors. These goals are then boiled down to a workable. hope.. Previously. methods. or information that a new technique is a very promising practice (Boyd-Franklin. Koocher. “What common therapeutic factors are most likely to help the client reach the goals?” 2. 2. solvable form and placed in priority order. that are understandable to both client and helper. or techniques will be most effective (based on research or wide acceptance by the therapeutic community). “What strategies. Replan the treatment on a regular basis. to move new problems into focus as old issues are resolved. rather than planning an elaborate treatment regimen that may collapse over time as the client’s situation changes. Part I acceptance by experts. 2013). Detweiler-Bedell. Formulate mutually agreed-upon treatment goals. By all means no technique on a list of discredited treatments should be considered (e. Norcross.212 Chapter 9 • Change Techniques. and acceptable to the client?” . The next step is to order the problems in priority. culturally appropriate. Steps in Treatment Planning Using the REPLAN Model The three basic steps in REPLAN treatment planning are: 1. “Which common therapeutic factors would be most helpful for Matthew in achieving his goal?” She believes that the therapeutic relationship is firmly established.2 shows the factors and the associated techniques you will be learning. Nadia asks herself. religious background.1 shows the first draft of the treatment plan that she developed for Mat- thew using the REPLAN method. identify the following positive goal: to be able to go out with a woman and have fun. She then selects strategies to evoke the common therapeutic factors. but because of the nature of the problem and her knowledge of Matthew. we will be looking at three common therapeutic factors. she asks herself the second question. who is shy and wishes to meet and date women but has not been successful. It also seems clear that practicing new behaviors and providing new learning expe- riences would be critical because the client’s goals involve acquiring new behavior and new ideas.1 Treatment Plan for Matthew Goal First Objective Common Therapeutic Factor Change Technique Possess better Be able to demonstrate Providing New Learning Teach basic communication interpersonal skills nonverbal listening skills Experiences theory. The rationale for this kind of approach is that it encourages the helper to consider a wider variety of planned interventions than a theoretically oriented or a diagnostically oriented treatment planning model. a 25-year-old single white male. taking in all that she knows in terms of his abilities. The use of REPLAN is a way of reflecting on what would best help the client. Chapter 9 • Change Techniques. In this chapter. Part I 213 To illustrate how this works in practice. Matthew’s main problem is anxiety in social situa- tions. Nadia. To initiate the REPLAN method.1 Writer’s Block TABLE 9. she develops a treatment plan that also reminds her to keep tabs on ruptures in the relationship. “What specific methods under these common thera- peutic factors would be most effective with Matthew?” She consults her initial assess- ment. Then the helper nar- rows down the list of potential techniques based on the client’s needs and background. In summary. Now that Nadia has identified the major common therapeutic factors. and self- disclosure Be able to ask Ask someone out for Practicing New Behaviors Role-playing in the office someone out for a coffee prior to homework date Maintain an honest Client will report both Relationship Remain vigilant to ruptures relationship with the successes and failures in in the relationship because helper his attempts to deal with the client is sensitive to anxiety being pushed . Together he and the helper. a chemist. culture. let us look at the case example of Matthew. the notion of common therapeutic factors is a way of identifying what the client needs and selecting a general approach to attending to the client’s problems. and history (ABC-1234). It is a heuristic. or a method for stimulating thinking about possible techniques to employ. listening. and it asks the helper to be culturally sensitive. MyCounselingLab Video Exercise 9. thinking about what will work for this unique client. Table 9. Table 9. Note that the treatment plan contains explicit goals for the relationship as well as other common therapeutic factors. ” which stands for enhancing efficacy and self- esteem (see Figure 9. Gordon Allport highlighted the importance of self-esteem in mental health in 1955.2). The next com- mon therapeutic factor we take up is “E.2 Common Therapeutic Factors and Associated Techniques Techniques Associated with the Factor in Common Therapeutic Factor This Chapter E 5 Enhancing Efficacy and Self-Esteem Countering Thought Stopping P 5 Practicing New Behaviors Role-Playing Homework L 5 Lowering and Raising Emotional Arousal Deep Muscle Relaxation Meditation Gratitude ENHANCING EFFICACY AND SELF-ESTEEM Although the REPLAN system starts with “R” for relationship. Part I TABLE 9. and now there is wide agreement that a positive self-concept is a Enhancing Efficacy and Self-Esteem Providing New Practicing Learning New Experiences Maintaining a Behaviors Strong Helper/ Client Relationship Lowering Activating Client and Raising Expectations. Hope.214 Chapter 9 • Change Techniques. Emotional and Motivation Arousal FIGURE 9. we have already discussed the importance of the therapeutic alliance in Chapter 2 and presented techniques to enhance the relationship using the nonjudgmental listening cycle (NLC).2 Therapeutic Factors in the REPLAN System: Enhancing Efficacy and Self-Esteem . 1969. & Hagen. 1971. Hewitt. . despite their obvious competence. that one is basically good and is worthy to live. and talented individuals whose major problems are deeply held negative beliefs about them- selves. They may possess needed skills but do not recognize these abilities and strengths. Despite high interest and considerable research. Adler felt that a clear sign of mental health was defined as “faith in oneself. he or she feels a sense of confidence or expectation that driving a car is a manageable task. STOP AND REFLECT Ten Things I Can’t Do Self-esteem can be improved by increasing client self-efficacy and self-worth. 1972). In short. though it may generalize to similar situations. Improvements in self-esteem have been associated with greater psychological health in relation to a wide variety of stressors and psychological problems (Dubois et al. van Tuijl.. 2014). Carl Rogers focused on reducing the gap between one’s perceived self and one’s ideal self. de Hullu. 1994. It is the sum total of one’s attitudes about the self: the fundamental belief that one is “okay” or “not okay” (Berne. we often meet intelligent. low self-esteem has long been identified as a cause of or contributing factor in many psychological diagnoses and symptoms. attractive. Likewise. Part I 215 keystone of mental health and that raising self-esteem is a fundamental task of helping (Carlock. Teismann. 2012. Witmer. the feeling of competence. McKay & Fanning. de Jong.” Likewise. It is also subject to modification by experience. It is possible to have efficacy (feel competent) in a number of skills and still experience low self-worth. In contrast to efficacy. Many clients are afraid to try new activities because of past failures. 2005. the concept of self-esteem has been attacked as too vague. & Hiester. especially depression and anxiety (Michalak. Dubois. individuals with low self-esteem often do not pay sufficient attention to suc- cesses and improvements. Sharma. 2011. 2009). let us focus on efficacy. Having an auto accident could undermine one’s sense of efficacy as a driver. Efficacy is tied to specific activities. and as a cure-all for problems. For example. & Nauta. King. Efficacy or self- efficacy is an expectation that one can perform a specific task (Bandura. 1962. Roufa. Sportel. As helpers. 2009. Heidenreich. 2013). Rosenberg. 1985). One way of clarifying the concept is to recognize that self-esteem has two aspects: efficacy (com- petence) and self-worth (Branden. includ- ing substance abuse (Backer-Fulghum. as over popularized. 1999. Helpers give clients these opportunities in session and in homework. Efficacy is increased when clients recognize their current abilities or learn new skills. Chapter 9 • Change Techniques. 1991). 1982. tending to focus on their losses and failures. Nordstrom. by focusing on strengths and competencies. 2014). when an experienced driver sits behind the wheel of a car. The helper. For a moment. self-worth is a global feeling that one has the right to exist. Flay. 2009. 1997). Patock-Peckham. enhances the possibilities for success and improved self- esteem (Thompson. it is self-approval. Goguen. & Vocks. Ströhle. The chances that a client will attempt a new activity are increased if he or she engages in warm-up activities. & Fagen. For example. place the letter T next to each item if you have talked to a friend or family member about engaging in this activity. your list might include: “I would like to learn to swim.” “I would like to be able to learn ballroom dancing.216 Chapter 9 • Change Techniques. For example. but they are so firmly entrenched that they are difficult to challenge and expunge.” 2. Once you have developed a list of 10 items. Albert Ellis (1973) ascribes low self-esteem to a set of “nutty beliefs” about the self and the world. To become more familiar with this process. talking about. Look at your list and decide whether your answers confirm this “readiness hypothesis. Conversely. and he has iden- tified seven of the most common: 1. It is thought that a person is more likely to engage in a new behavior if he or she gets ready by talking about it. but our ideas that hold us there. try the following: 1. 4. Ellis asserts that it is not a black cat that makes us afraid but the belief that a black cat causes bad luck.” Identify one or two behaviors that have the fewest letters next to them. The idea that it is a dire necessity for an adult human to be loved or approved of by virtually every significant other person in his or her life . Place the letter V if you have ever visualized or daydreamed about yourself performing this task. If we rid ourselves of irrational beliefs and develop more real- istic ones. and watching the behavior being modeled. Make a list of 10 things you cannot do at the present time but would like to be able to do. when we have not readied ourselves through these activities. Sources of Low Self-Esteem IRRATIONAL BELIEFS Irrational beliefs are self-destructive ideas that lead to low self- esteem (Daly & Burton. Place the letter A next to each task that you have attempted to perform in the last year. 3. Which letters are missing? The missing letters should indicate which activities you can initiate if you wish to increase your readiness. For example. Do you think you might experience any change in your self-esteem if you were able to engage in all the activities on your list? What factors impede a person’s ability to recognize his or her competence? 5. we reduce our emotional turmoil. It is not our expe- riences that keep us in a state of low self-esteem. Although we each probably have something unique about our belief systems. They cause us to suffer emotionally.” “I would like to be able to speak a little Spanish. and visualizing the new behavior. we are farther away from actually attempting the behavior. 1983).” “I would like to ask someone out on a date. Compare your answers and your reactions with those of others in your training group. do not include personal qualities that you would like to develop or global statements about self-worth such as “I would like to be more patient” or “I would like to be a better person. Place the letter M for “models” if you have seen other people perform this task on several occasions.” “I would like to be able to use a spreadsheet on the computer. Part I including thinking about.” For this exercise. Ellis found that most people’s irrational ideas fall into some broad categories. visualizing it. some clients have the wrong perception of their bodies. The idea that one should be thoroughly competent. even helpers need to pause and reflect on their accomplishments and positive qualities from time to time. and distress even in those without major emotional problems (Thompson & Thompson. 1983). STOP AND REFLECT One way to increase self-esteem is to ask clients to pay more attention to their strengths and abilities. low self-esteem associ- ated with body image may have been mainly the province of women. and capable of achieving in all possible respects to consider oneself worthwhile 3. Although.” BODY IMAGE Psychological literature tells us that attractiveness is a valuable social asset (Adams. Try to counter the preceding ideas with something more rational. and engenders low self-esteem. Chapter 9 • Change Techniques. loved or approved of me in return. helpers assist clients to identify and chal- lenge irrational beliefs and to replace them with more reasonable and realistic ideas. The idea that it is awful and catastrophic when things are not the way one would like them to be 5. because something once strongly affected one’s life. it should defi- nitely continue to do so (Ellis. The idea that certain people are bad. The idea that it is easier to avoid life’s difficulties and self-responsibilities than to face them 7. men’s magazines now reflect that society has chosen some male ideals as well. Part I 217 2. or a lack of attractiveness by media standards. . 1973. adequate. Those who do not like their bodies tend to be negative about themselves as a whole. Because helping is a profession where success with clients is not often immediate. The belief that one must be perfect is probably behind this powerful dissatisfaction that propels starvation. This kind of distorted body image might be a symptom of more serious psychological syndromes. causes self-induced vomiting in extreme cases. in the past. but that is not something I can control. An individual may have poor body image because of a physical disability. Those with high self-worth generally feel good about their bodies. 1977) and that feeling unattractive is often equated with low self-esteem (Greenspan. or villainous and that they should be severely blamed or punished for their villainy 4. For example. Today men are expected to have “washboard abs” and other perfect features that provide a negative comparison for the average person. The idea that human unhappiness is externally caused and that people have little or no ability to control their terrors and disturbances 6. Take this moment to reflect on your own personal assets. 1986. for example. 37) In order to improve client self-esteem. Body-image dissatisfaction is a particular problem of adolescent girls because of weight gain at that time of life (Choate. one could substitute Irrational Idea 1 with “I would like it if most of the people I value. a difference. 2008. p. 2013). 2013). especially eating disor- ders (Baird & Sights. seeing themselves as fat when they are thin. wicked. The idea that one’s past history is an all-important determinant of one’s present be- havior and that. 1986). Choate. anger. On the other hand. 7. When you wrote these down. This critic is probably cre- ated early in life through interaction with family and failure to meet self-imposed stand- ards (McKay & Fanning. List the top three accomplishments of your life so far. these thoughts tend to occur automatically. the “voice in the head” that reproaches and finds fault. 2005). List eight things that you do well. Ellis’s method (called rational emotive behavior therapy. it is often necessary to reduce the power of the internal critic and to modify these self-statements (Dowd. Did you hear this voice? Keep your answers in mind when you answer this next set of questions: • Now that you have completed this exercise. we will learn one key method for increasing client self-esteem: countering. Thus. The change technique of countering means finding alternative thoughts to combat self- disapproval. depression. 6. Part I A Self-Esteem Personal Inventory 1. Certainly many clients will also ben- efit from assertiveness training and other behaviors that silence external critics. or REBT) helps clients classify their beliefs as one of about seven major persistent irrational ideas. For example. Before one can experience self-worth. For example. 1985). Do you notice any difference in the way you feel? • Were there any answers you felt reluctant to write down? Were you apprehensive about “bragging”? What are the rules in your own family or culture governing when it is all right to give yourself a compliment? • If you were given this assignment as a client. and so on. and lowered expectations of the self. there may have been an internal critic that argued that these things are unimportant. goal oriented.” The negative thought leads to negative emotions of anger. Write down a few compliments about yourself that you hear from friends and family. but the first step is to decrease the disapproval that is coming from our own mental activity. you may be creative. before self-esteem can be built. conduct a brief scan of your emotional state. 3. before giving a speech. Then . how do you think you might have reacted? • Which question was the most difficult to answer? Why? • If you had been asked to list your negative qualities. List three occasions when you feel that you have truly helped another person. it is often necessary to silence the internal critic. As we mentioned earlier in this chapter. common to everyone.218 Chapter 9 • Change Techniques. 2. Write down eight personal characteristics that you are proud of. Characteristically. What are the good things people say about you? 4. which is a cognitive therapy technique for decreasing the internal critical voices that depress performance and create negative emotions. 5. the following thought might occur: “I am going to get up and make a fool of myself. organized. These irrational beliefs persist as silent sentences that the individual repeats in the mind and sometimes even aloud. or in some way disqualifying your strengths. would it have been easier or more difficult to answer? Silencing the Internal Critic: The Technique of Countering In this section. humorous. Write down three things that you like about your body. Clients begin to “catch” themselves. A counter is considered to be effective if it neutralizes the criticism. The client brings the card back to the next session and dis- cusses the thoughts he or she has noticed. client and helper brainstorm a number of possible counters. The self-criticism card serves three functions: It gives client and helper more data about the problem. or a single word such as “nonsense. HOW TO COUNTER Countering is a term coined by McMullin (2000). Often three or four general ideas (or core beliefs) about oneself come to the surface—for example: “I am not disciplined and never get anything accomplished.” Step 3: Identify effective counters. ask the client to engage in self-monitoring activities. Together. In countering. Here is an example of a self- criticism and a list of counters generated by client and helper: . Just as noting the number of calories consumed per day can decrease snacking. The counter can be a phrase. helper and client look at the self-monitoring material and choose a few negative patterns to focus on. Once helper and client have agreed that negative self- talk is a problem. Typically. Together. becoming aware of self-downing can lead to less negative thinking. and the client selects several with which to experiment.” The technique of countering is a constructivist version of Ellis’s tech- nique.” The counter is a way of talking back to one- self and disputing the self-criticism. writing down the frequency and types of self-downing thoughts. For this purpose. it helps the client make the connection between negative self-statements and the feeling states they produce. Part I 219 the helper uses rational argument to try and convince the client to abandon his or her “nutty thinking. a sentence.” “I’ll never be able to reach my goals. it is critical to determine the frequency of the negative self- statements and their effects on the client. Chapter 9 • Change Techniques. Countering means identifying the discouraging or self-downing statements a person says to himself or her- self and replacing them with equally powerful affirmations. the countering technique is based on the idea that each person’s belief struc- ture is different and the most effective arguments will be found in the client’s unique worldview. The countering method has five steps: Step 1: Do a brief assessment. wallet. or purse and notes each time a self-criticism is made. the major negative thought patterns and core beliefs about the self may be identified.” “I am disorganized. Effective counters are usually those that are consist- ent with the client’s own beliefs rather than those on a list supplied by the helper. Once the client has completed at least a week’s worth of self-monitoring. the client carries an index card in a pocket. By that I mean that instead of asking the client to use rational arguments against nutty ideas. Step 2: Identify the negative thought patterns and core beliefs. The client writes down the exact words of each self-criticism and the negative emotions these thoughts provoke. clients experiment with different arguments and use those that work for them. and it makes the client become aware of the thoughts. After making the self-criticism. But it’s not true!” 4. there’s no evidence for this.” SUDS after self-criticism—80 SUDS after counter—20 Step 5: Practice and report. . in every way. . The client is asked to notice whether negative thoughts have become less frequent. The next stage in the process of eliminating self-criticism is to evaluate the effectiveness of the counters that the individual has practiced since the last helping session. the client rates his or her emotional reaction to the criticism on a 10-point or 100-point SUDS (Subjective Units of Discomfort Scale). “That’s something my dad always told me. On the SUDS. “Feeling stupid doesn’t mean I am stupid.” 1.” but should actually dispute the negative ideas. At follow-up sessions. “I have always performed well in school. For example. One method for evaluating the potential effectiveness of a counter is for the helper to test the counter with the client during a session. the client learned that this self-criticism was very disturbing (80) and that the counter was very effective because it reduced the strength of the emotional reaction to about 20. They should not be simply positive thinking or “affir- mations. Part I Self-Criticism Counters “I am stupid. Remember that some negative self-statements are quite persistent. Self-Criticism Counter “I am stupid. Next the client reads a counter from the list that was brainstormed earlier and again rates his or her feelings of distress after saying the counter. MyCounselingLab Video Exercise 9. it is not tied to any particular self-criticism.2 Countering PROBLEMS AND PRECAUTIONS WHEN TEACHING THE COUNTERING TECHNIQUE Ineffec- tive counters should be discarded. there’s no evidence for this. the client is asked to practice countering and report at the next session. the helper and the client gauge progress and continually seek more effective counters. Counters should be realistic. “Not true!” Step 4: Test counters and modify them. one client found that introducing each counter with “Clearly . The helper should also suggest any personal words or phrases that might produce more self-confidence. and it may take months to eliminate these insidious automatic thoughts. The client can be asked to modify the coun- ter slightly in any way that might refine it or make it more effective. Once the client has identified some effective counters for one or two negative thoughts. and the client should be prepared for the fact that some counters are more potent than others. I’m getting better and better” is a “pep talk” without real substance.” 2.” 3. In the following example. First the client selects a statement from a list of self-criticisms and reads it aloud to the helper. a score of 100 (or 10) equals high emo- tional distress and 0 equals no emotional distress. A statement such as “Every day. .” gave the counter more power for her.” “I have always performed well in school.220 Chapter 9 • Change Techniques. & Judge. Negative visual images should be countered with positive visual images. Practice has always been a part of a “psychoeducational” approach to helping (Guerney. Rockenbaugh. 2003). the client is asked to label and state it either mentally or aloud—for example. “I’m not going to worry about the grade. boredom. Compared with the developing of counters. Schutz. 5). Also.” But the selection of the proper counter is based on what works for the client. “I have to get an A on this paper!” This repeti- tion brings the thought into clearer focus. One practical method when practicing thought stopping privately is to yell “Stop!” as loudly as possible. 1985): 1. Some helpers suggest wearing a rubber band around the wrist and snapping it along with a mental “Stop!” to produce the startle effect. The major idea is that many client problems are due to skill deficits. Eshelman. The helper teaches the client the technique in the office. the substituted thought might be something such as. it is best to say “Stop!” mentally. Creating a startling interruption 3. This can be either a spontaneous or a planned counter that the client produces to counteract the negative thought. In public.3). creating more and more anxiety unless we have the skills to suppress our thinking when it gets out of control. Three steps in the thought-stopping technique have been identi- fied (Davis. 1981. Young & Rosen. 2005). In this case. Part I 221 McMullin (2000) suggests that the counter should be in the same mode as the thought it is disputing. Witmer. includ- ing about smoking (Dodgen. PRACTICING NEW BEHAVIORS The third common therapeutic factor in the REPLAN system is “P” for practicing new behaviors (see Figure 9. 1985). The client then creates a startling response strong enough to interrupt the negative thinking pattern. You also might want to imagine a huge red stop sign. 2005) and obsessive-compulsive disorder (Hannan & Tolin. Chapter 9 • Change Techniques. We are all familiar with lying in bed at night thinking about all the upcoming responsibilities. 2000. Polster. A VARIATION ON COUNTERING: THOUGHT STOPPING Sometimes clients are troubled by unwanted thoughts and images that create anxiety and depression and damage self- esteem. self-downing thought. and negative self-talk during therapy sessions (Bakker. 1971. I’ll do the best that I can. Stollack. 1971. 2009. and the client practices it whenever a severely dis- turbing thought arises. The final step in thought stopping is to insert a positive thought to replace the irra- tional. Clients need to gain some basic knowledge about the problem. Lazarus. Thought stopping has been used to treat all kinds of recurring thoughts. shorter counters tend to be more effective than longer ones. thought stopping can be considered more of an emergency measure to halt the flow of negative messages. Grizzard. Substituting a new thought Once the troubling thought has been identified. they snowball. Once such thoughts get started. Unwanted thoughts and images may be memories of failure or concern about upcoming events. Stating the thought 2. Angry thoughts should be countered with compassionate ones and “passive thoughts with assertive ones” (p. Experienced therapists use thought stopping to treat their own distracting thoughts. Williams. & Guerney. & McKay. see models of the behavior they are . the helper cannot be content for the client to temporarily eliminate a problem behavior or merely gain insight into the fact that he or she is operating in a self-defeating manner. For example. modeling. You would then attempt the music with the instructor present. In this chapter. Helpers use each of these steps when teaching a new skill: explanation of theory. dealing with anger. The best instruction for any skill includes the following sequence: (1) The helper explains a theory or rationale for learning the new skill. we will focus on two specific methods used to aid clients in practicing new skills: role-playing and homework. 2003). and Raising and Motivation Emotional Arousal FIGURE 9. 2006. & Thibodeau. and later you would be sent home to practice. Some of the skills that clients need to practice include parenting. Part I Enhancing Efficacy and Self-Esteem Providing Practicing New New Learning Behaviors Experiences Maintaining a Strong Helper/ Client Relationship Activating Client Lowering Expectations. The process of acquiring a new behavior or a new thinking pattern takes place in much the same way. They may use imagery as a rehearsal (McEvoy. . 1985) or even technology such as video and computer simulation (Smokowski. Hope. Then the instructor would probably demonstrate how the piece is to be played. and (4) the learner practices through homework assignments. Saulsman. communicating better as a couple. 2015. (2) the learner views a model (helper or group member) who correctly demonstrates the skill. if you were learning to play the guitar. and homework. and developing more effective ways of thinking. and then rehearse. in-session practice. Suinn.3 Therapeutic Factors in the REPLAN System: Practicing New Behaviors trying to acquire. Witmer & Young. facing fearful situations. Erceg-Hurn. As an educator. Pierce. (3) the learner demon- strates the behavior in the real or simulated situation by practicing in class. Clients must overcome the force of old habits by establishing a new pattern of behaviors through practice and rehearsal. 1996. or you might listen to a recording of the selection.222 Chapter 9 • Change Techniques. the instructor might explain the fingering using a chart or graph. and sharing and analysis (Yablonsky. who plays all the roles in the drama. 1996). pp. Part of what Moreno objected to in traditional therapies was the separation of a client’s problems from the natural environment. 5–6). Graber. 2005) to working with clients with phobias (Martinez. ELEMENTS OF ROLE-PLAYING The technique of role-playing is a limited form of psycho- drama. 1986. & Nichols. Role- playing can be used as a rehearsal for these new behaviors. talk in front of an audience. It may also take place in a group setting with other participants who can give valuable feedback and act as auxiliaries or actors in the play. Acting-In: Practical Applications of Psychodra- matic Methods (1996). 1964. You meet people in the artificial setting of your office. Because it is not always possible to see individuals in their natural contexts. McDonald. feelings. Because we cannot reach into the subjective experi- ence of the person through words. and intuitions. Virtual role plays utilize computer technology or video and allow clients to learn in a simu- lated environment about issues such as how to cope with anxiety (Powers & Emmelkamp. 2008) or respond to sexually threatening situations (Jouriles. just as a religious sculpture or painting cannot be fully appreciated in a museum but must be seen in a church or temple. I try to give them the courage to dream again” (Moreno. “Well. It involves practicing a behavior in a contrived situation with the helper playing an aux- iliary or observer role. in their natural surroundings. Role-playing has always been conceived of as having three phases: warm-up. I start where you leave off. and Show and Tell Psychodrama by Carnabucci (2014). & Nelson. Part I 223 Role-Playing Role-playing is a change technique commonly used by helpers for social skills train- ing and in helping clients face situations they are avoiding (Kipper. the psychodramatic method proposes to re-create an individu- al’s joys and sorrows on the psychodramatic stage (Starr. express themselves to others. L. Those who want to learn more about the basics of psychodrama should consult Adam Blatner’s book. Platt. 2002). For exam- ple. including thoughts. Rowe. . confront someone. & Gomez. I meet them on the street and in their home. 1977). Dr. action. and an understanding of the whole theory of psychodrama is not necessary. On one occasion. Collins. don’t tell me!” He felt that most “talk therapies” relied on the client’s descriptions of problems. or tell someone their true feelings. a Viennese psy- chiatrist who formulated the psychodramatic method (see Blatner. 1976). Freud. 2005) to training students in family therapy (Browning. It has been employed in a variety of settings with many different types of clients from group work with children (Borbely. Moreno. Moreno is said to have responded. Chapter 9 • Change Techniques. or with the help of other individuals called auxiliaries. clients might wish to learn to refuse requests. 2011). Role-playing was introduced by the creative genius J. 2000). Moreno’s response reflects his belief that helping should involve learning in as naturalistic a setting as possible. You analyze their dreams. Role- playing can be performed by a single individual (the protagonist). we should transfer the mind onto the stage where the person’s total behavior. Moreno’s famous dic- tum was. is observable and changeable. “Show me. following a lecture by Freud. Kipper and Ritchie (2003) have summarized research on the effectiveness of psychodramatic techniques. the helper instructs the client to pretend to be the other person and respond as he or she might. and the com- petitive skier mentally runs the course. the client changes places and sits on the chair that previously repre- sented his mother.224 Chapter 9 • Change Techniques. but not immediately after the action phase. Instead of the client sharing more about his or her experience. proper warm-up is crucial to the success of the technique. the actor rehearses lines. It is a suggestion to begin with tangential events before moving to more significant or central issues. “Move from the periphery to the center” is a tip for helpers about how to get a client more involved in the role play. The client is required to construct possible responses of a significant other and devise strategies to cope with them. The warm-up decreases stage fright and allows the protagonist to develop readiness and involvement in the process. In role reversal. that is. the sharing phase of role-playing allows the individual to reenter the group situation. role reversal makes the situation more real. Part I THREE PHASES OF PSYCHODRAMATIC ROLE-PLAYING Warm-up. describing the situation verbally. It involves asking the protagonist to set up the stage to resemble the actual setting where the incident took place or where the behavior will possibly occur in the future. and identifying important people to be portrayed. during which members give feedback to the client and the role play is discussed. Role reversal is one of the most effective ways of getting the client involved in the role play. the runner does stretching exercises. For example. In this case. At some later time. The warm-up is any activity that helps the client get in touch emotion- ally with the experience he or she is trying to express. In group therapy. For example. Sharing and Analysis. using props. most of us have warm-ups. a feedback or analysis session is held. these scenes might include driving to the house while reminiscing about the relationship or replaying previous encounters between grandparent and grandchild. Scene setting is the preliminary step of this action phase. the other group members use this opportunity to relate personal experiences evoked by the client’s role play. For example. designating the time of day and date. the helper asks the client to take on his or her own role and enact the situation. Another way of warming up is to use role reversal. The client is given free rein to use available props and to orient the stage in whatever way feels comfortable. After the warm-up. This method also gives the helper more information about the client and the client’s relationships and life circumstances. He responds as his mother might in a similar circumstance. HOW TO CONDUCT ROLE-PLAYING Role-playing is one of the most effective ways of prac- ticing a new behavior. but would move the client through several less potent scenes. the helper would not begin with the deathbed con- frontation. . we use to prepare for action. With sufficient warm-up. or rituals. If you think about it. if the role play involves return- ing home to see a dying grandfather. The immediate observation and feedback allow for actual practice. This tech- nique re-involves the audience and helps the client feel less alone and exposed. In role-playing. Action. The helper assists the client in defining the stage. the client overcomes stage fright and is more in tune with the actual role play when it takes place. Warm-up might include asking the protagonist to discuss the situation or encouraging some physical activity. to get out of the spotlight. such as pacing back and forth. Besides. suggests that they role-play the situation to rehearse his talk. clear voice 3. To make the method easier to understand. the client identifies important people in the scene and briefly describes them. Patrick stops the action and takes on Martin’s role to model an effective closing statement. Smile when questions are asked 4. In this step. In our example. Patrick asks Martin to reverse roles and pretend to be his boss to get a sense of the boss’s demeanor and attitude. thanking the audience. Patrick asks Mar- tin to try the closing a second time in his own way using whatever parts of Pat- rick’s closing he liked. Martin wants to: 1. End the session by thanking the audience Step 2: Scene setting. to establish the scene. Step 3: Selecting roles and role reversal. Patrick. He also asks him to point out the chairs of some of the other board members and briefly describe those people. and understandable to the client. For the sake of simplicity. Patrick encourages Martin to point out various features.” Patrick acts as a coach during the first run-through. The feedback should be specific. Part I 225 not simply talking about problems. is anxious because he has to give a presentation to his board of directors concerning progress on his yearly goals. the helper asks the client to briefly portray the target behaviors as described during the warm-up. Using the principle of proceeding from the periphery to the center. he appears more relaxed. The method described here is a generic role-playing technique for practicing new behavior. In an individual session. The client. Patrick then invites him to describe his own office (peripheral) and later the board meeting room (central). details of the workplace. a hypothetical example unfolds throughout the explanation. Maintain eye contact with his audience 2. Step 4: Enactment. “Your voice was very strong and clear. In this step. this example will show what it is like for a helper to conduct role-playing in an office setting rather than in a group session. At a deeper level. empty chairs represent these significant persons. In this case. Step 1: Warm-up. Patrick tells Martin. and other tangential top- ics. Patrick begins the warm-up by asking Martin to discuss aspects of his job that he will be presenting. The most important aspect of this step is for Patrick to get Martin to describe the target behaviors very specifically. Speak from notes in a loud. other mem- bers of the group would be assigned to these roles. Martin. Step 5: Sharing and feedback. Patrick previews and explains the purpose and the elements of role-playing. In the warm-up. The helper is dissatisfied with Martin’s portrayal of the final behavior. It should mainly reinforce positive aspects of the behavior. After Martin has discussed the situation. For example. Following the modeling. I think you got your . At this point. the scene begins in his office and culminates with his entrance into the “boardroom. rearranging Pat- rick’s office furnishings to approximate the setup of the boardroom. The helper. In Martin’s case. such as the color of the walls and the furniture. In a group setting. the helper shares feedback with the client. Patrick lets Martin set the scene. prompting Martin to display each identified behavior. simple. observable. role-playing and role reversal can help the individual to become more fully aware of feelings and to explore the phenome- nological worlds of the significant people in his or her life. Chapter 9 • Change Techniques. 226 Chapter 9 • Change Techniques, Part I points across very well. I would like to see even more eye contact with the board members during the next run-through.” Step 6: Reenactment. Reenactment is a repetition of the target behavior from entrance to exit. The sequence is repeated until the client is confident that each of the behaviors in the target list has been mastered. Step 7: Homework and follow-up. At the next session, the client is asked to report practice results. Martin has practiced the behavior by giving the presentation to some family members, and he describes this to Patrick. Further role-playing prac- tice may be given during the session, if necessary. When the helper feels that the client has consistently demonstrated the target behaviors, the helper urges the client to attempt the behaviors in a real situation. PROBLEMS AND PRECAUTIONS WITH ROLE-PLAYING 1. The most frequently encountered difficulty with the role-playing technique is stage fright. Resistance to the technique is ordinarily the result of insufficient warm-up, inadequate preparation time, the client’s lack of confidence, or inadequate reassur- ance by the helper. 2. Because of the power of the technique, both the helper and the client may be unprepared for the strength of the emotion that is sometimes evoked. This is unlikely when using role-playing for practicing a new behavior. Beginning helpers should not attempt to reenact traumatic scenes from the past. 3. Because most helpers focus on the client’s thoughts and feelings, we sometimes have trouble thinking in dramatic terms. Usually the client is encouraged to describe an encounter and the client responds with something like, “I was angry because she neglected me.” In a role-playing session, the client would be instructed, “Show me how you expressed your anger to her.” By creating a dramatic situation, the helper learns a great deal about the quality and context of the behavior, rather than just the client’s description of it. Giving Homework Assignments as Practice Homework has been identified as a crucial tool in effective helping (Kazantzis & L’Abate, 2011; Miller, 2010). Homework refers to any tasks or assignments given to clients to be completed between sessions (Last, 1985). More than 80% of mental health practitioners in one study used between-session homework (Kazantzis, Busch, Ronan, & Merrick, 2007). Some tasks are used for assessment purposes; others are used to increase client aware- ness of the behavior (Martin & Worthington, 1982); still other homework assignments are designed as independent practice sessions. In this section, the main emphasis will be on homework that is used to practice new behaviors, in other words to serve as a change technique (Kazantzis & Lampropoulos, 2002). These new behaviors are normally learned during the therapeutic session and may be modeled or rehearsed in the office before they are assigned as homework. Review of homework provides a starting point for each new session with a review of progress made and problems encountered in the assignment. REASONS FOR USING HOMEWORK A major advantage of using homework assignments is that they provide follow-up or treatment continuance between sessions. When one real- izes that a client spends 1 hour out of about 112 waking hours per week in a therapeutic Chapter 9 • Change Techniques, Part I 227 session, it is easy to see how insights from the helping session can be diluted by other activities. Homework assignments, especially if they require some daily work, can enhance treatment (Cronin, Lawrence, Taylor, Norton, & Kazantzis, 2015; Strong & Massfeller, 2010). In addition, homework assignments turn insights into tangible behaviors and pre- vent helping from being only a place to unload one’s feelings. Transfer of training or generalization of learning is facilitated by applying descriptions and models of behavior to real-life situations as soon as possible. Homework practice also begins the shift of con- trol from the helper to the client. If the client attributes progress to his or her own effort in outside assignments, greater efficacy and self-esteem will result. EXAMPLES OF HOMEWORK ASSIGNMENTS Use of Aides. One way to increase the efficacy of homework practice is to enlist the help of a client’s friend, spouse, or family member as an aide who provides either feedback or support for completing assignments. Generally, an aide comes to at least one session with the client. The helper specifically identifies the aide’s role as either feedback or support. Let us say that the client is attempting to become more assertive. The helper gives the aide specific verbal and nonverbal behaviors to observe and to report observa- tions to the client. Alternatively, the aide might simply be enlisted to provide support or to accompany the client while he or she completes assignments. The client who is attempting to exercise regularly may use an aide as a regular walking partner. The aide would help the client increase regularity and provide encouragement from session to ses- sion. The major pitfall of using aides is that they must be supervised by the helper. Some- times aides are too helpful and wish to take excessive responsibility for the client. If this behavior cannot be modified, the client should proceed alone. Self-Monitoring Assignments. Journaling is a daily writing assignment given to the client by the helper. Ordinarily, the client brings the journal to the next session for the helper’s reaction. Journals usually serve one of two purposes. First, helpers use this kind of journaling for spiritual issues (Wiggins-Frame, 2001), in school counseling (Zyromski, 2007), and even in couples work (Lemberg, 1994). In addition to written journals, thera- peutic blogs are now common (Lent, 2009; Strang, 2013), and e-journals are used in counselor training to reflect on personal growth experiences (Haberstroh, Parr, Gee, & Trepal, 2006; Miller, 2014). Although expressive journaling can be beneficial, because we are focusing on prac- ticing new behaviors, let us instead discuss the second purpose of journaling as a way of recording practice sessions or self-monitoring. In this type of journaling, the client keeps track of practice successes and also reflects on progress. This might include writing down negative thoughts (cognitive), recording the amount of emotional discomfort (affective), or noting the number of times a new behavior was actually practiced (behavioral). In this vein, consider the following case study of Joe, a 29-year-old administrator for an insur- ance company who has come for help to deal with problems associated with “stress.” He has borderline high blood pressure, is often tense and angry after work, and as a result, sometimes becomes rude to his fiancée, alienating her. He plays racquetball competi- tively, and last week he purposely broke an expensive racquet after a bad shot. He wishes to control his anger and feel less “stressed” at work. During the assessment, the counselor identified negative self-statements as a major cause of the client’s stress and felt 228 Chapter 9 • Change Techniques, Part I that, in general, the most useful path for Joe was to increase the common therapeutic fac- tor of self-esteem. Joe agreed but also felt he needed better organizational skills. The initial plan was negotiated as a two-pronged attack: to decrease self-criticism and to develop better time management and organizational skills. Joe enrolled in a 3-day time management workshop sponsored by his company and, at the same time, began keeping a record or Self-Criticism Homework Card, as shown in Table 9.3. Figure 9.4 contains two graphs. The first is of Joe’s SUDS levels, and the second shows negative self-statements over the first 10 days. (As noted earlier, SUDS is an acronym for the Subjective Units of Discomfort Scale.) In this case, 0 represents no discomfort, and 100 represents extreme distress. Using a homework card, Joe found that he was producing anger by his self- statements, which were first aimed at himself and sometimes directed at innocent bystand- ers. Joe agreed to continue to monitor his self-statements for 2 more weeks and noticed a marked diminishing of his self-criticism. In Joe’s case, there seemed to be a correspond- ence between his self-criticism and his emotional discomfort. Although the major purpose of keeping this journal was to encourage practice, the client also developed insight into the way he maintained his anger. Notice also that, like most people, Joe’s emotional dis- comfort did not take a steady downward course but shows the normal ups and downs of the change process. PROBLEMS AND PRECAUTIONS WITH HOMEWORK 1. Choose homework assignments that have a high probability of success (Dyer & Vriend, 1977). This is true especially early in the helping relationship in order to keep the client’s hope alive. Also, by promoting small, easily completed goals, the client begins to learn that most change is gradual, not an overnight phenomenon. 2. Homework strategies should be individually tailored for each client (Miller, 2014; Scheel, Hanson, & Razzhavaikina, 2004) and should be co-created with the client TABLE 9.3 Self-Criticism Homework Card for Joe No. Time Self-Statement Feeling SUDS 1. 8:15 I’ll never get all this work done. Discouraged 85 2. 9:00 I didn’t do a good job on that report. Disgust 50 3. 10:00 I’ll never be good at this job. I’m just average and that’s all. Self-pity 60 4. 10:35 I’m daydreaming again. Why am I so lazy? Anger 35 5. 12:00 I offended the secretary again. Why can’t I just keep my mouth shut? Anger 45 6. 1:00 I feel fat after eating so much. I’m turning into a blimp. Disgust 35 7. 2:40 Another day almost done, and I’ve completed nothing. Anger 40 8. 3:30 My desk is a mess. What a slob! Discouraged 50 9. 5:15 Even my car is full of trash. I wish I were more organized. Anger 25 SUDS 5 Subjective Units of Discomfort Scale 0.....................................................................................................................................................................................................100 No emotional distress Extreme emotional distress Emotions 5 fear, anger, sadness, guilt, interest-excitement/boredom, joy, disgust, surprise Summary 9 5 negative self-statements; average SUDS 5 47 (approx.) Most prevalent emotion 5 self-anger/disgust Chapter 9 • Change Techniques, Part I 229 Average SUDS Level 100 90 80 70 60 50 40 30 20 10 Day 0 1 2 3 4 5 6 7 8 9 10 Negative Self-Statements 20 18 16 14 12 10 8 6 4 2 Day 0 1 2 3 4 5 6 7 8 9 10 FIGURE 9.4 Graph of Daily SUDS Levels and Critical Self-Statements for Joe 230 Chapter 9 • Change Techniques, Part I whenever possible. Too often, the helper uses a standard homework assignment that, to the discouraged client, may feel impersonal. By stretching one’s creativity, some assignments can incorporate more than one of the client’s goals. If the client likes to read, recommending self-help books as homework might work well. If the client enjoys writing, assign a journal. 3. Practicing regularly is important. It would be better, for example, if the client per- forms a rehearsal for 10 minutes once per day, rather than practicing for an hour once per week. 4. Homework should be simple and fit easily into the lifestyle of the client. Compli- cated homework involving extensive record keeping may not be completed. 5. As the client progresses, homework should increase in difficulty or discomfort. Clients usually have a feel for when they are ready for more challenging tasks and for tasks that are presently beyond them. MyCounselingLab Application Exercise 9.1 Selecting Practice Methods and Choosing Homework LOWERING AND RAISING EMOTIONAL AROUSAL The fourth common therapeutic factor in the REPLAN system is “L” for lowering and rais- ing emotional arousal. The overall purpose of this set of change techniques is to reduce the impact of negative emotions and to increase positive emotions. This is accomplished in three different ways: 1. Reduce negative emotions: Helpers are called upon to help clients reduce over- powering feelings of depression, anger, stress, and fear, primarily through methods of stress reduction and cognitive techniques. 2. Facilitate expression of strong emotions that are being ignored: At other times, helpers arouse emotions to act as catalysts for change: for example, helping a client get in touch with repressed anger or sadness and allowing him or her to recognize the powerful nature of unresolved feelings. 3. Activate positive emotions: Helpers also facilitate positive emotions such as joy, gratitude, serenity, interest, hope, pride, amusement, inspiration, awe and love, trust/faith, compassion, gratitude, and forgiveness (Frederickson, 2009; Vaillant, 2013). Positive emotions also tend to weaken negative ones. In this section, we will address each of these methods for raising or lowering emo- tional arousal and identify some key techniques that helpers use in each circumstance. Reducing Negative Emotions The three most common negative emotions that clients seek help for are depression/guilt, anxiety, and anger. Earlier in this chapter, you learned the countering technique, which is used to help clients reduce self-criticism. Reducing negative thinking also tends to reduce depressive feelings, and cognitive therapy has been a well-researched method for treating depression, by psychological means, since the early 1990s. Although depression, anxiety, and anger are treated differently, we only have room here to talk about one of these troubling emotional states, so we have chosen to present Chapter 9 • Change Techniques, Part I 231 techniques for coping with anxiety. Anxiety is a very common complaint, and there are several basic anxiety-reducing techniques that can be learned and applied rapidly. In this section, we present two methods, relaxation training via muscle relaxation, and medita- tion, which are both effective and low-risk. Reducing Anxiety and Stress Although a little anxiety may actually enhance performance at times, it can easily run out of control, causing distress and interfering with relationships and job performance. Modern life, with more crowding, more work pressure, and more choices, has led to greater stress levels for just about everyone. The emotional arousal associated with anxiety or fear may have been useful in more primitive times because the “fight or flight” syndrome chemically sparked physical readiness to deal with potential harm. What once may have increased the chances for survival now threatens our health, because the physiological by-products of stress cannot be easily dissipated in a sedentary lifestyle. Today’s helper is frequently called upon to help clients learn to reduce the causes of stress by helping them acquire time man- agement skills; develop habits for self-care, including exercise and good nutrition; and gain a healthier outlook on life. In addition, helpers assist clients in lowering stress by reducing emotional arousal through quieting techniques. Helpers also need to sustain their own mental health by utilizing stress-reducing resources (Lawson & Myers, 2011). Some of the better-known methods for reducing anxiety and stress are systematic desensitization for phobic anxiety (Wolpe, 1958), applied relaxation (Clark et al., 2006; Donegan & Dugas, 2012), progressive relaxation (Jacobson, 1938), coping skills training (Frydenberg & Brandon, 2002; Tubesing, 1981), guided imagery (Apóstolo & Kolcaba, 2009; McEvoy et al., 2015; Singer, 2006; Witmer & Young, 1985, 1987), confession/ ventilation (Menninger, 1958; Pennebaker, 2002), enhancing social support (Gilliland, James, & Bowman, 1989), stress inoculation (Israelashvili, 1998; Meichenbaum, 1993; Novaco, 1977, 1983), biofeedback training (Fair, 1989; Fedotchev, 2010; Stevens, Hynan, Allen, Beaun, & McCart, 2007), mindfulness (Call, Miron, & Orcutt, 2014), and meditation (Aftanas & Golosheykin, 2005; Bogart, 1991; Burns, Lee, & Brown, 2011; Carrington, 1998; Gutierrez, Conley, & Young, 2016; Shapiro, 1994; Singh, 2012; Young, de Armas DeLorenzi, & Cunningham, 2011). These techniques are frequently combined and offered in a psych- oeducational format as stress reduction or coping skills training courses (Nickel, 2007). The most fundamental and time-honored method for helping clients reduce arousal is relaxation. Relaxation training brings about relief from symptoms of anxiety and lets clients experience the positive sensations associated with lowered muscle tension (Pag- nini, Manzoni, Castelnuovo, & Molinari, 2013). This technique is explained in detail here because it is part of most stress reduction programs and forms the basis of systematic desensitization and biofeedback training. RELAXATION TRAINING Edmund Jacobson’s progressive relaxation technique (1938) was, for many years, the favored method for teaching clients deep muscle relaxation. Muscle relaxation had been found to reduce anxiety in clients with phobias by pairing relaxation with exposure to fearful stimuli, a process called systematic desensitization. Jacobson’s method, if faithfully followed, enables the client to identify and relax every major muscle group in the body. The traditional training process may actually take sev- eral months in weekly sessions, although abbreviated versions have been used success- fully (Gatchel & Baum, 1983; Harris, 2003). Following is a simple and even briefer format 232 Chapter 9 • Change Techniques, Part I developed by Witmer (1985), which can be learned in three or four sessions, each lasting about 20 minutes. Every session is identical and provides a complete tensing and then relaxing of all the major muscle groups (see Table 9.4). Please note that for most prob- lems, relaxation alone is probably not as effective as a treatment program that also incor- porates mental or cognitive control of anxious thoughts such as thought stopping or countering (Donegan & Dugas, 2012; Hinton, Hofmann, Rivera, Otto, & Pollack, 2011; Stevens et al., 2007). Still, relaxation training has been consistently shown to work as a treatment for various kinds of anxiety and can easily be included as an adjunct to other quieting strategies. The Technique of Deep Muscle Relaxation. Step 1: Preparation. Ask the client to find the most comfortable position with eyes closed. This may be sitting or lying down, but in either case, there should be sup- port for the head. The legs and arms should not be crossed. The procedure is TABLE 9.4 Areas to Tense and Then Relax A. Hands and Arms Hand: The back of your hand, fingers, and the wrist Lower Arm: The forearm and the wrist Upper Arm: The bicep muscles B. Head, Face, and Throat Forehead and Scalp: The entire forehead and scalp area Eyes and Nose: The eyelids and muscles around the eyes, nose, and upper cheeks Mouth and Jaw: The area around the mouth and the lower face Throat and Jaw: Muscles inside the mouth and throat Entire Head and Facial Area C. Neck and Shoulders Neck: The muscles in the back of the neck, at the base of the scalp, and across the shoulders D. Chest, Shoulders, and Upper Back Muscles in the Chest, Shoulders, and Upper Back Area E. Lower Back, Stomach, and Hips Lower Back: The muscles across the lower back area Stomach and Hips: The muscles in the abdominal area and hips F. Hips, Legs, and Feet Hips and Upper Legs: The muscles in the upper and lower parts of the thighs Lower Legs: The muscles from the knees to the ankles Feet: The muscles around the ankles, over the top of the feet, the arch and ball of the feet, and the toes G. Body Review Sense any places where tension still resides and then tense and relax that area again. or a standardized commercially available version of the technique should be provided. It may take some time to learn how these muscle groups are properly tensed. it actually produces positive states of happiness. the client is asked to relax and breathe diaphragmatically to let go of all muscle tensions. or body scan. alertness. . 2011. cramps and spasms may result. Lane. Seskevich. Step 4: The body scan. 1992. MEDITATION FOR LOWERING EMOTIONAL AROUSAL AND INCREASING POSITIVE EMOTIONS Meditation may be one of the most effective means for decreasing anxiety. Ask the client to practice the relaxation technique twice daily. Help clients learn diaphragmatic breathing by placing one hand on the chest and the other on the diaphragm/ stomach area. usually once upon rising and once in bed before falling asleep. After tensing the muscle group. This phase is critical because the client is learning to self-monitor. Step 2: Tighten and relax. Following the tensing of a muscle group. The most important phase of the lesson is the body review..4. improved concentration. It is the relaxed breathing demonstrated by sleeping babies and practiced by singers. Step 3: Relax fully and breathe. 2007. Diaphragmatic breathing consists of inhaling and exhaling below the ribs rather than in the upper chest. fearlessness. Chapter 9 • Change Techniques.. instruct the client to exhale and relax fully and completely. diaphragmatic breathing and should last 20 seconds or so. the client is asked to return to specific. joy. optimism. ask the client to focus attention on that area. discrete areas of tension during the relaxation procedure and to relax them. & Pieper. Young. The first administration of the relaxation technique should be recorded for the client. and ask the client to report this information at the next session. Ask the client to progressively tighten and then relax each muscle group in Table 9. Step 5: Assign practice. Encourage the client to hold each tensed muscle about 6–7 seconds until the experience of tightness is fully felt. The client may be instructed to raise one finger to indicate when an instruction has been understood or completed. Tell clients that a body scan can be used on their own. In this step. and persistent anger and depression (Burns et al. Have the client note which of the six areas of the body show the greatest sources of tension during the day. The tension and relaxation of the same muscle group is then repeated before moving on. This allows the helper to individual- ize the relaxation so that the client can spend time on the areas that he or she tends to tighten. panic. deep. 2012). Experiment and allow the client to try out his or her own ways of tens- ing that area but not to hurt himself or herself. and feelings of well-being (Chandler. simultaneously relaxing other parts of the body and holding the breath. meditation is not merely a method for reducing tension. Instruct the client to speak as little as possible and to avoid moving except as necessary to achieve a more comfortable position. If the posture is held too long. Diaphragmatic breathing occurs when the stomach hand goes up and down but the chest hand remains relatively immobile. While a muscle group is tensed. There are a variety of ways to move the body to tense each area. to check bodily tension. Moreover. at any time during the day. This relaxation is to be accompa- nied by slow. Kabat-Zinn et al. Part I 233 best practiced without the distractions of noise or glaring lights. 1984). After that. 2008. Young et al. These include mindfulness- based stress reduction (Kabat-Zinn et al. at least 30 minutes per day should be devoted to meditating. Gelderloos. It involves paying strict attention to what is happening in the present moment without judg- ing. Others have found it effective to repeat a word such as one or peace (Benson. Whether one uses mantra or mindfulness-based meditation. 1995). & Finkel. Mind- fulness is not merely an activity conducted in a meditation sitting. A recent study of this technique finds that it is an effective way for counselor trainees to reduce stress (Gutierrez et al. For those who are not attracted to a spiritually oriented meditation. a teacher is essential (Singh. include encouraging clients to talk about troubling experiences and feelings rather than avoiding them. meditation has the effect of producing mental quietude. Part I Holden. Bond. 2016). Zgierska et al. 2009). it is noted without judgment and allowed to pass through. Like relaxation. 2009). Mindfulness as a therapeutic tool contrasts with traditional cognitive therapy because mindfulness does not challenge or replace negative thoughts. Patricia Carrington’s The Book of Meditation (1998) and Meditation for Dummies (Bodian. it is also a way of life. 2006). Mindfulness is a form of Theravadin Buddhist meditation that has found its way into a number of new therapies without its religious accoutrements. For those who are spiritually inclined. 1992. Coffey. a noticeable benefit is a reduction in the constant chattering of the mind and the mental images that produce anxiety. Shafii. 1992). mentally. 2002). A mantra is a word or phrase repeated slowly and at intervals. 2006) are good resources. Regularity is crucial. 2012). Raising Emotional Arousal and Facilitating Expression Be aware that emotionally stimulating techniques can be traumatic and potentially harmful to clients. Compton. 2012. Singh. 2003). It substitutes “present aware- ness” for negative thinking. Cohn. and longer meditations are considered to be more beneficial than several short meditations. not aloud but with the “tongue of thought” (Singh. 1974. Like any skill or technique you learn. not just physical rest. Clients should be referred to a class if you are not qualified to teach them or you do not practice meditation yourself. At the . Fredrickson. 2011. Masuda. Mindfulness practitioners think that arguing with thoughts tends to strengthen them while allowing them to flow through consciousness reduces their potency. and acceptance and commitment therapy (Hayes. It contains complete and simple instructions for spiritual meditation for people of all faiths and exercises for getting started. Williams. read Rajinder Singh’s book Inner and Outer Peace through Meditation (2003). If you are interested in learning more about mantra meditation. For example. but we will talk about two: mantra medita- tion and mindfulness.. meditation must be practiced on a regular basis for at least 15 minutes per day for several weeks before real benefits can be realized (Benson. Along with prayer. Pek.234 Chapter 9 • Change Techniques. 1975. & Teasdale. 1984). Arousing techniques. Meditation is utilized in about 60% of addiction treatment programs (Priester et al. 1991. dialectical behavior therapy (Heard & Linehan.. any name of God can be used. Meditation has been used to treat and prevent substance abuse (Dakwar & Levin. & Kolander.. Smith. & Beryl. meditation is a key tool in the 12 steps of Alcoholics Anonymous. Mantra meditation has a long history in Western and Eastern thought. As a negative thought enters... & Lillis. Unlike relaxa- tion techniques. Walton. & Alexander. mindfulness-based cognitive therapy (Segal. 1994). There are several forms of meditation. Orme-Johnson. have you ever tried to sleep and found plans for the next day going around in your head? Meditation is a means of putting such thoughts to rest for a while. Luoma. 2009. in their simplest and most benign form. 1978). Research has generally supported the use of emotional expression as a therapeutic change technique (Rosner. Saint. psychodramatic methods (Moreno. every helper will see these methods on films or at conference workshops. & Daldrup. Because these listed techniques are advanced and require thorough training and supervision. TECHNIQUES THAT STIMULATE EMOTIONAL AROUSAL AND EXPRESSION The term catharsis is the most commonly used term in the context of arousal and expression. whereas managing or reducing anger may be more effective in preventing outbursts (LeCroy. guided imagery (Witmer & Young. 2005). Beutler. 2006). Expressive techniques. 1967). 1973). 1977. Because expressing anger feels so good immediately. Emotional arousal has been activated through hypnosis and drugs (Wolberg. 1969. 1996). bioenergetics (Lowen. we will focus on one specific method that most helpers can incorporate immediately: journal writing. 1996). The more confrontational and cathartic methods require very advanced skills to be used only by experienced practitioners within strict ethical guidelines and in conjunc- tion with close supervision (Young & Bemak. They are mentioned here because. 1977). Expressing anger tends to arouse a person more. free association in psychoanalysis. 2009). focusing (Gendlin. Part I 235 extreme. allow the client to communicate these emotions to the helper. on the other hand. 2000) even if many of the more radical approaches have been discredited (Norcross et al. More advanced methods for enhancing emotional awareness and emotional expression are often used in gestalt therapy (Perls. and many others. flooding and implosive therapy (Stampfl & Levis. feelings. you can experiment with this method yourself. we will discuss moder- ately arousing methods that encourage clients to focus on their emotions but do not pressure them to do so. there is what Goleman (2006a) calls a ventilation fallacy. Because some arousing techniques can produce harmful reactions. we are seduced into thinking that we have dispelled it. 1985). Hayes. 2014). and a number of group approaches. Arousing techniques put the client in touch with deeply held emotions. play therapy (Schaefer & Mattei. . the empty-chair technique (Polster & Polster. psychodrama (Moreno. the opposite may be true (see Tavris. sooner or later. 1958).. 1989). Besides the risks associated with arousing and expressive techniques. helpers may evoke powerful emotions that make the client feel out of control. In fact. 1958). & Park. 1988). The nonjudgmental listening cycle (NLC) and especially reflection of feelings are the primary methods that helpers use to allow clients to experience and express their emotions as deeply as possible. 1967). making him or her more likely to feel anger later. STOP AND REFLECT Journal Writing to Increase Emotional Expression Journaling is usually assigned as an open-ended writing assignment to help the client do more in-depth examination of his or her thoughts. Using the “Stop and Reflect” section. Prochaska & Norcross. but it has become a catchall that actually encompasses two separate activities: (1) stimulating emotional arousal of the client and (2) encouraging emotional expression by the client (Young & Bemak. Chapter 9 • Change Techniques. and behaviors (Cummings. Because you need not show this work to anyone. or stream-of-con- sciousness. She states that creating positive emotions both broadens one’s ability to see alternative solutions and builds resistance to negative feelings. or would it be best to let these issues lie?” • “What does your writing indicate about how comfortable you are now with this important period in your life?” • “What other artistic media would you personally be most likely to use if it were suggested by a helper?” Creating Positive Emotions Positive psychology is a term that was coined by Abraham Maslow in 1954. This is a free association. Maslow and other humanistic psychologists were concerned about the overemphasis on pathol- ogy and diagnosis. or we may write about particu- larly troubling or significant periods of change in our lives. method that psychodynamic therapists have found to be effective for uncovering under- lying issues. . The client is instructed “Once you have identified a particular time period. p. 2005. utilizing personal strengths. Park. answer the following questions. We admit things to ourselves that we may never have been aware of before. In writing. for- giveness. Some practice is required before one can really let go and allow thoughts and feelings to flow.” • “What were the major feelings you experienced during this period in your life? Did you reex- perience any of them while writing?” • “Did you find it hard to write in a stream-of-consciousness style?” • “How did you block yourself from letting the ideas flow out?” • “Did you encounter any personal reluctance to look at this period in your life?” • “Do you see any value in reviewing the past. and many others. 410). we have the opportunity to really examine thoughts in detail and to challenge them. authenticity.’ and continue writing for the allotted time. Steen. is not about how to maintain a positive attitude but how to pro- duce positive emotions as a bulwark against the stresses of the world and one’s own negative emotions. 2010b). More recently. . . & Peterson. called a “period log” (Gladding. Positivity (2009). In this activity. Part I Writing down our inner thoughts is a different activity from merely thinking about them or talking about them. Since that time. Her popular book. One of the most important voices in this movement is Barbara Frederickson (2001). humor. humility. daily feelings. the client is asked (1) to indicate a particular interval of life during which he or she experienced a number of changes or personal growth and (2) to reflect on the experiences in writing. begin writing and do not stop to edit your thoughts. positive psychologists have begun to accumulate a body of research support- ing the use of strength-based helping techniques including gratitude. When you have finished. optimism. turn off the internal censor and try to write whatever comes up or emerges without stifling your thoughts or feelings. positive character traits and enabling institutions” (Seligman. creativity. Start with the words ‘I felt . focusing on strengths has remained alive in the work of Carl Rogers and many others who have studied “positive emotions. We may record dreams. All these activities may help us become more deeply aware of emotional issues behind these events. or spiritual progress. One way of doing this is to place your pen on a blank sheet of paper with a headline indi- cating the particular time period and write without picking up the pen for about 5 minutes. meditation. reflections on self-concept.236 Chapter 9 • Change Techniques. who has found that these methods evoke positive emotions and that is why they work. 2012). clients seem to write the same things and do not pay atten- tion after a few entries. Chapter 9 • Change Techniques.” learn to enhance efficacy by attempting new behaviors . Although the pay is low. She was elated when she signed on. To counteract this. Clients are instructed to write and then deliver a letter to someone to whom they feel grateful but whom they have never acknowledged.” Sometimes. and better social functioning (Young & Hutchinson. “P. Techniques for Increasing Gratitude. Each of these factors has its place in treatment peutic techniques. clients are instructed to use a different letter of the alphabet each day and write five things to be grateful for that begin with that letter. Live Happy. and “L. She resents having to put up with rich clients whom she says do not respect her. In addition. Clients with better self-esteem are more likely to tic factors to organize our therapeutic efforts. improved sleep. These can be simple things such as “no lines at Walmart. Portia was asked to keep a gratitude journal about the good things in her life in order to counteract some of the negative thoughts and feelings she was experiencing. decreased depression. or e-mails. but is now unhappy with her work. including health insurance and retirement. Summary This chapter introduced the idea of using common enhancing efficacy and self-esteem. The gratitude journal is the most popular method for practicing gratitude. I was aware that Portia had said 2 months before that having a job was crucial to her happiness and financial well-being. Gratitude may be directed toward others or a higher power. For example. The timing of a gratitude intervention is important. thankfulness. and Daily Gift from Deepak Chopra. arousal.” practicing therapeutic factors as a method for planning treatment new behaviors. but they should also be aware of good things that are happening in their lives. the client discussed the fact that she finds her job boring. relationship satisfaction. The REPLAN system is a method of based on the problem that the client is facing. Those negative thoughts could impede her present job functioning as well as her ability to find a new job. Part I 237 GRATITUDE TO INCREASE POSITIVE EMOTIONS Gratitude is a feeling that results when one recognizes a benefit that is unwarranted and unexpected. Getting clients to focus on grati- tude following a major calamity is a mistake. Gratitude is something to build into one’s life over the long term.” lowering and raising emotional and understanding the reasons to use different thera. It involves feelings of won- der. These can be sticky notes. We succeed in accomplishing other goals. Clients who are prescribed gratitude interventions should not be instructed to ignore or gloss over problems. Inducing gratitude has been found to be asso- ciated with happiness. Another widely used method is the gratitude visit. but recently found a job as a retail manager in an upscale shop. not something to distract or cheer up someone after a serious loss. we saw a client named Portia who had been out of work for some time. 2003). In the meantime. automated text messages. Clients can examined three of these factors more closely: “E. She feels that her talents are not being recognized by her boss. At her counseling visit. she receives good benefits. treatment planning that utilizes six common therapeu. We discussed alternatives to her present situation and developed a plan to help her look for a new job. and appreciation (Emmons & McCullough. clients may need reminders to work on gratitude. Clients can set up reminders and even journal on their smartphones using a number of available gratitude applications such as Gratitude!. A client can be instructed to write daily or weekly and record five things for which he or she is grateful. emotions. Take a couple of minutes to allow client. Was the helper able to remain in a nonjudg- The client discusses one of the following topics with mental stance. depending on the depth of the . Neither is the involves identifying specific thoughts and finding helper to make an effort to challenge the client’s beliefs. reflec- • A time when someone disappointed the client tions of feeling. Finally. for 5–10 minutes. In sum. using all the skills in the nonjudgmental listening cycle. so pay attention to any and records the gist of those that seem to indicate an self-downing messages that you hear in the client’s underlying irrational belief. instead allows clients to express their feelings. cycle. an associated technique used in tor of emotional arousal and quieting. we looked at two change category of techniques is designed to reduce negative techniques for practice: role-playing and homework. use homework assignments to prolong treatment tude that the self is “not okay. with each student. and observers to share their thoughts about this exercise. and desired behavior right in the helper’s office and then achieve emotional regulation. form groups of four. Yet. Relaxation ending the chain of negative thinking. Observer 1 gives the helper the list of interventions and feedback about his or her performance on First. Exercises GROUP EXERCISES The helper’s job is to listen. help clients express withheld feelings and Role-playing involves re-creating the context of a increase positive emotions to increase well-being. this chapter introduced the category of apy technique aimed at reducing negative self-talk. Exercise 1: Identifying Irrational Beliefs for The helper is not asked to specifically identify irrational Enhancing Self-Esteem beliefs but simply to try and get the client to talk about The technique of countering described in this chapter the beliefs behind his or her actions. and engage in irrational behavior. In this exercise. and a demoralized attitude toward life. a fundamental cognitive ther. Helpers who regularly utilize practice in the office emotions. techniques that focus on the common therapeutic fac- and thought stopping. Observer 2 reviews the list of Ellis’s counters. effective arguments. self-esteem: countering.238 Chapter 9 • Change Techniques. negative iors. in turn. neither supporting irrational the helper: thinking nor judging the client for these ideas? The • A time when the client was very angry at someone helper can keep the list of interventions and • A time when the client was very angry at himself review them later. like gratitude. but simply to help the client become aware of them. In this chapter. we all have irrational beliefs 1. produces positive emotions. Low self-worth is a general atti. the list of interven- or herself tions should include several paraphrases. That countering process is diffi. cult to simulate in class because it is time-consuming Observer 1 writes down all the helper’s interven- to ferret out the specific thoughts and identify effective tions verbatim. Helpers also strengths and skills. insights into action and try out new behaviors experi. During the session. and two observers. and perhaps a reflection of • Something the client has a difficult time forgiving meaning or two. This or as homework are more likely to increase their cli- chapter covered two change techniques for enhancing ents’ transfer of training to real-life situations. One focus in this chapter Observer 2 listens carefully to the client’s statements is on enhancing self-esteem. Part I: Listening for Irrational Beliefs 2. reduces physical and emotional arousal. helper. this mentally. we will be trying to find Part II: Debriefing irrational beliefs in the client’s statements. thinking in a client’s story. Medita- peutic factor that helpers promote to help clients put tion increases physical and emotional relaxation and. statements. you can learn a first step in cognitive seven irrational beliefs described earlier in the “Sources therapy by listening for errors or counterproductive of Low Self-Esteem” section. Do not be afraid to share a real story. Part I and by paying attention to successes and their present acting out that new behavior as practice. helper. journaling Practicing new behaviors is a common thera. At this point. using the skills of the nonjudgmental listening taking on the roles of client.” and is responsible for a between sessions as well as to establish new behav- number of serious psychological conditions. verses roles again and becomes the other person.” tity. but would ing on the identity of the other person. client. STEP 2: SCENE SETTING. The client sits in a role-play situation.” thoughts and feelings to the empty chair as if the other “I was attracted to someone in the past. Role-playing as a rehearsal technique sometimes fo. Observer 1. The roles of helper. Following a review of the “Quick Tips: Role- should return to previous chapters for review and Playing” section. The helper asks like to bring to a positive conclusion. from that person’s perspective. the client will play both himself or herself and fies an individual in the past or present with whom he the other person with whom the client has unfinished or she has “unfinished business. this exercise has the following phases: other person’s reaction. In this step. the helper 3. the helper this significant other to describe himself or herself and directs a role play in which the client encounters this to give a little bit of background about the situation person and tries to express himself or herself in a posi. Observer 2 gives the helper feedback and discusses disagrees with the observer’s ideas and then indicates the exercise. Was it realistic and counters that might be used by the client as an anti. who identi. The enactment ends when the client returns to his or onstrate the skill of role-playing. person with whom the client has unfinished business. Then. and Observer 2 sponding to the charges leveled against him or her. STEP 1: WARM-UP. the helper asks the client to reverse refers to a relationship or an issue that he or she was roles and sit in the empty chair while completely tak- unable to adequately resolve in the past. The classmates. The client either confirms or 5. Observer 1 and the helper give the client feed- the helper and the two observers can identify some back on the practice session. 4. and STEP 5: SHARING AND FEEDBACK. the helper Observer 2 are assigned. For ex- ished business. was the client able to express everything he or she .” open. exercise.” Once the client has had the opportunity to ex- For this exercise. Issues from the past are addressed in terms of how similar situations can be handled in the future. the client re- four with roles of helper. The helper facilitates the client to express this “A teacher treated me unfairly. students form groups of press his or her thoughts and feelings. client. Chapter 9 • Change Techniques.” she identified in the client’s statements. It is recommended that participants use one of the following situations or a minor issue in their STEP 4: ENACTMENT. steps are summarized below from the earlier sec- 3. Now the client expresses some of the thoughts and “My boyfriend criticized me in front of his mother. To begin. The helper asks the client to cuses on situations in the past that clients would like briefly describe where and when a meeting with the to resolve. and two observers. As a group. In this The exercise begins with the client. If questions predominate. the client is rehearsing for a later one chair. 1. the helper invites the client to explain the situation and uses the non- Exercise 2: Role-Playing for Practicing judgmental listening cycle to get a clear understanding New Behaviors of the situation. client was able to finish the unfinished business. The client thinks of a situation involving unfin. The client speaks these able to explain. which he or she feels might be the most effective. the helper directs the client should schedule additional practice sessions with through the first five steps of role-playing. but I person were actually present. As a warm-up. assertive? dote to these beliefs. Observer 2 indicates any irrational ideas that he or tion called “How to Conduct Role-Playing. never told her. By attempting to bring them to closure in affected individual might take place.” Unfinished business business. gives the helper feedback on his or her ability to dem. STEP 3: SELECTING ROLES AND ROLE REVERSAL. and the other chair is left empty for the time when the issues can be addressed in real life. Once the client has presented the own lives such as: other person. tive way. and Observer 1 give the client feedback on how well the 2. Part I 239 client’s story. the helper asks him or her to return to the original chair and resume his or her natural iden- “My friend did not invite me to her wedding. feelings that he or she has wanted to get out into the but I did not mention it. ample. her natural role and original seat and responds to the Briefly. and I was never in any way the client wishes. re- Observer 1 gives the client feedback. have spir- and relaxed only once rather than twice. and ask the client to tense and necessary to implement the nonjudgmental relax those areas again. your confidence • Ask the client to move around slightly and in the procedure will encourage them. QUICK TIPS: RELAXATION TRAINING • If clients resist the role-play technique. diaphragmatic breathing as a transition between tensing and relaxing muscle groups. Suppose you give a client homework and he or Following the relaxation sequence. take 5 min- she does not complete the homework. rate homework in this chapter. as one would itual implications. and set the scene helps to warm up the client. • Keep your voice tone modulated and soothing. Could any of these be a . • Repeat the action phase several times if • Watch the client for signs of tension or needed to help the client feel comfortable discomfort. you able to relax using this exercise? ment step to cope with similar situations in the future? • Were the helper’s instructions presented in a calm and methodical way? • Did the helper allow sufficient time for relax- ation before proceeding to a new muscle group? QUICK TIPS: ROLE-PLAYING • What might the helper have done to deepen • Help the client overcome stage fright and your relaxation? initial discomfort by using a warm-up process such as a discussion of the situation before After this feedback. with the new role. gratitude. Each person has a turn as either client or helper. How utes to discuss the effectiveness of the procedure. developed. Each dyad finds as quiet a spot as possible to practice the SMALL GROUP DISCUSSIONS training. 100 5 extremely tense). Before starting the relaxation pro- to clients. Part I intended in an assertive and straightforward way? Was the your present level of tension. Subtract this score client overly aggressive or too tentative and passive? What from your original estimate. listening cycle instead of continuing with the • Make sure that you suggest deep role play. 100 5 extremely tense). should you emphasize the spiritual side cess. For this exercise. client and helper switch the role play begins. • Getting the client to physically move around. you • Ask the client to rate tension based on a may have to abandon it until trust is better 100-point scale. discuss one of the the toes and moving up to the neck and shoulders. • Ask the client to again rate himself or herself Exercise 3: Relaxation Training for Lowering on the 100-point scale and compare this with Emotional Arousal the pre-relaxation score. 2.240 Chapter 9 • Change Techniques. and find the most comfortable seating position reassurance that “you’ll get into it” may help before you begin the relaxation instructions. ask the client to do a body scan by returning • If clients experience emotional arousal as a to those areas where the client has difficulty result of the role play. them to get over their initial reluctance. roles and repeat the exercise. The helper takes the client through deep muscle Discussion 1: Practical Problems relaxation of the muscle groups given in Table 9. The cli- ent is instructed to tighten and relax muscles starting with In a small group of fellow learners. arrange chairs. the training group divides into dyads. Meditation and to some extent. When the procedure is complete.4. On the other hand. each muscle group is to be tightened 1. How deeply were behavior does the client need to practice in the reenact. The should you respond? Could this failure on the cli- client should answer the following questions: ent’s part lead to a rupture in the therapeutic rela- • Using the 100-point scale (0 5 most relaxed tionship? Review the problems and precautions for you’ve ever been. For following topics: time considerations. the helper should ask the client to rate the current or should you wait to see whether the client objects? level of present tension on a scale from 0 to 100 (0 5 What might happen if you fail to discuss this issue? most relaxed you’ve ever been. When you teach these methods do in normal practice. the helper may find it relaxing. Select a personal goal for yourself that involves practic- • Every time you stop at a traffic light. or appointment book. Prepare a second collage that represents your Give a gratitude assignment? feelings and experiences during one of the best times 1 2 3 4 5 6 7 8 9 10 of your life. • At the end of each day.” Place these dots on your computer screen. to remind you to do a body scan.” one. Report on your Homework 1: Diary: Keeping Track of Practice attempts in a paragraph or two. 3. drawings. tense and relax those muscles that seem the most uncomfortable. do a complete the number of times you engaged in the behavior. body scan and note the areas where the most . “I would like to take time every day to improve watch. Lowering Emotional Arousal Include positive comments from instructors or class The skill of relaxation requires the common therapeu- members. Does you have about why you did or did not practice this mean that diagnosing a mental disorder is not a the behavior during the day. and words cut from How confident do you feel in being able to: newspapers.” • Use small colored dots. write down • Before going to sleep each night. Do you think that self-monitoring by keeping a journal was help- SELF-ASSESSMENT ful to you? What kinds of clients might benefit from this approach? What kinds of problems On a scale from 1 to 10 (1 5 just beginning and 10 5 are best suited to keeping a diary such as this? mastery). “I would like to play my guitar every day. A collage is a visual collection of words and images 1 2 3 4 5 6 7 8 9 10 as a means of self-expression. This chapter suggests using the common therapeutic or a secure journal online. As you look back at each period of your Teach countering or thought stopping? life. You may include things that others may have Homework 3: Relaxation Techniques for noticed you doing well that indicated your progress. does it reawaken any of these feelings in you? 1 2 3 4 5 6 7 8 9 10 How might a collage such as this be useful for a client who is trying to deal with conflicting emotions from Now rate yourself on your ability to direct a client in a the past? Collages are often used with adolescent cli- role-playing activity. available in office sup- “I would like to cook regular meals to combat ply stores. your smartphone. Find a way of building relaxation practice into your HOMEWORK daily routine. magazines. Write down any ideas factors to plan treatment not just a diagnosis. summarize your conclu- cons of using a diagnostic model to plan treatment? sions in a half-page reaction. indicate how well you think you have devel- oped the skills described in this chapter. Part I 241 reason for the client not to have completed the or indicate whether you did not practice during homework assignment? the day. How might you develop a conversation with an 1 2 3 4 5 6 7 8 9 10 adolescent client using the collage as a stimulus? Identify two things you learned while practicing these skills. Use a blank journal. ents. Consider your practice sessions as well as the exercises in this chapter. tic factor of practice to make it a part of one’s life. Whenever you see my relationship with people at work. For example: diaphragmatic breathing to lower your tension. and other print media. Identify these feelings in writing beneath each picture. Chapter 9 • Change Techniques. do deep ing a new behavior. Consider the following suggestions and then implement one in your own life. Assemble two separate collages using photos. my tendency to snack throughout the day. The Assign appropriate homework assignments? first collage should represent a time in your life when 1 2 3 4 5 6 7 8 9 10 you were experiencing troubling or conflicting emo- tions. for 1 week. useful thing for a helper to do? What are the pros and • At the end of a week. Homework 2: A Collage as a Stimulus for Rate yourself on your ability to identify irrational Emotional Expression beliefs. For example. • Using the instructions in this chapter. we described how research has supported the others. Is your blessings each night before bed. Eleanor Roosevelt believed use of a gratitude journal to improve mood and in. that no one can make you feel bad about yourself with- terpersonal functioning. Keep a diary for a week and see positive things in your life each night for a week and whether the same areas tend to hold much of note the effects. What effects does it have on your level of tension and your JOURNAL STARTERS mental attitude? Sometimes helpers ask clients to consider incidents in their lives in which low self-esteem might have origi- Homework 4: Keep a Gratitude Journal to nated. out your permission. was the client affected by excessive criticism or perfectionistic expectations? Harry Stack Sul- Increase Positive Emotions livan said that self-concept is the reflected appraisals of Earlier. In this homework assignment. Think about your own life experi- keep a gratitude journal in which you count your ences and decide which view is closest to yours. On the other hand. Part I tension resides. Record the results of your experience your tension. in a paragraph or two.242 Chapter 9 • Change Techniques. meditate for 10–15 minutes each morning. Try to identify five self-concept based on your own or others’ opinions? . the factors also provide one way to reflect upon what change techniques are most 243 . The therapeutic factors in the REPLAN model provide a basis for understanding the common purposes that lie at the roots of the various theoretical systems. advice. you will be able to: 10. As we saw in Chapter 9. Hope. and Motivation • The Demoralization Hypothesis • Motivation and Readiness • Increasing Expectations and Fostering Hope Providing New Learning Experiences • Definitions of New Learning Experiences • What Client Problems Are Helped through New Learning? • Common Methods for Providing New Learning Experiences Summary Exercises • Group Exercises • Small Group Discussions • Written Exercises • Self-Assessment • Homework • Journal Starters LEARNING OUTCOMES By the end of this chapter. a treatment planning model that focuses on six common therapeutic factors. 10.2 Recognize the difference between praise and encouragement. and ask change questions. Part II Activating Client Expectations. 10.3 Identify the steps in brainstorming and reframing. 10.4 Recognize the appropriate situations in which to give information.1 Identify a client’s stage of change in case examples. CHAPTER 10 Change Techniques. This chapter completes our description of the REPLAN system. In this chapter. Part II Enhancing Efficacy and Self-Esteem Providing New Practicing Learning New Experiences Maintaining a Behaviors Strong Helper/ Client Relationship Lowering Activating Client and Raising Expectations. hope. those who seek professional help are demoralized. They have come to believe that there may be no way out of their difficulties. lack of confidence.” activating client expectations.” providing new learning experiences. Here. family. it is important to recognize the immediate obstacles most clients are experiencing when they first come for help: discouragement. Hope. brainstorming. The Demoralization Hypothesis According to Jerome Frank (de Figueiredo. Emotional and Motivation Arousal FIGURE 10.1 shows the REPLAN therapeutic factors and emphasizes the next factor: activating client expectations. before the clients can attack their problems. and motivation.244 Chapter 10 • Change Techniques. Demoralization is described by Frank as a “state of . encouragement. hope. Frank & Frank. Figure 10. we take up the last two common therapeutic factors: “A. giving advice. 2007. you will learn six change techniques associated with these factors: asking change questions. and “N. They have probably consulted clergy. and motivation. Remember that seeking professional help is often a last resort.1 Therapeutic Factors in the REPLAN System: Activating Client Expectations. and motivation. AND MOTIVATION Before learning the techniques for activating expectations. and demoralization. The clients have already tried several ways to solve their problems before coming to the helper. Hope. hope. 1991). and friends. and reframing. HOPE. giving information. ACTIVATING CLIENT EXPECTATIONS. Therefore. they must first overcome the conviction that their situation is hopeless. and Motivation likely to be useful in helping a client reach his or her goals. Chapter 10 • Change Techniques. For example. Some clients need education (visitors). loss of self-esteem. you can think of people as being at various stages of readiness for change. Frank also proposes that client symptoms and mental demoralization interact. Rollnick. The analogy is that clients who come to a professional helper are similar to clients in a retail store. it is often a first task of the helper to instill some hope that the issues that motivated the client to seek help can be solved and that the client will be fully invested in that project. For example. practitioners try to help clients become more aware of the issue surrounding a problem behavior and explore the costs. In other words. motivational interviewers carefully use confrontation. The client’s motivation is unique to that person and so each case must be under- stood individually. nonadversarial approach. Only customers are prepared to take direct action to solve the problem. Some are browsing (visitors). which is a state analogous to depres- sion. One readiness approach that has shown considerable success is motivational inter- viewing (MI) (Miller & Rollnick. but you already know the first step––listen with empathy. 56). Motivation and Readiness Instead of classifying demoralized clients as resistant or unmotivated. Seligman (1975) experimentally discovered an aspect of demoralization called learned helplessness. not every- one is ready. in his or her own mind. This person- centered/cognitive approach has been used most often with addictions. Prochaska & DiClemente. and others require help thinking about the prob- lem and weighing their options (complainants). complainants. Special training is required to practice motivational interviewing. In his research Seligman found that dogs and people exposed to unsolvable prob- lems became so discouraged that their later performance on solvable problems was negatively affected. and still others have come to the store looking for a specific product. and allow the client to be self-directing. hopelessness (feeling that no one can help). Still. The method is based on the idea that clients come for help at different stages of readiness. THE STAGES OF CHANGE Another way of looking at readiness is the stages of change theory (Norcross. Using a non- judgmental. others have a need to buy something and are checking out the prices and options (complainants). Part II 245 mind characterized by one or more of the following: subjective incompetence. Miller. accept client resistance. As you can see. alienation. Many clients do not give the helping process their full effort because they have little confidence that anything can be done to help them. sleeplessness may be seen as a minor annoyance by one person. MI has often been used with the stages of change approach. according to the demoralization hypothesis client problems and symptoms are worsened by the sense of discouragement and isolation. Steve de Shazer (1988) classi- fied clients as visitors. or helplessness (feel- ing that other people could help but will not)” (p. planning to buy something right away (customers). 2008). 2012. whereas the demoralized individual sees it as yet another sign of the hopelessness of the situation. or customers. After that. According to this approach. and risks associated with it. 2012. Similarly. helpers who do not recognize these differences in readiness will try to force a client into a particular treatment. & Butler. Salesclerks know they need to treat each kind of shopper differently. from giving a brief greeting to describing options and features to finalizing a sale. as a . benefits. the process is composed of many of the building blocks you have already learned. Thus. 1983). to enter substance abuse treatment on day one. clients are planning to change within 6 months. The preparation stage describes clients who have taken some steps toward change during the last 12 months and are ready to consider a specific action plan. Benac. & Imber. we discuss increasing expectations. Although treatment has begun. and tries to maintain change. their expectations of successful treatment and hope rise (Frank. we discussed de Shazer’s characterization of client readiness. Yet clients at this stage are ambivalent about making a change and are not ready to take direct action to address the problem. The most important implication of this theory is that people benefit from different interventions depending on which stage of change they are in. For example. In the contemplation stage. motivational interviewing. Nash.1 shows how a helper might think about selecting treatments based on the client’s readiness or stage of change. Stone. . or entered a treatment program. 2007). For example. especially as they experience relapse. Even those on waiting lists show improvement! This has been attributed to the placebo effect.246 Chapter 10 • Change Techniques. a client who needs to exercise has joined a gym and is planning to begin a program. Clients do better in programs that tailor their treatments to the clients’ stage of change than in those that do not (Noar. such as by quitting smoking or having instituted better communication in their relationships. the person is not even thinking about taking action. if clients find the helper attractive and trustworthy. It is critical because relapse is a constant threat. a medical analogy that has been unfortunately applied to the psychological realm. and increasing hope. Table 10. started attending AA meetings. In actual- ity. The Maintenance stage may be the most critical and can last from 1 to 5 years. which really means helping clients overcome demoralization. People can be aware of the problem and yet remain stuck in this stage for years. In the next section. for example. which characterizes individuals who have already changed their lives and behavior. the client has stopped drinking. All these views agree that the client’s motivation must be taken into account when planning treatment. the placebo effect. The placebo effect implies that the helper is fooling the client with an imaginary treatment like a sugar pill. and the stages of change theory. The client may have obtained a self-help book and seems to be taking some small concrete steps. In the stage of precontemplation. 1963. The final stage of change is maintenance. But it is really in the action stage that we find clients who have already made specific changes in their lives. At this point they have become conscious of both the positive and negative consequences of potential change. Part II person gets ready to change. Increasing Expectations and Fostering Hope Many clients improve radically early in the helping process. he or she needs a different kind of help at each step of the process. not even thinking that he or she needs to quit smoking or drinking. or expectancy effect. changes. For example. & Harris. MyCounselingLab Application Exercise 10. It states that there are five stages of change. it is likely that people move back and forth between the stages.1 Identifying the Stage of Change FINAL THOUGHTS ON MOTIVATING CLIENTS In this section.1 Identifying Stages of Change in Client Statements MyCounselingLab Video Exercise 10. Although these stages are pre- sented as distinct periods. the process is not complete. is tapping well-established factors in social influence. 1 Tailoring Interventions to Client Readiness Stages of Change (Prochaska. 2006. emphasizing client choice and responsibility Preparation Identifying specific Goal setting. have conflicting ideas about treatment and the possibility of success. What can the helper do to increase the client’s expectation that treatment will help without being unrealistic? Helpers need to inform their clients about the problems they are facing. For example. ambivalence highlighting discrepancies. some types of questions are useful in the intervention and action stage. thus. how the client can make the most of the opportunity. Chapter 10 • Change Techniques. the client understands the treatment ritual and does not develop unrealistic expectations that change occurs overnight. Faith is powerful medicine (Siegel. In addition. People seeking help may have already looked at Internet sources and. & Bruce. engaging support system. 1994) Stages (1988) Growth? General Approach by the Helper Precontemplation Visitor Raising awareness Relationship building. Patterson. Constantino. which is to establish the therapeutic alliance. maintaining an open door. It is the expectation itself that is healing. preparing client for realities of treatment. and what background and training the helper has to assist with the client’s problem. using encouragement to reinforce commitment Maintenance Learning skills to Helping client develop a healthy lifestyle maintain recovery and recognize the rewards of change. audio. it is important to let him or her know that there are effective treatments. 1986). Norcross. helping client recognize relapse triggers Greenberg. By asking stimulating questions. if you have a client suffering from depression. Many helpers have handouts that explain the nature of the therapeutic process. by outlin- ing the steps of treatment. ASKING CHANGE QUESTIONS One of the ways that helpers foster hope is to encourage clients to think about a time when the problem has been resolved and change has occurred. These . Providing information can increase hope. understanding client’s perceptions. using readings. 1973). the helper encourages the client to think about a better future. But just as questioning in the goal-setting stage of the helping process is appro- priate. Up until this point. or video to raise awareness Contemplation Complainant Resolving Helping client consider pros and cons. Part II 247 TABLE 10. and appropriate helping client make a decision to change change techniques and publically announce it Action Customer Helping client Helping client carry out the treatment plan agreed upon. we have largely discouraged informational or closed questions because they tend to put the client on the defensive and do not further the purpose of the nonjudgmental listening cycle (NLC). de Shazer’s What Promotes & DiClemente. To get the client to identify a course of action.” Helper: “And what would it take to move you from a 4 to a 5?” Client: “I guess I could continue to listen more and maybe we could take some time in the evenings. where are you right now?” Client: “Right now. Let’s suppose that tonight. 1988. Here is a dialogue with one member of a couple that illustrates how scaling questions might be used. the helper asks the following ques- tion slowly and carefully so that the client has time to think: Helper: “I want to ask you a question that’s a little unusual. Let us use the miracle question in the same example with a member of a couple who is complaining about communication problems in the relation- ship. Part II special questions are called change questions. Because you were asleep. The miracle question takes clients by surprise. The miracle question. with 10 meaning that you believe that you can improve your couple relationship and 1 meaning that you think that it is hopeless. but I was at a 2 last week. Now here’s the important part. Embedded Questions. Scaling questions were devised and tested by solution-focused therapists. but I think that I put in more effort into trying to under- stand what she was saying. I’d say about a 4. you go to bed and sleep and when you awake. Just think about it before you respond. when you get home.” The Miracle Question. What would be the first thing you noticed that let you know that something had dras- tically changed?” . 1988). O’Connell. the problem that brought you in here has been solved.” Helper: “What was it that you did that moved your level of hope from a 2 to a 4?” Client: “I’m not sure. Their purpose is to encourage action and motivate change.248 Chapter 10 • Change Techniques. is designed to get clients moving toward their goals (de Shazer. what will you be doing then that you are not doing now?” “When you decide to learn to get along with your ex-wife. or strategic questions because they are not utilized for the purpose of gathering information but to influence or persuade (Tomm. Consider the following: “When the problem is resolved. scaling questions. what will change in your family?” Can you see that these helper changes are future-oriented. Embedded questions have a hidden suggestion and an expectation that things are going to get better. will you feel that you have achieved something?” “When you let go of your anger and forgive your father. you didn’t know that the miracle had occurred. not just to talk but just be together. and perhaps this makes it easier for them to talk about changes they need to make. Helper: “On a scale of 1 to 10. and the miracle question. optimistic messages that the client will change and that the client is expected to act? Scaling Questions. like scaling questions. 2005). There are literally scores of these but we will talk about only three: embedded questions. Encouragement is a change technique that is closely aligned with Alfred Adler’s theory of individual psychol- ogy (1954). There certainly are times when praise is useful.. For some helpers. This helps the client envision such an outcome. instead they need to develop faith in themselves. the client is now discussing changes in behavior that might lead to intimacy. but it is a tool that focuses clients on a world where the problem no longer exists. we mentioned that praise can be a road- block in the helping process. Chapter 10 • Change Techniques. our thoughts naturally turn to encouragement. and strength-based approaches to counseling and supervision. the helper focuses on respectfully pushing the client to develop a more positive view of life rather than merely giving the client approval or a pat on the head—what some counse- lors call “throwing the client a marshmallow. We sincerely want to uplift clients’ spirits. 2000). the survey supports the notion that encouragement is an essen- tial therapeutic ingredient for most helpers. Most adults do not need a cheerleader. narrative therapy. and positive psychology. too.” This brief example shows that the miracle question gets the client on a new track. and suggesting ways to reach that world. this idea goes against the grain.” As we said earlier. . the compliment. our definition of coaching is “counseling with an emphasis on encouragement. And how would you respond to that smile?” Client: “I would probably smile. In addition. however. 1993). Encouragement Versus Praise. In a national survey conducted by the author (Young & Feiler. Yet. Moreover.” Encouragement seeks to modify motivation rather than behavior (Sweeney. Earlier. giving clients courage. and we want them to pay attention to their positive attributes. Instead of talking about the problem-saturated story of their discord. ENCOURAGEMENT As we discuss demoralization and enhancing client expectations. encourage- ment was the second most frequently used counseling technique. However. It is foundational to solution-focused therapy. Encouragement is the primary way in which we give each other support.” Helper: “Well. enhancing expectations.” Helper: “How do you think your partner would react to that?” Client: “I think she would be shocked and not sure what to do. The miracle question is not a miracle cure. 2009). and ask if I could fix my partner a cup of tea. that would be different. praise definitely puts the helper in the role of a judging parent and the client in the role of an obedient child. It was utilized by 90% of the mental health counselors and counselor educators surveyed. encouragement is probably inte- gral to what most people today call “coaching. Wong (2015) claims that encouragement is a common element of self-help books. leadership skills. parenting. This is where encouragement comes in. so we utilize one of our favorite social tools. family resilience. the use of encouragement is not limited to Adlerians (Watts & Pietrzak. treatment of childhood disorders (Silk et al. Through encouragement. fostering hope.” If you learn to effectively and appropriately utilize encouragement you will have learned a valuable and marketa- ble skill. Part II 249 Client: “I would go into the kitchen and my partner would smile at me. espe- cially those who work with children. 2013). We cannot be certain from these data whether all respondents were operating under the same definition of encouragement. instill confidence To maintain or strengthen a specific behavior Nature Focuses on inner direction and internal control.250 Chapter 10 • Change Techniques. enjoyment. and conditions of specific problem behavior Thoughts/ A balance of thinking. Source: Modified from Witmer. to foster hope. IN: Accelerated Development. (1985). Focuses on outer direction and external emphasizes personal appreciation and effort control. and patterns in this picture. encouragement is designed to inspire. In general. cooperation TABLE 10. response that is observable satisfaction. dependency on a specific person or thing. situations with limited self-control and development. J. and actions Attending primarily to an action (behavioral) Feelings/Actions with feeling underlying the responses. i. whereas praise is designed to increase the likelihood that a specific behavior will be repeated. reinforcee is expected to in spontaneous and creative ways. The table makes the argument that praise (positive reinforcement) and encouragement both have important but distinct uses. Witmer. Part II To better understand encouragement. more perhaps dependence. less likelihood of Tends to develop a strong association.e. Copyright J. look at Table 10. challenge Creativeness Spontaneity and variation in how encourager Reinforcer responds to very specific behavior responds. helpful in establishing goals Autonomy Promotes independence.2. How have you done that? Looks like you have made about 80% of the 80% is good. which compares the con- cepts of reinforcement from the behavioral tradition and the Adlerian concept of encour- agement. I noticed that you used a lot of different colors That is a very pretty picture.. that you are not falling back into your old pattern. and to support (Pitsounis & Dixon. . self-reliance. less likely to generalize to other life situations Examples: You have been working hard on that project for You are a hard worker! a month. however. inspire. tends to emphasize material more than outcome appreciation. hearten. to stimulate. way to your goal. Encouragement focuses on developing autonomy. It must have been difficult. M. may be difficult to understand the expectations little doubt about the expectations of the of the encourager reinforcer.2 Comparison of Encouragement and Praise/Reinforcement Dimension Encouragement Praise/Reinforcement Purpose To motivate. it respond in a specific and prescribed way. feeling. Pathways to personal growth. emphasizes outcome Population All ages and groups Seems most appropriate for children. encouragee has freedom to respond in a specific way. 1988). between a specific likely to generalize to other life situations reinforcer and a behavior. Reprinted with permission. It sounds like you’ve done a lot to make sure You are doing great. Muncie. You really stayed with it. M. I believe we are going to get there. and pushing with enthusiasm. for power. If we analyze these situations. Some of the major writers in the area of encour- agement have been Dinkmeyer and Losoncy (1996). it may be obvious that these are clients who have given up on the world or other people or are fearful that things will spin out of control. 2000). In sum- mary. Sweeney (2009). Chapter 10 • Change Techniques. 2015). Optimism is the tendency to view the world as a benign. possibilities. It is useful with clients who avoid participation and responsibility. but it may also give some general direction to helpers and improve the understanding of the method. Types of Encouraging Responses. and it places the helper in a position of superior judge (see Punished by Rewards by Alfie Kohn. encouragement positively affects the therapeutic relationship (Wong. cut off from social support systems. Lending enthusiasm and asking for commitment toward goals Summarizing these 14 interventions may oversimplify the Adlerian concept. and conditions rather than on past failures 3. Becoming involved with the client through honest self-disclosure 10. or who tend to be close-minded. Part II 251 rather than competition (it avoids comparisons). Losoncy (1977). Offering assistance as an equal partner in the helping process 11. Providing accurate feedback on deeds rather than on personality 13. and Wong (2015). Witmer (1985). praise has several drawbacks in the helping relationship because it only recognizes success. and for revenge. Together. persons who are dependent. On the other hand. Showing faith in the client’s competency and capabilities 5. Praise is a reward that strengthens a behavior when it occurs. and an internal locus of control (Hitz & Driscoll. MyCounselingLab Application Exercise 10. for control of situations and people.2 Recognizing the Difference between Praise and Encouragement Who Benefits Most from Encouragement? According to Losoncy (1977). depressed. Showing respect for the client and the client’s individuality and uniqueness 9. Focusing on the client’s strengths 4. Concentrating on the client’s present capacities. 1988). emphasizing equality and individuality. Using humor 12. who are perfectionistic. they identify 14 types of effective encourag- ing behaviors: 1. Focusing on those things that interest or excite the client 7. Encouragement also helps clients who have an excessive need for attention. Focusing on the Positive and the Changeable. Asking the client to evaluate his or her own performance rather than comparing it with another standard 8. friendly source of support. not intentions. Acknowledging the client’s efforts and improvement 2. Not everyone shares this view of . I have collected these interventions in three major helper activities: focusing on the positive and the changeable. Confronting discouraging beliefs 14. or suffering from low self- esteem are best suited for encouragement. Showing an interest in the progress and welfare of the client 6. Encouragement is helping someone discover the courage to be imperfect. ” Helper: “It sounds like there were some uncomfortable moments. and it was a total disaster just like I said it would be. lowered achievement. it asks the client to develop a balanced view that includes the positive aspects of life. research indicates that pessimism correlates with depression.” Helper: “You’re right. optimistic interventions in the fol- lowing client/helper dialogue: Client: “I feel like I’ve totally messed up my future.” Helper: “Yes. It sounds like you hit on a good strategy. Encouragement should not be seen as trying to get the client to ignore difficult issues. and health problems (Seligman. what is going well and what makes you feel optimistic. Scheier. . Focusing on the positive and the changeable also includes redirecting the client’s discus- sions from the past to the present. well. 1998). Such encouragement entails noticing the client’s success as well as showing faith in the client’s ability to succeed. Seligman. But it isn’t always easy. All foster development of an optimistic attitude by helping to shift the client’s atten- tion from the deficits to the strengths in his or her life.” (focusing on the positive) Client: “What? . This was done to help the client understand that he or she can push the positive button. but optimism can be learned (Carver.” Client: (Laughing) “Me.” Helper: “Tell me what you really enjoy doing. too. rather than ruminating over the unchangeable. Do you agree?” . and I am not sure that I can turn things around. In addition.” This dialogue shows a helper who is a little abrupt in shifting the focus to the posi- tive. and the helper encourages him. I don’t like the job or the life I have right now. but it also sounds like you did something positive to deal with her mother’s criticism. 1998). & Seggerstrom. so my wife and I ended up spending most of the time playing with the kids and talking to each other. Note the positive. In the preceding list of 14 characteristics. and it has a strong relationship with emotional and psychological well-being. it helps to focus the client on the parts of the problem that can be changed. I really enjoy working in the garden. But I always feel better when I think about good things like that. interventions 1 through 4 are grouped together into the encouraging helper behavior of focusing on the positive and the change- able. Oh. Here is an example: Client:“We went to the picnic. 2010.” Client: “What?” Helper: “Well. I was wondering what was going on in your life besides the problem areas. instead. Part II life. not just the negative one. I prefer to feel good. Her mom started criticizing us again.252 Chapter 10 • Change Techniques. .) Helper: “How do you feel now as you think about gardening?” Client: “Better. instead of getting involved in the argument. you got away from it and spent some time with each other and some with the kids. so do I.” (The client goes on to describe the feelings he enjoys. On the other hand. right?” Client: “Right. It was hard. Chapter 10 • Change Techniques.” How to Encourage. Notice the confrontation and the helper pushing the client to make a commitment: Helper: “So although you know you’ve overcome a lot. ‘Two years too late. you’ll let me know what happens. don’t you think I’ve done a lot?” Helper: “You tell me. and when we get back together. But really. I’m not sure I can ever please her. The client must come to evaluate performance against internal standards and to appreciate his or her personal strengths and distinctive approach to life. first of all. Following are general guidelines for encouraging a client. I have come a long way. I will try to let it go in one ear and out the other. sometimes you still use your mother’s yardstick on your life rather than your own. I think I’ll just spend less time over there. But how are you going to stop get- ting depressed when you hear her criticism?” Client: “Well. The accompanying example illustrates that encouragement consists of giving the client . Through encouragement.’” Helper: “What about you—how do you look at it? Are you proud of what you’ve accomplished in the last 8 months?” Client: “Well. Encouragement pushes the client by giving accurate feedback. all she can say is.” Helper: “So you are determined to succeed. as in the following client/helper exchange: Client: “I finally got off drugs.” Helper: “What do you mean. There is an element of confrontation and a sincere effort to produce movement in the client. and using humor to turn the client around (Mosak.” Pushing with Enthusiasm. but it’s still not good enough. asking for a commitment. it’s still not good enough?” Client:“My mom won’t let up about how I disappointed her. Interventions 11 through 14 demonstrate that encour- agement is not merely support. Even though I’m back in school in the fall.” Helper: “That sounds like a good start. Part II 253 Emphasizing Equality and Individuality of the Client.” (asking the client to self-evaluate) Client: “I have. got a job and an apartment. confronting the private logic of the client. Let’s consider that as a plan for this week. The follow- ing example continues the client/helper dialogue from the previous section. The essence of interventions 5 through 10 on the list of encouraging responses is to communicate to the client that the helper and client are on equal footing and that each is unique. 1987). Discouragement can be a self-perpetuating defensive maneuver that seeks to maintain the status quo through inaction. it does not mean believing that the client’s troubling situation should be accepted. too. Would you agree?” Client: “That’s when I get depressed. My life is back on track. the helper teaches the client to challenge the idea that the worth of a person is judged by external standards. but that’s not going to stop my recovery. how I was sup- posed to finish college 2 years ago. You seem to have job-seeking skills. Neither did my father-in-law. During that session. Notice that the nonjudgmental listening cycle (NLC) forms the foundation for the encour- aging remarks of the helper. but mostly I am angry.” Step 3: The Helper Focuses on the Positive and Notes Client Attempts. we might be able to find a solution. my feeling is that what you really need right now is an ally in this process. he had lost all ambition.m. Helper: “Herb. Encouraging responses will not be appropriate if the helper does not fully understand the client’s problem. to Accomplish the Goal. According to Herb. a good work history. Step 2: The Helper Offers to Be an Ally. Perhaps together we can help you find your enthusiasm again. However Small. Herb: “I still get up at 6:30 a. Herb was a furniture salesman out of a job. Part II directives to pay attention to his or her strengths and to focus on what can be changed. Helper: “So tell me. in itself.254 Chapter 10 • Change Techniques.” In this part of the dialogue. Although he had initially been rather active. and he feared he would never be able to locate a new job. I get depressed and resentful. That’s when I start getting down. Perhaps if we put our heads together. but I am at a dead end now.” Helper: “You’re mad at yourself for being in this situation. and frustration.” Helper: “My thought is that we begin to look at this thing from a different angle. but she refused to return for later appointments. What kind of a man am I? My father never lost a job. Step 1: The Helper Uses the Nonjudgmental Listening Cycle to Gain Rapport and Understand the Problem. Now my wife is taking care of me.” Helper: “You mention your father and father-in-law. I read the paper and start to make a call or two. First. and a positive attitude about your chosen profession. He was very pessimistic about getting hired again after being out of work for 4 months. .” Herb: “Exactly. reflects feelings. what it is like to be out of a job?” Herb: “It is hell! Everyone blames me. These reflec- tions of feeling and meaning convince the client that the helper understands the situation at a fairly deep level. an encour- aging process because it promotes a relationship based on equality and respect. The NLC is. I get dressed and start out all right. was embarrassed. anger. Sometimes I think it is hopeless.” Herb: “I guess you’re right that I have had success in the past. His wife accompanied him to the first session. the helper begins with an open question. like I did when I was working. You’ve shown a lot of success in sales previously. she strongly expressed her worry. recently he had spent more time driving around in his car than actu- ally looking for a position. You seem to be saying that working is an important part of being a man.” Herb: “Of course. I end up driving around town. and finally reflects meaning about assumed gender role. I am supposed to be the provider. Let’s continue with this plan. I think this would help you feel better about yourself. Even though you are not making the contacts. I guess I averaged about one call per day. I would like you to keep track of your activities a little better. Right?” Herb: “I guess so. But I am only asking that you begin to keep a log of what you’re doing toward finding a job each day. and it might help the rela- tionship. Helper: “I’ve got some feedback for you if you want it. rather than look back. I feel good about these first steps. I’m afraid that this won’t work. It is difficult.” . That kind of progress is what we’ve been looking for. but let’s try to focus on the present if we can.” Helper: “It seems like one of the problems is that you are not being honest with yourself or your wife about what you do all day. Again.” Helper: “Yes. Part II 255 killing time until dinner. You are set to get back into a work routine. The first day I did three. and you seem to like that.” Helper: “I agree. then one. I got no response. it can be scary. rehearsing for that day when you are back to work. I can do that. making my wife think that I am out looking for a job. and I took the weekend off. too. that it will be just like last time and fizzle out.” (One Week later): “I didn’t make two calls per day looking for a job. Besides. I’ll call you about Wednesday to see how things are going. by being honest about it. I didn’t do what we decided.” Step 4: The Helper Offers Feedback or Confrontation and Pushes for Commitment.” Herb: “Okay.” Helper: “I am very glad to hear about this.” Herb: “It is hard to do when I get nothing back. I have been hoping that you’d make this beginning and then hang in there until something breaks. and you’ve gotten through that.” Step 5: The Helper Shows Continued Enthusiasm for the Client’s Goals and Interest in the Client’s Feelings and Progress. then one again. That is a good sign and some- thing we can build on. one of the things I notice is that the rhythm is still there. Why am I doing this?” Helper: “Well. and we will see if we can increase that or make some changes in the direction of your search.” Herb: “All right. Herb: “Since the last time we talked. Now what is needed is keeping up your efforts. you’ve now included me in what’s going on. Chapter 10 • Change Techniques. It seems that getting off dead center is the hardest part. you are practicing. relabeling. In addition. 1985). Clients have been able to recall insights and learning up to 6 months following therapy (Martin & Stelmaczonek. and Raising and Motivation Emotional Arousal FIGURE 10. perception transformation. can be sparked through mod- eling. developing insight. Definitions of New Learning Experiences A number of terms have been used to describe this common therapeutic factor. we want to explore the techniques included under the final therapeutic fac- tor—providing new learning experiences. On the first day. and it can also be stimulated through techniques such as stories. Let us look at a couple of client stories in order to demonstrate how these two types of new learning experiences are commonly embedded in a treatment plan. 1988).256 Chapter 10 • Change Techniques. cognitive restructuring. perception shifts. and reframing.2 Therapeutic Factors in the REPLAN System: Providing New Learning Experiences . the “aha!” experience. new learning is not merely acquiring facts. Gaining a new perspective is one of the most frequently mentioned therapeutic experiences cited by clients (Elliott. metaphors. All these terms seem to involve two basic helping techniques: (1) imparting to clients new information or skills and (2) helping clients to change inappropriate or ineffective beliefs. in a therapeutic session. reframing. inter- pretation. meaning attribu- tion. developing out- look skills. and redecision. It may be a shift in perspective. Learning is not just instruction.2. redefining personal mythology. which is highlighted in Figure 10. such as changing the worldview. Hope. • Maritza is a 23-year-old woman who was admitted for substance abuse problems following her arrest on a charge of driving while intoxicated. the Enhancing Efficacy and Self-Esteem Providing New Practicing Learning New Experiences Maintaining a Behaviors Strong Helper/ Client Relationship Activating Client Lowering Expectations. New learning. perceptions. and outlooks. Part II PROVIDING NEW LEARNING EXPERIENCES In this section. or it may dawn gradually. and intense fear. clients can change their thinking about painful remembered events and rethink their sense of guilt and failure. Once the helper explains the reason for the problem. What Client Problems Are Helped through New Learning? A number of client problems are the result of inadequate training or lack of knowledge and these deficits can be addressed in group or individual settings. confronted. The result of this information is that Maritza begins to stop thinking of herself as “weak” or as morally unworthy. During moments of high anxiety. The client’s transference reactions toward the helper are a pri- mary focus of interpretation. Once insight occurs and the client acknowledges that he or she is bringing this projection to the therapeutic relationship. It reduces guilt. Instead. • Dujuan is a 30-year-old man referred for help with panic attacks. They can see themselves and others in a new light. she starts to realize that she has a bio- logical weakness. one can learn to cope with stress. In a one-on-one session. Once this reaction is interpreted. Dujuan is able to say. the client may even see the therapist as a punishing figure. “I could lose control over myself and go crazy. “Watching for danger actually increases my fear rather than reducing it. This new perspective has been stimulated by learning. career building. how to improve communication with a partner. 2007). and clarified. 1995. the client may start to see the unconscious motives behind his actions. and hear about alternatives to addictive behavior.” During the next 3 weeks. the helper encourages Dujuan to examine and modify this core belief. Part II 257 goal of the staff is to introduce clients to a “disease concept” model of alcoholism. McHenry & McHenry. Common Methods for Providing New Learning Experiences This section presents a few of the many tools helpers use to assist clients in seeing things in a different way and creating new visions for the future. the helper identifies a core belief that seems to be at the root of his anxiety. Insight may occur (an aha! moment). Maritza attends a class where she learns that she is genetically predisposed to addic- tion based on her family history and that she cannot help the effect alcohol has on her. a client develops insight and is then presumably better able to change. He feels that he has modified a core belief. In this example. changes her attitude about herself. The goal is to help him to focus on the evidence for and against this belief and then to develop a more reasonable point of view. and they can discover that situations that they have feared and avoided are not really so dangerous. a client’s reaction to his boss may be a carryover from his lifelong issues with his own father. In psychoeducational seminars and workshops. It is better to have a panic attack once a month than to spend every day worrying about it. and increases her hope for recovery. that learning may be applied to other situations. Chapter 10 • Change Techniques.” Six months later Dujuan claims that he rarely finds himself falling into his old way of thinking and he has had fewer attacks. and parenting skills. Thus. For example. INTERPRETATION Interpretation is one of the oldest therapeutic techniques (Clark. Interpretation consists of encouraging the client to look at the problem in the context of the theoretical orientation of the practitioner. from a psychodynamic perspective. rapid heart rate. the client may become aware of similar tendencies in his relationships . he has been experiencing shortness of breath. At their first session. After a month. . Raphael. resources for selecting books and manuals are available (cf. it is not entirely compatible with an emphasis on collaboration in the helping process. such as the Carnegie Library of Pittsburgh. 1981). For example. One good self-esteem book for kids is called Stick Up for Yourself (Kaufman. 2010). Although it is not possible here to provide an exhaustive list of good bibliographic materials. Once a helper has recom- mended a book or audio assignment. In addition. the helper should have read the book and should carefully think about whether it will be acceptable to the client’s frame of reference and is in tune with the client’s goals. Today interpretation is a controversial technique because it firmly places the helper in the role of expert. The psychodynamic technique of interpretation is an advanced method that cannot be grasped in a few paragraphs and must be learned in an extended training program. is older but useful for a broad audience. Jackson. he or she should follow up in subsequent sessions to discuss the client’s reading and go over important points. Kicking Your Stress Habits (Tubesing. adoption. thus. Perhaps the most common use of the term interpretation is in the context of dream interpretation. Numerous studies have found it to be an effective treatment for dis- orders ranging from alcohol addiction to sexual disorders (McKenna. research has provided mixed results (Høglend et al. David Burns’s (2008) Feeling Good contains an excellent cognitive approach to depression that the average person can easily grasp. 2015). Besides informing the client. the therapist listened to and then interpreted the meaning behind the client’s dream. Many of the offerings in trade books are oversimplified. & Martin. 2010). Originally. bibliotherapy has been supported for clients with mild to moderate problems. Part II with other authority figures. The Courage to Heal (Bass & Davis. we watch others and copy them. & Owen.258 Chapter 10 • Change Techniques. Many clients with marital problems have benefited from Michele Weiner-Davis’s Divorce Busting (1992) and The Divorce Remedy (2001). and so on (see also Karges-Bonee. Hilsenroth. and Schiraldi. fears. Hevey. 2006. This method should be contrasted with merely recommending a self-help book. perhaps even asking a few relevant questions about how the assignment fits the client’s current dilemma. and based on opinion or a few anecdotes. A very good stress management workbook. 2013) addresses specific problems and developmental issues such as adoles- cence by recommending specific books. the Harry Potter books have been used to help grieving children (Markell & Markell. Bandura (1971) is responsible for recognizing the potential power of . 2008). The influential “Big Book” of Alcoholics Anonymous provides a number of true accounts of individuals who have successfully overcome drinking problems. Many children’s libraries. 2015). 2008) is often prescribed to women who have survived child sexual abuse. bibliotherapy can provide covert practice by exposing the client to a fictional or historical model of a desired behavior. and Fanning’s (2005) Self-Esteem Companion is better for adults. McKay. A postmodern or constructivist point of view believes that it is often better to help the client find a view- point that works with his or her unique understanding of the world (Siegel. Levy. Gladding & Gladding. & Espeland. 1991. In general. have online bibliotherapy booklists for kids on special topics such as divorce. BIBLIOTHERAPY Bibliotherapy means assigning readings to clients to help them achieve their goals. 1999). Clients may identify with case studies or with fictional characters who face similar problems. bullies. The Novel Cure (Elderkin & Berthoud. MODELING AS NEW LEARNING When we want to learn something. Before recommending a book to a client. 2001). unscientific. to teach alcoholics methods of relapse prevention. Bryant. to train helpers. Intentional modeling is exemplified by a helper role-playing a specific behavior while the client watches or by exposing clients to symbolic. St. Are these traits you have tried to develop in yourself? • Which of your favorite teachers would you consider to be a helper and not just an instructor? Why? . to assist developmentally delayed adults in skill develop- ment. & Young. Chapter 10 • Change Techniques. to instruct parents. Onge. it is common for members to copy the helper or other group members who are functioning more effectively. The client then attempts to reproduce the skill. 2010. 1986. Milan. or was it through the subject matter that he or she taught? Or was it something beyond the curriculum? • Look over the list of personal traits. In group therapy. An example of the latter occurs when clients take on the man- nerisms or copy the clothing of the helper. Write their names in the following chart and describe them as best you can in the space provided: Ways the Personal Values Most How Did Teacher Went Trait You Modeled Important the Teacher beyond the Most Subject by Thing You Influence Traditional Name Admired Taught Teacher Learned You? Relationship • As you look over your answers. either as an intentional process or as an unexpected by-product. 1995). Clients learn to be more self- disclosing. getting feed- back from the helper (Mitchell & Milan. biographical. Modeling has been used extensively to help children learn prosocial behaviors. and to help clients deal with fearful situations (Perry & Furukawa. videos. Yalom (1995) found that group therapy participants identified interpersonal learning as one of the most important common therapeutic factors. clients are able to see a success- ful performance of a skill. STOP AND REFLECT Think about three of your favorite teachers. assertive. how do you think the teacher influenced or changed you? Was it primarily through modeling. or fictional models in books. and spontaneous by seeing examples of these behaviors and try- ing them in the safe environment of the group. 1983). Eaves. Through modeling. Modeling takes place in the helping arena. 1985). Part II 259 modeling in the helping process. and movies (Erford. stories. Judie was an only child and was close to her parents. EXPOSURE TO AVOIDED STIMULI There is a story about a woman who sees a man rubbing a rabbit’s foot furiously and asks what he is doing.” The purpose of the metaphor was to teach the client something about worry. The helper credited this story as the turning point in Judie’s treatment and in restor- ing her sense of control. She also had one peculiarity. This was true in the case of Judie. Metaphors and stories engage the listener with imagery. but one night (a week before the wedding). fear of dogs. and humor. whose relationship with each other was quite poor. and we had a very healthy and strong mare. Through the image of the open gate. rearing up. “it’s working. she telephoned the helper in a crisis of doubt about whether to go through with the cere- mony. he was telling her that she could retain the option of leaving. A story bypasses some of a client’s resistance to new ideas. 2003). She didn’t mind being in the corral. Like the man in the . For example. Judie had considered marriage to several different men in her twen- ties. They had fought bitterly for years. She just wanted to make sure that she could leave at any time. and she believed that they had stayed together for her sake. she apparently grasped that she did not have to feel imprisoned by her relationship and that she could retain a sense of freedom.” Judie came for help because she had finally met a man whom she wanted to marry. And she never ran away. She felt better about her deci- sion to get married after these sessions. Part II METAPHORS AND STORIES Metaphors.” Many clients come for help because of avoidance of social situations. Knowing that she had this option would help her stop worrying about being trapped. He used the metaphor of the corral because she saw marriage as a form of prison. she calmed down. In the first few sessions. It gently points out that the client might need to find another way of dealing with the problem rather than trying to solve it when it is not immediately solvable. Gordon. and parables are common ways of stimu- lating new learning in clients (Barker. Of course. but it’s something to do. It doesn’t get you anywhere. In fact. the client is too engaged to fight. she had ended the relationship when marriage seemed to be the next step. worry is like a rocking chair. reflective listening uncovered her fears about relationships. a 35-year-old woman living in New York City who had grown up on a farm. “See. we discovered by accident that if we left the gate open. “I am keeping the tigers away. we lived on a farm. there is danger in overuse and in telling stories that clash with the client’s worldview. Although no interpretation was made. Each time.” he replies.260 Chapter 10 • Change Techniques. Con- sequently. sometimes even hurting herself on the wooden fence. She hated it when we closed the gate of the corral. Sims. the client is not always aware that he or she is learning something. She was filled with confusion and had changed the date of the wedding twice. The story seemed to be much more effective than giving advice because it allowed her to decide for herself how to act. The helper used the farm story because of his knowledge about Judie’s background. She admitted that she saw love as “chains. but gentle. her helper told her the following story: When I was a boy.” she argues. On the telephone. fear of airplanes.” he says. she would run around in circles. One day. “But there aren’t any tigers around here. a helper once came up with this little aphorism for a client who was stewing about a situation over which he had no control: “You know. She was high spirited. 1985. suspense. 1978. or a feeling of discomfort at being far from home. clients benefit from the support of others who are experiencing the problem. 2015). encourage clients to face more and more difficult scenarios. and they learn vicariously from the experiences of fellow learners. The helper can only cautiously hope that the therapeutic relationship is strong enough to sustain it. group. substance abuse. It can also increase rapport if the client does not feel that the helper is trivializing his or her concerns (Goldin et al. but the very nature of humor is that it is spontaneous. Chapter 10 • Change Techniques. and myriad other programs. Many clients would rather attend a class than go to “therapy. they find that most of the feared conse- quences of assertiveness never occur and that their relationships actually improve. Direct instruction involves lecturing. Williams. Like a metaphor. Roehrig. couples counseling may involve training in effective communication skills right in the office. Thomas. 1992). and the use of films and demonstrations to provide new information to clients. psychoeducation is less expensive to deliver because it can be given to a group. and other social skills that a client needs to acquire. Jokes can be used in individual. humor that is inappropriate or that falls flat is quite likely. 2006). Most humor is part of a conversation. improves medication compliance. many people fear that being more assertive will worsen relationships in their families. 1971). interpretation. HUMOR We know that learning is facilitated in a light atmosphere (Gardner. & Downing. As they become more assertive. anxiety or depression. 1956. 2001). It is frequently called psychoeducation. Mosak. anxiety management training. & Yang. Research indicates that brief psychoeducation is effective for a variety of mental disorders. and this should be taken into consideration. it is imperative that you understand your client (Thomas. Because a client has learned to reduce anxiety by avoidance. couple. or message. couples enrichment seminars. Vereen. a joke tells a story and sometimes contains a philosophical shift. Part II 261 story. Ricks.. Shaughnessy & Wadsworth. Hancock. Goodrich. helpers set up hierarchies of feared situations (least anxiety provoking to most anxiety provoking) and. or family work (e. . For this reason. 2006. Goldin et al. Direct instruction can just as easily take place in the helper’s office. 2013). & Evans. DIRECT INSTRUCTION Direct instruction is one of the most often used methods in help- ing. substance abuse education. stress reduction groups. 1987. step-by-step.. not a planned joke. cognitive therapy for depression. Psychoeducational seminars are the stock-in-trade of par- ent education programs.g. 2006). For example. sexual abuse. Darg. 2015. Exposure is the technique of helping clients to gradually face feared stimuli (Emmelkamp. 1978. modeling.” In addition. Besides the educational material that is presented. Exposure is extremely effec- tive but is often neglected as new therapeutic fads come along (Schare & Wyatt. Humor also offers a subtle way to shift a client’s viewpoint (Ansbacher & Ansbacher. discus- sion groups. To safely and gradually expose clients to fearful situations. 2014).. Clients learn important les- sons from facing rather than avoiding these situations. 1982. 2009).. Helpers often assign books and other reading material to educate clients about specific topics such as stress. proper parenting procedures. Humor is often cultur- ally defined (Maples et al. They learn that many of their fears are groundless and that their perception of how people will react to them may be errone- ous. he or she must be taught that the feared object or situation is not really harmful. Before using humor. For example. and reduces relapse in people with serious mental disorders (Zhao. Foa & Goldstein. they are not willing to give up avoidance behaviors even when those behaviors are superstitious or ineffective. Butler. and they freely dispense advice to their friends in an attempt to help. Are we then to blame the clients or to recognize that the art of helping is more challenging than this? Real helping is an art that involves getting people to solve their own problems and is much more difficult than supplying solutions by giving advice. . this is how the media portray the helping professions. . and family members. Similarly. and the helper gives a good dose of advice. the help- ers can expect no better than 50% compliance. and. Spokane. 2007. friends.” Generally. . Because beginning helpers like to give advice too liber- ally. they typically expect advice. Sometimes advice does stimulate a client’s think- ing about the problem. . They hardly need to pay a therapist to tell them what to do” (Kleinke. Perhaps some of the clearest evidence against advice giving is that about 50% of all medication prescribed by doctors is not taken (Brown & Bussell. Most of us are familiar with this “game” from work and social situations. but only in the right amount. “Yes. This advice-giving game involves a routine set of transactions between client and helper called “Why don’t you . Yadav. or when a client is being exposed to physical violence. but . Recent studies suggest that advice giving is not as effective as other brief interventions at least in the treatment of addictions (Meyer et al. . Tymms & Merrell. 1994. However. when helpers give clients advice and homework assignments. “Why don’t you . & Vance. However. Another reason that professional helpers avoid giving advice is that although clients may listen to it politely.” or WDYYB. advice is beneficial. 2007). advice giving is a veritable minefield. text- books often have little to say about it. It lures us into think- ing that we are actively helping a client. 2006). 1978). Part II GIVING ADVICE Like salt.?”. Giving advice can be crucial in emergency situations when a client is engaging in dangerous behavior. students tend not to be aware of its drawbacks and may find it an easy habit to fall back on. There is no doubt that it is a complex subject (Couture & Sutherland.. Why Are Professional Helpers Reluctant to Give Advice? In the Peanuts cartoons. They view it as tangible assistance. p. . The client pays. and we may feel . as one writer notes. but . 2011). 9). If helping were merely giving advice. we urge that you consider “retiring” that skill at this point and develop other alternatives. 2006).. Mehta. Games are sequences of behavior that are frequently repeated and involve a payoff for at least one of the players. but even in medical settings it seems to have a rather small effect (Sutton & Gilbert. If you have a tendency to give advice. 2008. such as practicing unsafe sex or using drugs. & Mohan. as a consequence. we could set up such a booth at the local grocery store. . It is thought that a major reason that medical patients do not follow physician recommendations is that they have private medical beliefs that are more influential than the doctor’s sugges- tions. . many teachers ban it outright in the initial stages. Eric Berne (1963) identified a “game” that illustrates this point. he or she begins.” and then gives reasons why the advice will not work. “Advice: 5 cents. when college students come for help. For example. because advice giving is rarely addressed. but more often it is simply disregarded (Mallett.? Yes. Pal. the cli- ent responds. Lucy sits at the psychiatrist’s booth with a sign that says. There is not very much research on advice giving. they simply do not act upon these suggestions. The game goes like this: When the helper gives advice. To give exactly the same advice as everyone else in the client’s world makes the helper seem impotent.262 Chapter 10 • Change Techniques. This section explains some of the reasons for leaving this skill out of your practice sessions for the present. “Clients can get all the advice they want from acquaintances. In fact. and cultural background • Ability to see advice as a two-way interaction between helper and client (Couture & Sutherland. If the helper gets the glory for having supplied good advice. even when the helper is no longer in the picture. or religion. he or she is really look- ing for opportunities to think aloud. 2000) considers lecturing and preaching to be among the “dirty dozen” of bad communication practices because they communi- cate to a client that he or she is incapable of solving the problem. and it may also harm the therapeutic relationship. Frequently. why don’t you get a divorce?” When Is Advice Appropriate? A helper who gives advice must have the following knowledge or experience: • Special knowledge and training in the specific issue the client is facing • Firsthand experience or experience helping many people deal with the particular issue • Understanding that the helper’s experiences are not the same as the client’s experiences • Ability to give advice in a way that outlines the risks as well as the opportunities that following a certain course of action entails • Thorough understanding of the client’s history. If you can identify a sermonette in your practice sessions. By solving a client’s problem through advising. A final reason to avoid advice giving is that it may violate the values of an individual’s family. then the helper is responsible for the resultant change. rather than focusing on the client’s unique situation. you may also be sending the client an embedded message. Thomas Gordon (1975. Another persuasive argument against giving advice is that the consequences of giv- ing the wrong advice can be severe. during the goal-setting stage of the helping process. and find his or her own solutions. 1983). both to the client’s life and to the client’s faith in the therapeutic relationship. be understood. they gain confidence and skills for dealing with future issues. Part II 263 confused and frustrated when good suggestions are rejected. including the client’s ethnic. Chapter 10 • Change Techniques. “Give me a fish and I will eat today. how has this empowered the client to solve future life problems? There is an aphorism that states. beginning helpers launch into a “sermonette” on expressing anger and self-acceptance. but to help the client. What we need to remem- ber is that although a client may appear to be asking for advice. For example. a client identifies excessive anger as one of the areas she wishes to work on. you are probably using disguised advice giving. Consider these examples of potentially inappropriate advice: “I advise you to quit your job and go back to college. Lecturing and preach- ing are advice giving in disguise (Patterson & Eisenberg.” “I suggest you learn to be more assertive with your mother. Such advice will probably be rejected.” The long-term goal of helping is not to supply a quick fix. but when clients resolve their own difficulties. reli- gious.” “If you don’t like all the arguing. The effect on the relationship is that the helper moves into the role of expert and begins to speak in generalities. Another crucial drawback to advice giving is that if the client follows the helper’s advice. 2006) . Sometimes advice may be needed to solve emergent problems. teach me how to fish and I will eat forever. culture. explore the options. you can expect to be in an accident or in court. & Hepburn. Giving advice is appropriate only at carefully considered moments rather than as standard procedure. for example. Do you think something like that might work for you?” This advice invites discussion and asks the client to tailor the advice to fit his or her particular situation (see Butler. What do you think?” “My mother thinks I am too young to date. especially because you drive in that condition. Would you be willing to do that?” This advice to get an assessment is designed to inform the client about the likely outcomes of drinking and also identifies potential physical danger. Danby.” Clearly. Here are some examples of advice that might be appropriate: “Your statement that you are drinking too much has me concerned. in certain situations advice is inappropriate and could be harm- ful to the therapeutic relationship: • When the client seems to be dependent on others to make decisions and needs to learn to choose his or her own course of action. The helper is giving inappropriate advice. Advice is also appropriate when the client is in some physical danger and a helper’s directive can reduce the risk. If you continue to drink. talking about the upcoming day. “You’ve outlined several possibilities. • When the client is asking for assurance on issues with unpredictable outcomes. and your parents will have to understand.264 Chapter 10 • Change Techniques. upbringing. such as: “Should we have a baby?” “Should I get married?” “Should I move to Saudi Arabia?” • When the purpose of obtaining advice is to influence another person: “My husband believes in spanking our child. On the other hand. Emmison. You have to do what you want. Potter. Advice about what to expect from certain courses of action may be quite helpful. Part II Appropriate advice is concrete and invites reaction and discussion. • When the advice conflicts with a client’s basic values. but I don’t. 2010). Have you considered directly confronting your co-worker about her unsafe behavior on the job? What effect do you think that might have?” This advice asks the client to think and to dis- cuss the alternative suggested by the helper. but you live in America now. the times when advice giving is useful are quite limited. It is presented as one alternative along with other solutions generated by the client. Do you agree?” • When the client has information available and is capable of solving the problem without advice. If . for example: “Do you think I need a new haircut?” “Do you think I should go home this weekend as my parents ask. It has been a way of building in a moment of contact in our hectic lives. or should I do what my boyfriend wants?” • When the client has not heeded advice previously. my partner and I always try to spend 20 minutes together every morning over coffee. or culture. It suggests that the cli- ent should alter the instructions to fit the circumstances. Let me add one more. He or she might ask. when he or she says: “You may come from an East Indian culture. “You know. I want you to go to an alcohol treatment center for an assessment interview. grandparents. do you want advice. Informa- tion giving might include making referrals to social services or community resources. Information giving can also take the form of a planned psychoeducational program such as teaching the cli- ent assertiveness training. drugs. did the person giving it have particular expertise in that area? • What other characteristics did the person giving the advice have that encouraged you to accept it? • If you cannot recall any advice given by friends. parents. Chapter 10 • Change Techniques. and stereotypes about different ethnic groups. a helper uses information giving sparingly because too much data will overload the client who is already struggling with ideas from significant others. parenting. STOP AND REFLECT Think back for a moment on pieces of advice you have received from teachers. about which college to attend. and then consider the following questions: • What was it about each piece of advice that made it helpful or not helpful? • When considering the helpful advice. Information giving can also subtly change the relationship between client and helper by emphasizing the helper’s superior . friends. parents. what conclusions might you draw from this? • When you have a problem. It might have been about the purchase of a car or house. try this experiment: Avoid advice giving altogether until you have learned to conduct an entire session using invitational and reflecting skills. you will have the chance to develop the subtler skills of helping the client find his or her own solutions. a new set of skills has the chance to take hold and become stronger. or about what to do in a relationship. professional helpers. It can include correcting erroneous ideas about topics such as sexu- ality. school counselors. teachers. It differs from advice giving (Prochaska & Norcross. By letting go of an old way of responding. GIVING INFORMATION Giving information is the change technique a helper uses when he or she is supplying data or facts to help a client reach his or her goal. or is it more important to have someone listen so that you can figure things out for yourself? • Have you ever given a friend advice that was really heeded? How did it turn out? • What can you conclude about the role of advice in helping you to make decisions in your own life? Will your conclusions have a bearing on your willingness to give advice as a helper? Discuss your answers with a small group of classmates. There is an analogy in boxing training in which a left- handed puncher ties that hand behind the back in order to learn to operate only with the right arm. if you can let go of your tendency to sermonize and give advice. or fam- ily members. Identify one piece of good advice and one that was not very helpful. Information at those times will likely be ignored. Similarly. or other family members. Part II 265 advice giving is something you rely on in your natural helping style. 2009) because it means offering facts rather than opinions. Like advice giving. During crisis states. We will talk more about the topic of referral and follow-up when we discuss ter- mination of the helping relationship in the next chapter. they stop trying. The job of a helper is to be an “expander” (not a “shrink”) who urges clients to enlarge their viewpoint. Because of our train- ing and the pervasive influence of the media. consistency can be a hobgoblin. social conventions. I would like to refer you to the Consumer Credit Counseling Service. All ideas are recorded. When people seem to find that nothing works to solve their dilemmas. Perhaps you have heard the story of the man who takes his son to the emergency room. The conditions and ground rules. Helpers also encourage their clients to think creatively when they have problems. To brainstorm. 2010a). Would you be willing to go?” Most information we give clients does not sink in. 1991). your financial problems are significant and you could use some professional help. he’s my son!” We do not automatically recognize that the doctor must be the child’s mother. we unconsciously fall back on our usual way of thinking. Here is an example of an appropriate use of giving information: “Based on what you have told me. A sort of tunnel vision develops that narrows our thinking. The concept of learned helplessness has been advanced to explain why people fail to look for alternatives following experiences of failure (Seligman. the helper must follow up with clients to see whether information or referrals have had an impact. jump-start their thinking. we become even more conservative and less creative. What Is Brainstorming? Brainstorming originally was developed by Madison Avenue advertising firms to increase the creativity of staff members responsible for commercials. Indeed. Therefore. poetry.266 Chapter 10 • Change Techniques. Medical patients remember less than half of what the doctor tells them. sculpture. As Emerson noted. BRAINSTORMING Creativity and the Art of Helping. They are flex- ible and open to a variety of options when problems arise (Gladding. even when circumstances change. it is important to find out whether the client has really been helped. For example. Part II knowledge. “I can’t operate on this child. and the doctor exclaims. they may at times use artistic media—drama. a group of people sit around a table and generate ideas. Although the helper feels effective when referring or providing informa- tion. people with suicidal thoughts may have concluded that killing themselves is the only option available. This agency can help you make the decision about whether bankruptcy is a good answer for you. 2011). 2005. 1995). painting. and music—to help clients express themselves (Gladding. that a doctor must be a man. and engage their creativity. Everyone in the group is called upon to participate. Helpers are often creative people. The helper must avoid the temptation to give “sermonettes” on topics like relationships or parenting unless he or she is providing important information or a refer- ral. They try to help clients devise novel ways of thinking and problem solving. and no one is allowed to dominate. but the focus remains on a specific . Cooperation rather than competition is encouraged. leading us into foolish repeti- tions when what we need is to break out of our old ways of thinking. and personal history. and helpers can expect the same (Brown & Bussell. however. A major difficulty in problem solving is that we tend to see things through the lens of our outmoded ideas. are a little different from those of an aver- age meeting: The atmosphere is relaxed and even playful. They are also taking time to listen to the ideas of others instead of formulating new ideas. 4. they do not generate as many new ideas as they do when they compile their lists separately (Diehl & Stroebe. Hitchhiking is encouraged. the wilder the ideas the better. Hitchhiking. Research has suggested that sometimes when two or more people brainstorm together. How to Brainstorm. 1991. and small ideas can be used to improve bigger ones. But developing a creative list of ideas is not the ultimate aim. Evaluating and agreeing upon potential solutions . Generating ideas 3. A large pool of ideas is needed as a source of good solutions. A playful attitude by the facilitator can increase freewheeling. but a major aim is to help the client develop skills of creative thinking. there are some specific rules that differentiate it from other problem-solving activities: 1. which can generalize to other situations. brain- storming is a creative and cooperative process that has the power to unearth hidden solutions and engage both helper and client. Production blocking can also occur in a therapeutic relation- ship. By combining ideas. we are also teaching a valuable life skill. No ideas generated by brainstorming are evaluated. The flow of ideas dries up. The helper acts as a facilitator and participant. At the end of a brainstorming session. Freewheeling is encouraged. a concept grows and develops. Brainstorming takes a client through three basic steps: 1. Thus. While we are trying to help the client arrive at a solution. 1991). The reason is “production blocking. Seemingly unimportant ideas actually can spark thoughts from other members of the group. with only slight modifications. The client is reluctant in that setting to really think in a spontaneous and freewheel- ing way because of the weight that he or she places on the helper’s ideas. Sometimes it is more effective for both helper and client to write down their ideas or to have the client generate ideas and the helper record them. Mullen. This allows for more freewheeling than the start-and-stop approach that a conversation entails. Brainstorming is also a change technique in the helping pro- cess. 2. so that the limits of creativity can be reached. In fact. 3. Evaluation involves a critical function of mind rather than a creative one. Part II 267 problem that the group wants to solve. Creativity flows best in a nonjudgmental atmosphere. Conducting brainstorming between a helper and a client involves the same basic activities that groups use. Chapter 10 • Change Techniques. The quantity of ideas is more important than the quality. They are simply brought before the group and recorded.” Production blocking means that people are sometimes too polite in a group situation to spontaneously blurt out their ideas while others are talking. The contributions of women may be limited in brainstorming sessions because men tend to interrupt more. & Salas. Practical considerations are not brought up during a brainstorming session. is building on the ideas of other people. both helper and client should have a clear idea about the next steps to take to solve the problem. Challenging the client’s assumptions and asking the right question 2. Brainstorming requires that each person be allowed to express his or her ideas without having to wait for others to stop speaking (Johnson & Johnson. or piggybacking. 2008). Johnson. Beyond these general conditions for brain- storming. ” “Someone is going to lose his or her job. participants listed all their assumptions about school counselors. the couple had assumed: “Someone is going to have to move. not the real problem. If David refuses the assignment. For example. he risks losing his job. Another story illustrates how assumptions about problems can be challenged and how. while designing an innovative program for training school counselors.268 Chapter 10 • Change Techniques. What is the goal? The reason this step is so crucial is that often clients are examining previous solutions rather than the current problem. but what is the real question? With the assistance of the helper. both manual and electric. One tactic for dealing with assumptions is to reverse them.” Ideas based on this new concept were then gen- erated. “How will we be able to spend enough time together and feel close to each other if David goes out of state for 2 years?” Previously. preexisting ideas will color the next idea-generating step. the client carefully considers the assumptions he or she has about the problem and tries to shake free of them. and she wants David to stay. Otherwise. Helpers assist clients in identifying the key issues by asking closed questions such as: “What do you want to achieve by solving this problem?” “What is it you are afraid of losing?” “What is the most important thing you want to accomplish?” Similarly. Participants began thinking about how school counselors should be available to parents after school and in the evenings.” “Someone is going to be unhappy. A good example of how this happens comes from the food industry. creative thinking leads to better solutions. For several years.” This assumption was then reversed and rewritten. however. The couple came for help because they have come to an impasse in their decision-making process. David wants Gloria to quit her job as a part-time graphic designer and move with him. One of them was “School counselors work during school hours. the couple realized that the question that really needed to be asked was. in turn. leading the client to substitute previous solutions rather than to think creatively. This can be determined by asking what is to be achieved in the end.” . Neither wants to live alone for the 2-year period. David and Gloria have been married for 5 years. This led them to include family counseling train- ing as part of the curriculum. David and Gloria might argue over who is going to move. “School counse- lors do not work during school hours. even if he gets demoted or loses his job. Gloria wants to stay where she is. Step 1: Challenging Assumptions and Asking the Right Question. a whole new set of creative opening features developed. Part II In the first step. A nearby public school system is now incorporating this idea in its new school. David’s job requires that he move to another state for a 2-year period to work on an exciting project. Acting as a facilitator. Someone ultimately was able to ask the question in a different way: “How do we open a can?” When the problem was stated in this way. too. the helper took them through the three basic steps of brain- storming to help them arrive at a solution. The first step is to ask the right question. a can opener is a previous solution. The plans allow flexible working hours for school counselors so that they can meet with parents in the evenings. the question was often asked in this way: “How can we make a better can opener?” This formulation generated a number of new can openers. 4. Step 2: Generating Ideas. When a helper asks . 6. We will Skype every evening. Not only have the clients been fully involved in the solution. not with other family members. It challenged viewers to determine whether they saw a glass as half empty or half full. 9. We could both take a class to fill our time and discuss it with each other. David will come home once a month and Gloria will travel to see David once a month. the couple were ready to start generating ideas. We will spend our vacations and holidays with each other for the next 2 years. David and Gloria went through the list at this point and discussed each possibility. We will meet halfway every weekend. When a client and helper devise a creative solution to a knotty problem. 7. 3. 13. 2. they began to hitchhike on each other’s ideas. Although the case of David and Gloria may seem too good to be true. many clients and helpers have learned to use brainstorming in just this way. “We could take a class. 8. but they also have learned or relearned an important problem-solving skill. When Gloria said.” David suggested that they take a Spanish class and share their learning when they meet in Mexico. They settled on four or five suggestions to imple- ment that best fit the goal of keeping their relationship vital while they lived separately. We can take pictures of things that happen and share them with each other. David will ask the company for time off to come home. In a freewheeling and cooperative atmosphere. 10. This commercial points out that there are two ways of looking at a situation: in terms of its assets or in terms of its deficits. Gloria will take some of her work with her to David’s place and stay for a week at a time. David and Gloria took a few minutes to identify creative answers to the question “How can we remain close if David takes the job for 2 years?” Because quantity is encour- aged. We will e-mail every day. We will Skype every day. 12. MyCounselingLab Video Exercise 10. As the ideas got crazier. the therapeutic relationship is enhanced and the client’s confidence and sense of hope is increased. Step 3: Evaluating and Selecting a Solution. They came up with the following list: 1. 5. We can meet halfway in Mexico.2 Identify the Steps in Brainstorming THE TECHNIQUE OF REFRAMING There was an advertisement for the Peace Corps that ran on television during the 1960s. the helper insisted that they generate at least 10 ideas. 11. Part II 269 Once the problem assumptions had been put aside and the real problem identified. We can send smoke signals. We will send video recordings to each other. Chapter 10 • Change Techniques. The final step of brainstorming is evalu- ating and selecting a solution. Osborn. it is best to proceed as follows: . How to Reframe According to Watzlawick. Helpers use reframes like this to guide the client to see the problem in a more constructive and responsible way (Long & Young. or does it really uncover something positive about the characteristic? • As you look over your own list. Weakland. Kindsvatter & Paez. Have you ever noticed it is easier to get people to identify their weaknesses than their positive qualities? In this exercise. more solvable or positive way. To reframe a client’s problem. do you see that person differently? Discuss some of these issues and your own reactions with your classmates. 2008). We use relabeling in career coun- seling to help clients recognize their personal strengths (see also Ward & Reuter. the helper must appreciate the client’s worldview and then replace it with an acceptable alternative.270 Chapter 10 • Change Techniques. STOP AND REFLECT The technique of reframing is based on the constructivist assumption that there are many different ways to understand a problem—there is not just one correct viewpoint. not work.” Negative Viewpoint Positive Viewpoint Compulsive Organized Sloppy Casual. and Fisch (1974). Take a look at these examples that have been given a “positive spin. One easy way of understand- ing the idea of multiple viewpoints is a technique called relabeling. Part II a client to see the problem situation in a new. more constructive definition of the problem that fits the facts just as accurately as the old definition. Relabel each trait in a more positive way as shown above. An even better example of reframing comes from Mark Twain’s story of Tom Sawyer. who convinces his friends that painting a fence is fun and a privilege. West. 2007. relaxed Loud Enthusiastic Now make a list of your own negative traits and another list for someone you know. Then they try to think of another descriptor that puts a positive spin on the very same trait. For these reasons. would you really want to lose this quality? What would you be giving up? • When you relabel another person’s traits. 2011). Reframing fails when helpers do not take the time to make sure that the new viewpoint is accurate and that it does not clash with the client’s perspective. reframing means coming up with a new. clients make a list of their own undesirable traits and a list of some undesirable traits of someone else they know. he or she is using the change technique of reframing. Then consider the following questions: • Is reframing like this just putting a happy face on a negative trait. One way of sustaining the shift is to assign homework that forces the client to see the problem in a new light. How might this job actually give you a little more freedom?” (reframe) Step 3: Reinforce the Bridge. That makes you mad. Before reframing. it may be impossible to identify all aspects of a prob- lem that might be important to the client. one of my statistics teachers used to try to reframe his examinations as “sharing experiences. Part II 271 Step 1: Use the Nonjudgmental Listening Cycle to Fully Understand the Problem. Chapter 10 • Change Techniques. Reframing is most likely to be success- ful if the client is able to relate the significant aspects of the new frame of reference to corresponding features of the old frame of reference. I have to move whether I like it or not. A shift in perspective. I wonder if this may not be a blessing in disguise. what bothers you the most is the lack of control over the decision. A few months ago.” The analogy was not successful. it is especially helpful to reflect meaning to get a grasp of the client’s worldview and values. is often something that develops slowly. and the environ- ment where the problem exists. Marlene: “So that’s the story. For example. stimulated by reframing. Develop a reframe that bridges the client’s old view of the prob- lem with a new viewpoint that stresses the positive aspects of the problem or presents it as solvable. a personal rejection. Problems and Precautions with Reframing. It’s like being fired and I have no control over it. and everyone groaned because “sharing” is not a graded activity (an important feature). Marlene. Either I move or I am out of work. you were even considering a new job or moving to another state. including the people involved. at the same time. the basic ele- ments of the tale must conform to the client’s situation. for example. the helper summarizes a number of the feelings and meanings the cli- ent. might be given a homework assignment to do more research on the positive aspects of the move. or else the reframe may be rejected. Sometimes I think it’s their way of telling me they want me to quit. Although you feel uneasy about this because you don’t like it when the decision is made for you. suggesting another way of look- ing at it. their relationships. In a metaphor or story told by the helper. at the same time. but every effort should be made to imagine those that could be crucial. Marlene. The important point is to acknowledge some aspect of the client’s viewpoint while. In the following example. Unfortunately.” Helper: “From what I have heard so far. The nonjudgmental listening cycle gives the helper a firm grasp of the details of the problem.” (reflection of feeling and meaning) Step 2: Build a Bridge from the Client’s Viewpoint to a New Way of Looking at the Problem. . Helper: “I wonder if you could start thinking about this move in a different way? You have always wanted to travel. But sometimes you see this situation as your failure and. I’ve never lost a job before. has expressed during the session. the client to develop a sense of trust. or family and gets their perspective on the problem facing them. During this time. one acts as the client. the client’s current way of looking at the problem. times to “downshift” and return to a listening stance. Then the client is asked to move out of on a monitor. In other words. and “N. The helper chooses the best reframe for bers to practice reframing. and highlighted the foundational basic relationship skills will be needed again and technique of encouragement. One person is designated as the client based on his or her own thinking and the the helper. STEP 3: The helper brings the client back into the pres- Instructions ence of the reflecting team and delivers a reframe to For this exercise. Exercises GROUP EXERCISES listening cycle to understand the problem as com- pletely as possible in the 5–10 minutes allotted for this Exercise 1: Reframing with a Reflecting Team activity. Part II Summary In this chapter. gest alternative ways of looking at the client’s problem. More important. assemble a group of six to eight mem. the tations and hope. The team watches but does not interact with A special technique that originated in family therapy the client or the helper. encounters obstacles on the path to solutions. The team makes aged to respond to the reframe. The team is encouraged to identify or she has heard. The nonjudgmental listening cycle allows therapeutic factors in the REPLAN model: “A. as the client methods for determining motivation. the client. the team conducts a group discussion The helper then returns to the client and presents a about alternative ways in which the client’s problem reframe of the problem based on the suggestions he might be viewed. bibliotherapy. giving in. as shown in the Feedback Checklist. Midway through the session. nonjudgmentally and working on solutions as long as niques of interpretation. The observers (the reflecting team) sug. You must go back and forth between listening new learning experiences. the STEP 2: Once the helper feels that he or she has a good helper stops and consults with a group of observers grasp of the client’s viewpoint. This exercise gives a small group the reframes that are consistent with the client’s worldview opportunity to think aloud. create. .” activat. prise the final common therapeutic factors in the The therapeutic relationship requires that the helper REPLAN system. take notes. who uses the nonjudgmental ing a 5-point scale. let us recognize again the impor. we looked at the last two common happen. and reframing. Team members may wish to is the reflecting team. reframe that was presented by the helper and team us- ation with the helper. exposure to avoided stimuli. modeling. and there are on the change techniques of giving advice. A helper meets with a client. and values. The client is encour- members form the reflecting team.272 Chapter 10 • Change Techniques. Under the heading of again. and evaluate pos. used to call this “shifting gears. but that are more positive and hopeful than sible reframes. and direct instruction. formation. be patient when using change tech- Before leaving the change techniques that com. When this has been suggestions but also allows the helper to think aloud completed. and the remaining thoughts of the reflecting team. abandon forward progress at times to reestablish the tance of the helping relationship in making change vital therapeutic bond. and consider various ways to reframe the problem. earshot or leave the room for approximately 5 minutes. couple. the role play is over. We spent the most time push forward and break new ground.” to pay off as the client takes tentative first steps in providing new learning experiences. activating expec. a helping relationship lasts. the helper finishes with who have been watching through a one-way mirror or a summary. Thomas Gordon (1975) aphors and stories. and that begins ing client expectations. One cannot go full speed ahead at all times.” There are times to humor. niques. brainstorming. and motivation. We presented changing his or her life. met. STEP 4: The client gives written feedback regarding the STEP 1: The client discusses a real or role-play situ. hope. we touched on the tech. generated. After hearing the advice. allowing several members the opportunity to play the 3. the client is asked to review both the advice- the real issue. • The helper should take the role of facilitator _____ 3. group. Chapter 10 • Change Techniques. Disagree somewhat 3. Strongly agree pinpoint the real problem. It may be a current acts as the client and describes a real problem to the dilemma or one that the client faced in the past. The client is asked to identify a problem that tions of possible topics for the client to discuss include: is not too personal so that he or she does not feel uncomfortable discussing it in some detail. another becomes the helper. The helper • Whether or not to commit to a relationship (student or teacher) uses the nonjudgmental listening • Whether or not to end a relationship cycle to understand the issue. When the story has been • Whether to move or stay in the same place fully articulated to the helper. One student takes on the role of a client. Following the brainstorming session. Next the helper moves with In the third part of the exercise. Agree somewhat • Use closed questions to help the client 5. Exercise 2: Practicing Brainstorming Students work in groups of three or four. about the client’s problem. Then the helper uses the nonjudgmental listen- discusses with the class which advice he or she is most ing cycle for several minutes to understand a little more likely to follow and why. _____ 4. The reframe fit with my own personal outlook and • Make sure that the final creative solution values. • Create a playful and cooperative atmosphere _____ 1. her assumptions about the problem and to identify Finally. the group thinks about • Whether or not to begin an academic degree the client’s story. The final solution. The client discusses a dilemma with a helper. The reframe was a more constructive way of looking and write down all the ideas that are at the problem. In the second part of the exercise. the client section. Part II 273 The exercise continues by changing roles and 2. _____ 2. The helper’s success in getting the client to think Use the following number codes to rate the four questions creatively. Strongly disagree for this client? 2. in the session by modeling freewheeling. One student choice between two alternatives. The helper challenges the client to review his or the issue and to come up with his or her own plan. between helper and client meets the “reality criterion”: It must effectively address the problem. the helper Before beginning the brainstorming process. the client and observer(s) give the helper general feedback on: Feedback Checklist: Reframing Client Name: ______ Helper Name: _______ 1. The reframe was a more positive viewpoint than the • Come up with a few unusual ideas yourself original statement of the problem. 2. and each person writes down a piece program of advice. Neutral QUICK TIPS: BRAINSTORMING 4. This activity can be used as a whole-class activity or ation in which the client is forced to make a difficult for groups of at least six or eight students. role of the helper who makes the reframe. Exercise 3: Giving Advice and the others act as observers. The helper understood my problem completely. giving and brainstorming sessions and indicate what . the helper uses a the client through the three steps of brainstorming: brainstorming approach to get the client to think about 1. The dilemma should be a situ. Was it realistic and appropriate 1. Sugges. to encourage the client’s creativity. the collects the written advice and reads each student’s ad- helper first reviews the “Quick Tips: Brainstorming” vice to the client. below: 3. The handling of the nonjudgmental listening cycle. The helper and client brainstorm solutions. The helper and client agree on a solution. versal of the assumption—for example.274 Chapter 10 • Change Techniques. or Customer (Cust). (Com).” some clients would not participate in group. For example. Discuss your thoughts on this visitor (V). and customers described in the section in the helping process. She ent change perceptions and when should the client be recognizes the possible legal consequences and encouraged to act to change the situation? her parents’ objections. His present . cerning their son’s argumentative behavior at ber that it is important to let go of the mind’s evalua. Next to each assumption write a re- class or group discusses the results. be vol. SMALL GROUP DISCUSSIONS they are made of hardened paper and can be recycled. complainants. clients must be motivated (a customer). Then. ________ A client comes for help to learn better about the item you chose—for example. Hope. complainant. but doesn’t want to lose Discussion 3: Reversing Assumptions and her boyfriend. the parents squabble tive function and allow creativity to flow. Discussion 2: Change the Viewing or Change 1. the fol. tionship is the issue. These are recorded on a 4. If these criteria were applied. remem. are for hanging to poor relationships with co-workers. As the important ethical issues concerning treating clients final step in the process. Dis- topic with a small group. The rela- getting clients to act (advice giving and brainstorm. “Activating Client Expectations. He wants how to improve a common household item such as a to repair his relationship with his wife and will end clothes hanger or a microwave or any other product of the affair. She has talked to her friends. begin listing of ideas about his wife because he is having an affair. During the session. _______ A 16-year-old girl comes to her school see the situation differently (reframing). Give equal counselor suggests some couples counseling. Add any new ideas to the list of improvements. ning away to California with her boyfriend. Motivation That is. cuss your answers with the class or small group. but claims he should not have to give up the group’s choosing. Do not think and verbally abuse each other. Exercise 1: Identifying Levels of Client willing.” what action he or she actually took. “Clothes hang- lowing week. the student client is asked to report on ers are not in a closet. and so on. _______ A man comes to couples counseling with In groups of five or six. If so. hang in a closet. and the Doing? it turns out one of the members has what you believe to be a severe alcohol problem. they time to wild ideas. and Motivation. Review Steve de Shazer’s classification of clients into visi- untary. identify each of the following clients as either a couple. and so on. Now make a separate list of assumptions you have 5. There are new creative ideas. individual. “It’s not an issue. ideas as possible in 2 minutes. or family work. When In this chapter we discussed techniques that involve confronted she says. to devise any Motivation is a knotty issue in helping. Then brainstorm any ideas that arise as a result of the reversal. Part II course of action he or she is most likely to take. When the school about how practical the ideas are at first. How the best.” “They are not made of wire. Under what counselor indicating that she is considering run- circumstances do you think it is useful to help the cli. and possess the skills and abilities to participate tors. _______ A couple comes for relationship help. evaluate each idea and select who are unwilling or unmotivated to change. The task is to produce as many his “friendship” with the other person. clothes hang.” ing) and also a technique that encourages a client to 2. Now Discussion 1: Motivation see whether you can force-fit any two ideas on the list together. The clothes. _______ Parents come to a school counselor con- piece of paper. For this first part of the activity. and able” to participate in the helping process. Brainstorming 3. school. communication skills. Can any of the good ideas be combined to would you feel about having a client who was forced create a new product? The final design should meet the to come to counseling and so was unmotivated? What reality criterion: Is the product really an improvement? do you think about requiring counseling? Should chil- dren be forced to receive help by schools or by their parents? Should counseling be mandated if a college WRITTEN EXERCISES student develops problems with alcohol? Some helpers say that clients must be “ready. if they are not wire. add them to the list. indicate that they only want help for their son. He lost his previous job due ers are made of wire. If possible. both about leaving and about staying. or hitchhike (combine ideas). either in or think about a part of your body that you do not the exercises in the book or in your practice sessions feel is very attractive. A crisis hotline.2.” when a 5. why do you cling to this belief? In what ways • Reframing: (successes and difficulties) have you distorted your view of the self? Write a half- • Which of the techniques presented were most page reaction to this exercise. Get opinions from eight friends with fellow students. them. Do you tend to use praise in your 4. evaluating the client too much. knowledge. saying “Good. Couples and relationship education classes in interacting with friends and family? 7. __________ Homework 2: Personal Experiments to Develop I use encouragement rather than praise most of the New Perceptions time. or family members whom you believe will be hon- • Encouragement: (successes and difficulties) est. Do _________ people really think you are aloof? Go ask 20 people Assessing Your Skills in This Chapter you know.2. which shows the levels of expertise. What do you notice about your development? Have you noticed HOMEWORK any such changes in your confidence over the course Homework 1: Knowing Sources of Information of your training? Review Table 1. See Previously. 3. Indicate any success or thinking about something that you don’t do very well. Do you see how clients useful or appealing to you? might benefit from personal science? • Identify two ways you could learn more about the skills in this chapter. Information for families who have a child with cer- I overuse praise. beginning with naivette and end- and Referral in Your Community ing with master. now he is whether you can identify someone in your commu- coming to the realization that the problem lies in nity who delivers them or provides information about the way he talks to people. ___________________________________________ JOURNAL STARTERS 2. suicide prevention service. ___________________________________________ Reread one of your journal entries from the beginning and another from the middle of this class. Review the following list of services. Try to apply this to yourself by ter (excluding advice giving). Part II 275 boss has suggested some kind of training because other individuals who have specialized services or he is encountering the same sorts of problems. _________ Personal science is a term for the technique of getting I do not use much encouragement or praise at all. Personal science asks you to test your per- ceptions by getting feedback from others or by con- Take a moment and think about the skills in this chap. Where do you place yourself on this Helpers regularly give clients information about other chart? What training experiences will help you develop sources of help. or SELF-ASSESSMENT 24-hour emergency line Using Praise 2. They refer clients to agencies and to to the next level? . Chapter 10 • Change Techniques. 1. he blamed his co-workers. ebral palsy or autism _________ I use praise about the right amount. 1. Parenting classes ment in Table 10. difficulty you had in learning each of them. clients to do action research on their problems. ducting an experiment.” and “That’s great. maybe once during a session. Help for domestic violence sessions. Treatment for substance abuse client makes a positive step? When do you use praise 6. A nonprofit consumer credit organization that pro- vides help for people with financial problems Review the difference between praise and encourage. How accurate is your self-concept? If they do not • Brainstorming: (successes and difficulties) agree. 1) is evaluation and reflection.3 Identify techniques for maintaining progress following • Written Exercises • Self-Assessment termination. and Termination Evaluating the Effectiveness of Helping Basic Outcome Evaluation Methods • Use Progress Notes to Track Improvement on Goals • Use a Global Measure to Detect Overall Improvement • Consistently Assess the Client’s View of Progress and the Therapeutic Relationship • Use a Specific Measure • Use Subjective Scaling and Self-Report to Measure Improvement • Use Another Person to Monitor Change • Use Client Satisfaction Scales • Use Goal-Attainment Measures Termination • How to Prevent Premature Termination • How to Tell Whether Termination Is Needed • How to Prepare a Client for Termination • Dealing with Loss at Termination • The Helper’s Reaction to Termination How to Maintain Therapeutic Gains and Prevent Relapse Following Termination • Follow-Up • Booster Sessions • Engaging Paraprofessionals LEARNING OUTCOMES • Self-Help Groups • Continue Self-Monitoring Activities By the end of this chapter.1 Identify and differentiate between different kinds of outcome measures for evaluating progress. you will be able to: • Role-Playing for Relapse Prevention • Letter Writing 11. • Small Group Discussions 11. • Homework 11.2 Use criteria to make a decision about terminating the helping Exercises • Group Exercises relationship.CHAPTER 11 Evaluation.4. Reflection. Evaluate one of your transcripts or recorded sessions to • Journal Starters gauge progress to this point. Summary 11. The final phase of the road map of the helping process (Figure 11. a time when helper and client look at progress and consider terminating the relationship. One potential 276 . In this chapter. 2002. these studies are conspicuous by their absence. Outcome research is at the heart of this new trend toward scientific helping. both helper and client may experience strong feelings about the end of the road. someone wants to . & Walz. Norcross. Bleuer. 1996. Lambert. Surpris- ingly. & Goates. Outcome research is the gen- eral term for studies that look at whether what we do actually benefits the client. agency. 1997). EVALUATING THE EFFECTIVENESS OF HELPING Because of the emergence of managed care and a growing awareness that many unsound treatments have been used. the end becomes a beginning. and we also address both the emotional and practical aspects involved in terminating the helping relationship. hospital. When goals have been reached. In fact. and Termination 277 START Relationship Building HERE Assessment Goal Setting Intervention and Action Evaluation and Reflection STOP FIGURE 11. Chapter 11 • Evaluation. Reflection. Whiston. we look at ways of determining and reviewing success and progress toward goals. Today. Sexton. there has been growing interest in outcome evaluation in the medical and other helping professions (Asay. insurance companies and researchers are now asking clinicians to show through data that they are using proven practices and that the client was actually helped by the therapeutic process. Gregersen. Yet.1 Road Map of the Helping Process: Outcome Evaluation and Termination decision by helper and client is that more work needs to be done or that additional goals should be pursued. or private practice. Sexton. and termination seems advisable. 2011. whether you work in a school. especially as a beginner. as clinicians. So the helper’s task is a complex one: to determine “what treatment. This might be called using practice-based evidence (McLeod. 2007). 2002). You should have received data. and you can grow in confidence as you see the actual data accumulate. by whom. Second. Granello. research confirmed that other tech- niques are likely to be more effective (Beamish. It helps us evaluate and think about what we are doing in practice. we have only studied a fraction of thousands of available change techniques. both qualitative and quantitative.278 Chapter 11 • Evaluation. ethical helper must stay abreast of research and be constantly watching the professional literature. The extremists in this evidence-based practice camp suggest that we should only use treatment methods that we can back up with research. & Belcastro. We must be able to tailor the treatment to the individual person and circumstance (Roth & Fonagy. Years later. Third. You are already familiar with practice-based evidence because in this course you have been trying out the basic helping skills using a partner or small group. p. Still. We should primarily use proven and promising techniques. I utilized relaxation procedures to help clients with panic disorder because I had been trained in stress management and it seemed logical to do so. I had very little suc- cess. we value research as a reflective tool rather than as a prescription. Another reason for collecting practice-based evidence is to maintain helper self- confidence. The com- petent. These clients had trouble reaching deep states of relaxation through progressive relaxation procedures. Because of the wide variety of clients. or “outcome evaluation. Reflection. we also know that two depressed people are depressed in different ways. you can utilize some very simple methods to keep track of what . and Termination know whether you can demonstrate that what you do is actually working (Granello & Granello. We know from medicine that two clients will react to the same prescription differently. is the most effective for this individual with that specific prob- lem or set of problems. Let me give an example. You receive feedback by noting what works and what falls flat. this does not exonerate the helper from recognizing that some approaches have been better studied than others and have more to recommend them. You can regularly monitor progress and make adjustments. 2001). I did not know whether to attribute this to the technique or to the intransigence of the mental disorder. problems. 2005). clients have very high expectations of the helping relationship and may not recognize when progress has occurred. disorders.” can give you periodic encouragement. It keeps us from wasting our time or from potentially damaging the helping relationship. and under which set of circumstances” (Paul. This is using research as a prescription for practice. For more than 2 years. But you do not have to wait for research to inform you. rather than only listening to your fears. you can gain a personal sense of power and confidence that you are doing something that works. This is why. Unfortunately. No treatments (including medica- tions) work for 100% of the clients. This feedback is the kind of evidence you can also obtain from clients. 1998. You can ask. and discouraging thoughts. from fellow students and from your instructor. Frequently. it is hard to feel effective. “Are we going in the right direction? What has changed since we started meeting? What is not working for you?” This kind of questioning assists the helper as well as the client. and treatment options. If you track outcomes. 111). 1967. Information about progress. guesses. Even if you are not particularly attracted to the scientific or research aspects of the helping profession. this idea is also limited. Stick- ing to what has been fully studied would handicap the helper as promising strategies emerge. Chapter 11 • Evaluation. or any sensitive information that is not relevant to treatment. A goal-oriented note also reduces the time it takes to do paperwork because the focus is so specific. Cameron & Turtle-Song. and plan. BASIC OUTCOME EVALUATION METHODS Use Progress Notes to Track Improvement on Goals When you begin seeing clients in a clinical. These commonly used methods are throwbacks to treatment planning sys- tems that focused on diagnosis and collecting data each session. Reflection. In a problem-oriented case record. assessment. 2002) and the DAP (data. If you want to keep a journal of “process notes” or reflections. These notes should (1) restate the goals. I recommend a system that tracks the client’s goals. we discuss the use of progress notes. objective. Williams. keep them separate from your progress notes (Moline. and (5) specify what plans have been made for the coming week and next sessions as they relate to the goals.(or progress-) oriented case record (POCR). Instead. which keep records for individual therapists or large organizations. (2) indicate what progress has been made during the week (outside of the session) that was relevant to the goals and the results of any homework assignments. Derogatis. Clients have a right to read these records and to have them sent to third parties like courts or employers. discussions about other people that might be embarrassing if revealed. In short. The Brief Symptom Inventory (BSI. (3) contain any new information or relevant events that occurred this week including crises or new problems. The standard formats for notes in some agencies are the SOAP format (subjective. the helper evaluates progress toward the goals at every session. the progress note should keep the helper on track.2 shows a sample case note that utilizes this method of evaluating client outcomes relative to goals at each session. focusing on the agreed-upon aims and not becoming waylaid by tangential conversations. MyCounselingLab Video Exercise 11. client satisfaction forms. A variety of systems for note taking exists including computer programs such as Athena and TheraScribe. you will be asked to document progress by the client using some sort of progress note form. and Termination 279 works. (4) state what was talked about in the session that relates to the goals.1 A Heart Person Use a Global Measure to Detect Overall Improvement There are a number of global measures of psychological distress and psychopathology. Utilizing these measures periodically can help you chart whether the client is generally improving or deteriorating. All of these are minimally intrusive in the helping process and push both client and helper not only to dream but also to fulfill dreams. plan) format. 1998). 1975) and the OQ-45 (adult and youth versions. and goal-attainment measures. & Austin. This is sometimes called a problem. hospital. assessment. In the first section of this chapter. This goal-oriented approach helps avoid some of the pitfalls of writing case notes.. or academic setting. global measures. One of the drawbacks is a tendency to write personal reflections or reactions to the client. It is not a blank page that the helper must puzzle over. agency. You should also omit personal opinions. Lambert et al. specific symptom measures. 1996) are two well-established . Figure 11. Counseling Activity During This Session Goal 1. New Information (Changes in Client’s Situation or Mental Status) Denied that suicidal thoughts were intense or increasing. Any Progress in Goals Since Last Session 1. A brief alternative to the OQ is the 4-item Outcome Rating Scale. Denied any planned method or available suicide means. 2. Consistently Assess the Client’s View of Progress and the Therapeutic Relationship There is a growing literature suggesting that client feedback about the effectiveness of the sessions and the working relationship between helper and client (the therapeutic alliance) is important to good outcomes and prevents dropouts (Lambert & Shimokawa. The Session Rating Scale (Johnson. Client to challenge negative self-statements as homework and call if suicidal thoughts increase. client was confronted on self-downing and was taught to challenge negative self-statements. Decrease depression and suicidal thoughts. B. Homework Assignments. and Plans Goal Plan 1.2 (Miller & Duncan. Miller. This offers us another way of making sure we do not miss a positive or negative change. He agreed. Goal 2. Both can be administered and scored in just a few minutes. James REPLAN date 6 / 9 / 2016 FIGURE 11. Referrals. used to identify global change. 2000) is an extremely brief measure of the therapeutic rela- tionship that can be given at every session to prevent ruptures from curtailing the client’s . Reflection. No effort or progress toward this goal.2 every 4 weeks and track the results over the course of treat- ment using a computer program. During session. Will call friend to accompany him to first ACOA meeting. We did not address this goal except for client to indicate that he is not quite ready to work on this issue. and Termination Client Name John Doe Session No. 2011).2 Sample REPLAN Record and Case Notes paper-and-pencil instruments containing 60 and 45 items. respectively. which was actually adapted from the OQ-45. 1999). Client indicates that depression decreased significantly but still having suicidal thoughts 1 time per day. Counselor Signature B. 2. In our clinic we give every client the OQ-45. 3 Date 4 / 18 / 2016 Client/Counselor Negotiated Goal Statements 1. & Duncan. We have long known that client estimates of the alliance are more predictive of success than helper ratings (Bachelor & Horvath. Increase brief contacts. 2.280 Chapter 11 • Evaluation. I suggested he consider attending Adult Children of Alcoholics as a preliminary step. 2000). Resolve family problems. This four-item scale is minimally intrusive and quickly accomplished. In general. Basically SUDS asks the client to indicate on a scale of 1 to 10 or 1 to 100 how physically or emotionally uncomfortable he or she currently feels. Use Subjective Scaling and Self-Report to Measure Improvement SUDS SUDS. Use a Specific Measure Sometimes you are looking for a specific change such as a decrease in depression. 31). couple distress. was described earlier in this book. and (3) the strength of the emotional bond. 2011) col- lected statistics on self-tracking of health data and found that 21% of adults tracked data about their health. a number of smartphone applications are avail- able to track moods. The measure asks the client to rate (1) whether or not goals are shared. & Brown. Steer. new products for smartphones and wristwatches have mushroomed. he or she has a more accurate understanding of the specific problem and is more aware of the situations in which it occurs. Many of these apps allow users to share data about themselves as well as store and graph data. Reflection. and self-tracking of distances walked. there are a number of brief measures of depression such as the Beck Depression Inventory–II that can be used routinely (Beck. SELF-RECORDING OF SPECIFIC BEHAVIORS The Pew Research Center (Fox. The helper will probably get more accurate information from these applications than the client’s guesses about the frequency of the behaviors. . the Subjective Units of Discomfort Scale. and the like. and Termination 281 progress. habits. heart rate. intensity. stress—even alcohol consumption. Because this self-recording of behaviors is in its early days. goals. The 21-item Beck has been used extensively in research. For example. Chapter 11 • Evaluation. The clinician regularly requests an update from the client and records changes in SUDS on the progress notes. p. anxi- ety. (2) whether techniques and procedures in the sessions are mutually agreeable. 2012. or duration such as: • How many cigarettes did you smoke? • How many times did the child pull out his or her hair (trichotillomania)? • How many times did each member of the couple give the other a compliment dur- ing the session? • How intense was this marital argument (on a 10-point scale)? • How intense was your fear of dogs in this situation (on the SUDS)? • How long were you able to meditate today (see Insight Meditation Timer app)? When a client tracks his or her own problems or successes. energy. 1996). Besides the fact that helpers can see and inform clients of improvement. blood sugar. and the like is possible on these devices. none can be recommended especially because we do not yet know about risks to privacy. Helpers might also ask clients to keep written logs of specific behaviors in terms of frequency. and many clinicians like to administer it every week when they are seeing a depressed client because it appears to be sensitive to improvement in mood. Since that time. keeping track of SUDS gets the clients thinking about their goal and about the changes they are making. In addition. the research supports the validity of SUDS as “global measures of both physical and emotional discomfort” (Tanner. but helpers can also look at client outcomes by including a few useful statements to be rated (say.” 3. Obviously whether or not to use an aide or ally and the choice of the ally should be the client’s. or goal achievement. In this case. In this case.282 Chapter 11 • Evaluation. 5. Finally. such as: • I was able to achieve my goals as a result of these sessions. • I have a more positive view of the future because of these sessions. • My relationship with the helper was important in helping me improve. It may be useful to look at overall sat- isfaction from a program evaluation standpoint. & Lopez. suppose a college student is trying to become more outgoing and talk more in class and in social situations. on a monthly basis.1 is used in the following way: 1. . 3 meetings per week rate a score of 4. but others are nationally normed and can give feedback on how satisfied clients are com- pared with other clients around the United States. In the table. “Regular attendance at support meetings. the helper may utilize an ally of the client—a friend who will give the client periodic feedback when the friend sees the client behaving in a different manner or sees evidence of avoidance. Use Client Satisfaction Scales Client satisfaction scales are measures of how happy the client is with the services ren- dered. Reflection. his or her own needs and desires for the client can complicate matters. Most of these are developed by agencies and schools to answer specific questions. “Maintain social support for sobriety. including the fact that they may take too much responsibility or they may not respect confidentiality. Kiresuk & Sherman. on a scale from 1 to 7). Each goal is briefly described in the goal statement section. In this case. Still. Use Goal-Attainment Measures One graphic method for evaluating progress is goal-attainment scaling (Brady. Rather than rely on client reports. an average for all goals is calculated to get an idea of how the client is progressing overall. For example. Newton. Busse. are noted in the sections just beneath the goal statements.” 2. and Termination Use Another Person to Monitor Change Often someone in our social circle is better able to identify change in us than we are. In addition. Specific indications of success. Goal-attainment scaling allows helpers in schools and agencies track client goal achievement and also provides another measure of effectiveness (see Table 11. the least favorable outcome is one meeting this month and the best outcome is 15 meetings this month. The client’s actual outcome (3 meetings per week) is recorded for each of the goal statements and given a rating of 1–5. if the ally is a spouse or parent.1). The goal-attainment worksheet in Table 11. 2002). 4. 2014. There are pitfalls to the use of allies or aides. hav- ing someone in the client’s daily life report on a specific change can be extremely useful and can also motivate the client. Then the least through best possible outcomes are specifically described. one goal is filled out as an example. it is. 1968. the goal-attainment worksheet provides a tool for review of therapy during the termination process. Reflection. Chapter 11 • Evaluation. How to Prevent Premature Termination Frequently our issue is not how to exit the relationship but rather how to restrain the cli- ent from terminating until real progress has been made (Swift & Greenberg. If handled well. some progress was made. Even the word termination evokes dread or at least an Arnold Schwarzenegger movie. Besides the ability to monitor progress. TERMINATION Termination is the word helpers use to denote the period of time when client and helper negotiate the end to the helping relationship. Two . Quintana. Termination is a loss and potentially a crisis but it is also an opportunity for growth because the client is challenged to apply the learning from the therapy hour to the future (Gelso & Woodhouse. 2015). 1993). At times. the client may be discouraged because one of the goals has not been achieved. 2002. termination is a time for celebration as the client reviews progress made and together helper and client make plans to keep the momentum going when they are no longer meeting on a regular basis. and Termination 283 TABLE 11. The worksheet may be able to show that even if the best outcome was not achieved.1 Goal-Attainment Worksheet Client Name __________________________________________________________________ Goal Statement A Goal Statement B Goal Statement C Maintain Social Support for Sobriety Specific Indicator of Goal Specific Indicator of Specific Indicator of Achievement Goal Achievement Goal Achievement Regular Attendance at Support Meetings Least Favorable (1) One Meeting This Month Less than Expected (2) One Meeting Per Week Expected (3) 2 Meetings Per Week Better than Expected (4) 3 Meetings Per Week Best Outcome (5) 15 meetings this month Actual Outcome 3 Meetings Per Week Score for each Goal 4 Average Score for All Goals ______________ 6. Do not process clients through several channels. Orienting the client to the process can develop positive and realistic expectations and diminish client fears. Create a strong working alliance early on and fix ruptures as they occur. Dropout rates are higher in younger clients. Although some clients seem to come only during emergencies and fail to follow through. 5. Provide a safe environment so that clients can talk about the therapeutic process and how it is fitting their needs. It is also a good idea to go over this again in the first ses- sion. Avoid delays in seeing clients. Obtain the client’s permission to call or to write a brief reminder just before the next session. Fees. here are some recommendations from the literature concerning ways of preventing clients from terminating prematurely (Joyce. money. Wierzbicki & Pekarik. Halgin. make con- tracts with clients for completing a small goal or a small number of sessions (6–10). 4. & Fennig. Harel. Piselli. Grant. & Klein. and emotional pain (Roe. 2007. and those with eating disorders (Swift et al. Clients who are interviewed by an intake counselor or clerical person for screening and then referred to their perma- nent helper may not return because they have been treated impersonally. A major reason for premature termination is a rupture in the therapeutic relation- ship. No single client characteristic can predict premature termination (Connell. 2015): 1. 2012). Ogrodniczuk. & MacEwan. 2006). Mennicke. that is. they should be referred to the proper setting. & Piper. In cases and settings where clients might be expected to drop out early. Dekel. clients with person- ality disorders. & Burgoyne. they leave the helping rela- tionship when they feel it is not helping them meet their goals. They also leave the helping relationship due to dissatisfaction with the helper or the process and because of circumstances such as travel time and financial con- straints. 2012). 2005. 1993).284 Chapter 11 • Evaluation. Asking them to disclose their problems to several people may be too much. & Mullin. Greenberg. expectations of client behavior. 2006). the client can read it as he or she waits for the first appointment. 2011. Use client feedback and assess client progress. Certainly clients “vote with their feet”. Use reminders to motivate client attendance. Even a dropout rate of 1 in 5 is a significant problem. 3. Swift & Greenberg. Pekarik. But there are a number of reasons that clients terminate prematurely that have little to do with how much progress they are making. Provide an orientation to the helping process. 2. 1985. 2012. or they may be the result of progress leading to feelings of relief that reduce motivation (Connell et al. with younger therapists. clients who must wait 2–3 weeks for an appointment may not arrive at all or may be hostile and less motivated. In addition to the risk factors mentioned above. Reflection. 2006. confidentiality. Lent. 6. Ogrodniczuk. Piper. and Termination meta-analyses found the premature dropout rate to be between 20% and nearly 50% (Swift & Greenberg. & Kominiak. 1988. and other issues can be included in the handout. This simple suggestion can . and offer information about the qual- ifications of the helper. billing proce- dures. If clients are not appropriate for the services you are offering. On one side are the potential benefits of change and on the other the costs in time.. Swift.. Whipple. Joyce. If it is written as a handout. It is dif- ficult enough for many people to reveal their need for help by making the phone call for an appointment. Clients seem to be making a cost-benefit analysis. Unplanned endings can be due to a deterioration of the therapeutic relationship. state in their codes of ethics that a client should be terminated if he or she is not making progress. Are life and work more enjoyable for the client? 5. 8. would I be seeing this client?” (p. when they have been receiving counseling or psychotherapy for some time and have not made progress. Think about your dentist. Is the presenting problem under control? 2. coming late for ses- sions. employment. such as missing sessions. call him or her and find out why. or when there are signs that they can handle their issues independently. Most professional organizations. physical health. or rude- ness from support personnel. Sciscoe (1990) identi- fied five questions a helper might consider in order to assess a client’s readiness for termination: 1. 37). school grades) or from some ideal of mental health advanced by theorists? Mathews (1989) suggests reviewing one’s caseload and asking oneself. This may mean agreeing with the client’s idea to interrupt therapy (assuming this is appropriate) and directly inviting the client to set a follow-up appointment. Some of the signals that suggest a client is ready for termination. How to Tell Whether Termination Is Needed Clients should be terminated when they have attained their goals. difficulty with transportation. In addition. can also be due to contextual factors such as a change in working hours. Based on Maholich and Turner (1979). When a client terminates early. The decision about whether a client is making progress is not always easy. Has the client reduced the initial level of distress by developing better coping skills? 3. Chapter 11 • Evaluation. and a referral should be made. the helper should try to go the extra mile (Kaplan & Sadock. In such cases. or failing to do homework. or finances. Consider negotiating a treatment plan with the client that includes time limits. Reflection. the American Psychologi- cal Association. How exactly do we know when helping has been successful? Should we consider success from the standpoint of the client or from the standpoint of the helper? Should we define success in terms of societal standards (dangerousness. 9. Help the client overcome these barriers. “If I had a waiting list right now. There may be several unexpected reasons for the client’s termination other than a feeling that the therapy is unproductive. 1998) by making it easy for the client to return at a later time. and the National Association of Social Workers. and therefore terminating a client who does not seem to be making progress is a delicate process. These reasons range from the embarrassment of having seen an acquaintance in the waiting room. including the American Counseling Association. the American Association for Marriage and Family Therapy. In cases where the client decides to terminate before goal completion. 7. Does the client now feel capable of living without the therapeutic relationship? . Brief treatment tends to have fewer dropouts. the client should be made aware of alternative sources of help. Has the client achieved greater self-awareness and better relationships? 4. Do you get a call the night before reminding you of the appointment? A phone call midweek may also serve to remind the client of homework and encourage the client to work on thera- peutic issues without the helper even mentioning them. and Termination 285 improve attendance significantly. all helpers have a duty not to abandon clients seeking help. Use reflective listening to allow the client to express feelings of loss. 3. 2010. At times. Some helpers like to read case notes that they wrote early on and other notes written later in the relationship to highlight changes. space appointments over increasing lengths of time. During the preparation period. Hasty. 6. 1983). and Termination The first four of Sciscoe’s questions highlight improvements that have been made and goals that have been achieved. MacCluskie & Ingersoll. Specify the number of sessions at the very beginning. 5. there should be a period of preparation. Swift & Greenberg. Macneil et al. Swift & Greenberg.. 4.286 Chapter 11 • Evaluation. play up the sense of accomplishment and the value of independence.1 Is the Client Ready for Termination? How to Prepare a Client for Termination Most experts agree that sudden termination is not advisable (Knox et al. MyCounselingLab Application Exercise 11. Some suggestions to help prevent. and the client should be encouraged to think about how he or she will look back on the experience in the future (Swift & Greenberg. the helper leads the client in a discussion that reviews the counseling process and progress made (Fragkiadaki & Strauss. but how soon should the topic of termination be brought up? Dixon and Glover (1984) recommend that at least three ses- sions in advance of termination be devoted to issues of termination. Bring termination up early. Help the client to see his or her own actions that led to success and that the client has the personal resources to deal with future issues. 1984). it is useful to discuss an ear- lier session when the client was at a different stage of functioning in order to examine the contrast. it is important to emphasize the client’s strengths and to end on a positive note. 2010. & Berk. Dealing with Loss at Termination Clients may be upset by termination because they associate it with other historical losses (Macneil et al. 2012).. so both helper and client are prepared for termination. 2010. and resolve these feelings include the following (Cavanagh. One way to review is simply to compare before-and-after client functioning from the viewpoint of both helper and client. Help the client think of termination as an opportunity to put new learning into practice. say Cormier and Cormier (1985). Play down the sadness of termination. 2015): 1. Macneil. In general. 2. Dixon & Glover. .. 1984. Conus. 2001. and one-sixth of the time spent in therapy should be devoted to termination. In other words. 2015). 1982. Any unfinished business between cli- ent and helper should be addressed. areas left untreated or unresolved must also be discussed (Anderson & Stewart. Use a fading procedure. however. Reflection. The last question is especially important because it asks the helper whether or not the client is able to maintain the gains of helping without the therapeutic relationship. 2015). Answering these questions in a dialogue with the client and arriving at a mutual decision can help in working out the knotty question of termination. As much time as was spent in relationship building in the beginning of the therapy should be devoted to termination. whereas Lamb (1985) recommends at least seven sessions. This is where outcome evaluation using client goal- attainment or testing can be extremely informative. Ward. explore. 2011. according to Shulman (1979). 7. that is. 2014. Besides the fact the helper must fre- quently let go of what seems to be an incomplete project. Chapter 11 • Evaluation. . Mayo-Wilson. 348) lists several possible reasons that helpers have trouble letting go: 1. The relationship may be quite significant to the helper. The helper may miss the vicarious excitement of the client’s exploits. making sure that the therapeutic relationship is open enough to allow the client to be honest when relapses occur. 2. 2012. 2015). Expect relapse and prepare the client immediately for setbacks. 4. 2008). They may also be unprepared for their own feelings or for the powerful loss experienced by the client. For example. 1990). Goodyear (1981. The helper may believe that he or she was not effective. Gladding. This section covers a num- ber of other techniques designed to help maintain therapeutic gains and avoid relapse (Cavanagh. p. 1982. the helper may have also become deeply involved in the client’s life. and Termination 287 The Helper’s Reaction to Termination Kanfer and Schefft (1988) suggest that helpers need to accept the fact that termination inevitably occurs at a point far short of perfection. 3. & Pilling. 6. Helpers may even postpone termination because of their own attachments and feelings of sadness and loss (Fragkiadaki & Strauss. lifetime relapse for depression has been estimated to be as high as 60% or 70% (Clarke. 5. Reflection. Relapse prevention has been studied extensively in relation to addiction (Daley & Maccarelli. HOW TO MAINTAIN THERAPEUTIC GAINS AND PREVENT RELAPSE FOLLOWING TERMINATION Relapse prevention is another name for client and helper activities that anticipate situa- tions that are likely to lead to a return to former behaviors and practice alternative responses. The termination may uncover historical events associated with loss in the helper’s life. The helper may feel uncertain that the client will be able to function independently. Beginning helpers may keep clients too long because they like the client or because they hope that the client will accomplish even greater goals. 1987). Many clients leave with the helper feel- ing that the solutions are still under construction. Perry & Paquin. 8. A helper’s feelings of loss at termination may also be due to a reliance on helping relationships to meet a need for intimacy (friendship) as well as a conscious or un- conscious sexual attraction. no matter how much they are intellectually informed. who was looking forward to gaining experience from the client’s peculiar problem. Kenny. Krantz and Lund (1979) feel that trainees may have special difficulty with termination. 7. The termination may represent a loss of continued learning for the helper. The helper may feel that his or her professional identity is challenged by the client’s premature termination. A general technique to deal with relapse is to normalize it. A supportive super- visory relationship is the best way to help trainees through difficult terminations (Sciscoe. 2005) but relapse is a threat for all sorts of behavior and mental symptoms. Marlatt & Donovan. One ben- efit of planning for refreshers is that the client need not later feel a sense of failure if a return appointment is needed. Self-Help Groups Self-help groups. In other cases. & Kordy. and after a year. For example.” with the stated aim of reviewing learning and dealing with any problems (see Donovan et al. if improperly conducted. de Niet. 2010). Mental health clinics. Continue Self-Monitoring Activities Self-monitoring means that the client is asked to keep records of progress on the treat- ment goals. stress management. Because clients are sometimes reluctant to attend self- help groups. and Termination Follow-Up The term follow-up refers to a brief contact the helper makes a few weeks or months following termination. or “refreshers. The client can be informed of the follow-up system during the final sessions. college students who have alcohol problems rarely attend Alcoholics Anony- mous because they do not see themselves as alcoholics and do not want to be different from their peers. These reports can be reviewed at the follow-up sessions. The quality of such groups is variable. When clients are learning specific skills.288 Chapter 11 • Evaluation. It is crucial that the helper support attendance at support groups in these cases and encourage the client to attend a few sessions (perhaps three times) before giving up. such as assertiveness training. and so the helper must be familiar with groups in the client’s vicin- ity before making a recommendation. but they can also be extremely powerful supports for clients following treatment. clients can continue to record progress (Bauer. Earlier we discussed how collecting data is important for recognizing success during the process of the helping relationship. . is to determine how the client is progressing and to remind the client that the door is open if help is needed in the future (Wolberg.. For example. may provide home visits by case- workers to monitor medication and identify areas of continuing need in those suffering from severe mental disorders. helpers must strongly encourage clients to become involved. which might be a phone call or an e-mail. The purpose of the contact. 2015). for example. Through smartphone apps or simply using a journal. Engaging Paraprofessionals Some agencies provide follow-up services with a paraprofessional for clients on a free or inexpensive basis. it may be useful to actually have the client return for a single session at each of these times. 6 months. can be a case of the blind leading the blind. Sometimes clients do not want to attend self-help groups because it forces them to admit they have a problem. Booster Sessions Another way to maintain treatment gains is to schedule follow-up sessions with longer and longer intervals spaced over 12 months. These planned sessions are particularly useful with chil- dren and adolescents because they may benefit most from reminders and may see them as a sign of the helper’s continuing interest. and communication. Timman. a helper can make brief contact with the client at 6 weeks. 1977). Reflection. these follow-ups can be called booster sessions. Hinkle. and Termination 289 Role-Playing for Relapse Prevention The technique of role-playing was described in detail in a previous chapter. helpers can build in some the helping relationship. which is to take place . Young and Rosen (1985) describe a group therapy activity in which clients write a letter to themselves during the last group session before termination. clients remind themselves of their goals and also excuses they may use to try to avoid achieving their goals. When you have both had the op- Exercise 1: Develop a Goal-Attainment Scale portunity to fill out the worksheet with your client. the helper can assist the client in constructing a scene that the client feels is somewhat challenging. Reflection. If the client is in an indi- vidual setting. A major problem is determin. out the goal-attainment scale worksheet (Table 11. the relationship. a client who is trying to quit smoking role-plays sitting at a bar when a friend offers her a cigarette. Exercise 2: Role-Play a Termination Session In pairs. Even after the help- chapter also deals with termination or the ending of ing relationship is over. SUDS of early termination and to develop a positive end to scales. Role-playing can allow the client to face risky situations more realistically. 1997). Using outcome measures such as tests. two members role-play client and agine trying to change. and goal-attainment scaling. In a small group. Letter Writing Letter writing by the helper is an underutilized but powerful way to spark the client’s motivation to continue working on goals as well as to remind the client that the helper is concerned and available (Kress. The helper may need to play the part of the client if she needs assistance in finding the language to refuse. In their letters. The goal is to have the client discover a sat- isfactory way of dealing with a situation that could trigger a relapse. For example. & Baird. help- ents are working toward their goals. assures us that cli. means of maintaining the client’s progress while leav- ing when a client has reached the maximum benefit or ing the door open for booster sessions. using helper discussing termination. We sug- outcome research or evidence that the client is chang. gest ways to assist helpers in reducing the probability ing. Summary This chapter advocates that helpers stay current with whether the client is terminating prematurely. Complete the worksheet. dis- The purpose of this exercise is to allow students to fill cuss how useful it was to analyze the goal in this way. The that might accompany the ending. students each take a turn as helper and client identifying a real or fictional issue that they could im. The group facilitator mails the letters to clients about a month after the completion of group therapy. a helper can reinforce the client’s new life story and help the client continue to see the new perspective developed in therapy (White. Clark. We also recom. Chapter 11 • Evaluation.1). 2000). 2011). Exercises GROUP EXERCISES the six steps contained in the “Use Goal-Attainment Measures” section. & Protivnak. The client is then coached as he or she plays various parts. When clients reach their goals. Through let- ters. ers should first prepare them for termination and then mend using practice-based evidence or clinical data deal with the clients’ feelings of loss (and their own) like progress notes to evaluate clients’ progress. Narrative therapists have been the main champions of letter writing (Andrews. What happens right before the problem behavior? cern with numbers seem like a good idea or just an For example. Based on your answers to questions 2. 5.” additional burden? 5. “Biting my nails makes me WRITTEN EXERCISES feel less anxious when I am alone watching televi- Exercise 1: Functional Analysis and sion or reading a book. “When I am biting my nails.” counselor provides stress workshops to sophomores 3. and specificity as you can. When I . The client and helper agree that most to persist in it even when we do not want to. the other what factors are supporting the behavior. the chain of events and his interest in receiving training as a chef has that leads up to and follows your bad habit. Clients can learn the helper feedback on the following: functional analysis and then devise self-management strategies to eliminate bad habits by building in re- • Did the helper review the history of the helping wards (positive reinforcement) for new behaviors.” “I feel a Discuss the following case with a small group.” How would you determine whether helping is near- 7. identify a hypothesis about the prob- ing completion? lem behavior. Reflection. people. His grades have slipped over the last semester.290 Chapter 11 • Evaluation. do you think you should be con. Indicate things that occur simultaneously with or around the same time as the problem behavior. select a behavior of • Did the helper help the client celebrate success your own that you would like to change. I am not around other helping profession. and mates. For diminished. This is called members of the small group act as observers and give conducting a functional analysis. Then I engage to determine whether he or she is making progress? in negative self-talk when I realize what I am What sort of outcomes would you likely be tracking? doing. For example. For example. A bad habit can be frustrating because we seem watch television by myself for a while. How could you manipulate the environment to Self-Management reduce the problem behavior? For example. Begin by identifying the behavior or bad habit you readiness to terminate? would like to change with as much objectivity.” 8. 4. and Termination in a week’s time. “I am nervous or excited. In this step. When you are working in a “When I am biting my nails.” been discussing suicidal thoughts with his class- 6. Based on this exercise. Label a blank in attaining the goals? sheet of paper “Functional Analysis” and follow these • How did the helper handle unresolved issues? instructions: • Did the helper leave the door open and. On what goals would you want to focus? example. describe. “I One obstacle to change is overcoming the force of could make an agreement with myself not to habit. but the client feels that there are way of attacking bad habits is to scientifically identify still some unresolved issues. “I bite my fingernails about four times a day for SMALL GROUP DISCUSSIONS 5 minutes at a time. helpers of all kinds are asked to prove that what instance. One goals have been met. express confidence in the client’s 1. To relationship with the client? understand this process better. In this scenario. List everything you can think of that is usually not and collects data that show improved test scores as a associated with the bad habit.” Discussion 1: Justifying Your Job 2. Your little less nervous when I bite my nails during a client is a 17-year-old high school senior who has scary show. result of the intervention. simplicity. “I am angry at myself for biting my nails and I call myself an idiot. “I bite my fingernails when I am watching they are doing really works. a school television or when I am reading a good book. at the same time.” cerned about client success? Does this growing con. For example. 4. nonjudgmentally. what do you think is maintaining (rewarding) the problem behavior? For example. For Today. it seems to What sort of assessment techniques would you use distract me and I feel less nervous. 3. What happens right after the problem behavior? Do you get a reward or is something negative Discussion 2: Sample Case eliminated? For example. rate your mastery • Demonstrate goal-setting skills including using of each skill and compare your answers with the questions to identify a goal and boiling down Midcourse Checkup you completed at the end of the problem Chapter 6. “I plan to only watch television with other people for the next 60 days or wear gloves if I am alone. I could wear gloves _____ Gestures and facial expressions or coat my fingers with something that tastes _____ Door openers and minimal encouragers bad. take some time to review the feedback you recording. Choose the best 15–20 minutes of the video and tran- 3 5 I can do it occasionally. Reflection. What kinds of clients and client problems might Previously. Step 2 2 5 I can identify it and give examples. Be sure you have permission from your client to _____ Attentive silence record. Devise a plan to manipulate the environment and Compare the scores with your answers at the to reward alternative behavior. I will reward myself with a new article of clothing or Here are three ways to evaluate a sample of your work. your goal as a helper is to: have received from teachers and fellow students dur- • Demonstrate the nonjudgmental listening cycle ing group exercises and in your individual practice. midway point of the course. How could you use rewards to change the behav. scribe every word of both client and helper using the 4 5 I can do it regularly. a manicure. and Termination 291 am reading or watching TV. I won’t bite my nails without _____ Open and closed questions thinking. 1 5 I understand the concept. Step 1 SELF-ASSESSMENT Record 20–30 minutes with a classmate who is discuss- Before you record and transcribe a final session with ing a real problem or who is role-playing. are going by without comment. for every HOMEWORK week that I succeed in refraining from nail biting.” ________ Boiling down the problem 10.” _____ Paraphrasing 9. In addition. format in Chapter 6. If I can make it through a week. _____ Reflecting feelings ior? For example. Chapter 11 • Evaluation. • Demonstrate challenging skills Using the four-point scale below. Where have you improved? state your plan for changing the environment and Where do you still need improvement? reward system. A transcript clearly how will you know which rewards will be the shows when the helper fails to respond the client and most effective? instead changes the subject.” Each gives a slightly different picture. For example. Homework 1: A Final Recording and Transcript Questions to Consider When Utilizing A transcript allows you to see whether you have a Functional Analysis back-and-forth dialogue or whether the client’s stories When applying these techniques with clients. I will treat myself to an _____ Summarizing ice-cream cone. During the a client. _____ Eye contact so that the connection between the two can be exam- _____ Body position ined. I ________ Using questions to identify a goal will go and get a manicure. You can do this aloud on the recording and/ _____ Voice tone or in writing. “If I can make it through one day _____ Reflecting meaning without biting my nails. Now you might want to make a final reinforcement? video and evaluate it in the same way. That way. In this final step. you recorded and transcribed a ses- work best with a functional analysis and positive sion with a client. It is important that the client’s state- ments appear directly below your helping responses. . . Consider whether you are responding strong (i. These are the most important session. feelings. closely you are meeting competency in using each area • Harmful (1) 5 the helper or trainee demon- of the therapeutic building blocks. Reflection. closed ques. based on rubric descriptions. and Termination Step 3 your present skill level so you can see areas that need improvement and present strengths. It is important to identify the skills using the terminol- Helper Competency Scale (HCS) ogy in this book so that you can count them and see how accurate you are. What impact has it had on you personally or tencies (3) 5 the helper or trainee demonstrates on your professional goals or on your relationships inconsistent and limited knowledge.to 30-minute tions (CON) you used. Also. skills. . or focuses the Helper Competency Scale below. reflections skills. excess or deficit in the use of the specified ation of the session and provides feedback on how helping skill(s). Make some comments about what you have • Near Expectations/Developing toward Compe- gained. strates harmful use of the specified skill(s) By this point in the book. their responses rather than categorizing them. It is important to get a picture of of the following building blocks.292 Chapter 11 • Evaluation. First.e. and record rating of meaning (ROM). or • Meets Expectations/Demonstrates Competen- meanings? cies (4) 5 the helper or trainee demonstrates In a separate paragraph. A score of 3 or Listen to the recording or read the transcript and less on any skill suggests that you need to identify the make comments. exceeding the expectations of a to the last thing the client said. Evaluate your session using or encourage the client’s disclosure. In a 20. reflections of feelings (ROF). with others? What steps have you taken so far? What and dispositions in the specified helping skill(s). summaries (SUM). until now. you should have a because the skill is performed in a way that recording or transcript of a helper/client session last- harms the therapeutic relationship. Sometimes students evaluate reach competency (a score of 4 or better). and confronta. fails to invite ing at least 20 minutes. go through and count the number of open questions (OQ). look for the following Scales Evaluation Guidelines: mistakes: (1) focusing on the wrong person (some- • Exceeds Expectations/Demonstrates Compe- one other than the client) and (2) sermonizing or tencies (5) 5 the helper or trainee demonstrates giving advice. the helper should be able to demonstrate most building block skills. which was in- the client away from his or her goals. Are you letting long beginning professional helper) specified helping sections of a client’s story pass by without acknowl- skills in this category. in the “score” column on the left. edging or reflecting his or her thoughts. troduced in Chapter 7. Homework 2: Evaluate Your Session Using the • Below Expectations/Insufficient/Unacceptable Helper Competency Scale (2) 5 the helper or trainee demonstrates an The Helper Competency Scale gives an overall evalu. reflect for a few min- consistent and proficient ability in the speci- utes on your progress from the start of your training fied helping skill(s). must you do now to go further? ability to facilitate therapeutic conditions. and professional disposition(s) and behavior(s). Directions: Evaluate the helper or trainee’s helping tions (CQ). naming each of the skills that your problem you are having and then practice until you response exemplifies. . Relies on open and closed appropriate use of appropriate use inconsistency ended questions questions as questioning open-ended and of open-ended in using open. leaving are minimal the client to fill encouragers. of helping reflecting skills. effective nonverbal effective inconsistency limited nonverbal not inviting. are used only when needed. sparingly Uses the primary closed questions. for prolonged questions at Closed questions periods. once. . Demonstrates Demonstrates Demonstrates Demonstrates Body language is tion. Demonstrates Demonstrates Relies too much Uses too many Instead of couragers and door appropriate use of appropriate use on encouragers encouragers reflecting. in the silence too often. on open-ended the majority of closed questions May ask two questions. eye contact. into the helping skills for the communication etc. 293 . posture. Helper Competency Scale (HCS) Near Exceeds Meets Expectations/ Below Expectations/ Expectations/ Developing Expectations/ Demonstrates Demonstrates toward Insufficient/ Building Block Specific Helping Skills Competencies Competencies Competencies Unacceptable Harmful Score Helping Skill(s) and Descriptors (5) (4) (3) (2) (1) Nonverbal Skills Includes body posi. helping session. Questions Use of appropriate Demonstrates Demonstrates Demonstrates Uses open. or does not use interventions session. voice invites the client communication nonverbal skills. Encouragers Includes minimal en. enough. majority of skills. distance communication that nonverbal in his or her communication from client. helping session.” allow the client to for the majority moves to to reflecting skills of the helper’s open up. and closed ended questions mostly closed intervention. openers such as “Tell encouragers that of encouragers but occasionally instead of moving 70% or more me more about . relationship. tone. use of silence. with an emphasis questions for and may use questions. of feeling are reflects feeling. core absent. other people. and rarely or absent. as a primary important More used. describe “why” the questions to get issue is important to at meaning. . undershooting or overshooting. to a deeper level) urging the client to session. Consistently during the session. Interspersed with distilled fashion. focus. rarely reflected reflection of Feelings accurate. him or her.e. The helper is other invitational. paraphrase. or some not. reflections is generally inaccurate. client’s story in a are needed. upset. inconsistent in opening.294 Helper Competency Scale (HCS) (Continued) Near Exceeds Meets Expectations/ Below Expectations/ Expectations/ Developing Expectations/ Demonstrates Demonstrates toward Insufficient/ Building Block Specific Helping Skills Competencies Competencies Competencies Unacceptable Harmful Score Helping Skill(s) and Descriptors (5) (4) (3) (2) (1) Reflecting Basic reflection Demonstrates Uses paraphrase Paraphrases Paraphrases Paraphrases Paraphrasing of content— appropriate use consistently are brief and are inaccurate are judgmental paraphrasing of paraphrasing to reflect the inaccurate. inconsistent inaccurate or with some too general. Advanced Advanced reflection Accurately reflects Accurately Unable to Does not move Reflection of Reflecting of meaning including meaning several reflects meaning reflect meaning the client deeper meaning and Meaning values and core be. and paraphrasing. i. reflecting skills. times during the at least once during the by reflecting deeper questions liefs (taking helping session. Reflecting Reflection of feelings Reflections of Reflections Helper rarely Feelings are Absence of Reflection of feeling are regular. accurate and sad. But utilizes beliefs. on values.. Focus is Paraphrases may way of reacting aspects of the paraphrases frequently on have the wrong to client story. and regular and Accuracy of and are either feelings or are frequently include a accurate. and/or actions in a in the client’s supportive fashion. this session. 2015. the client’s words and discrepancies discrepancies. 295 . future. during pauses and at least twice only at the end totally absent in judgmental or Summarizing behaviors. Demonstrates Demonstrates Uses other Absence of Confrontations ent to recognize the ability to the ability methods of confrontations of are harsh or and evaluate challenge clients to challenge confrontation any kind in the judgmental and inconsistencies through verbalizing clients through such as humor session. thus do not inconsistencies and verbalizing but does not balance support discrepancies in inconsistencies explicitly reflect and challenge. Note: The HCS is based on the Counselor Competencies Scale by the University of Central Florida faculty and the Counselor Competencies Scale–Revised (CCS-R): see Lambie. discussion. and the session to plan for the that point. contain explicit or plans session to focus the session to signal or summaries veiled advice. Confrontation Challenging cli. and focus the reflections of plan for the future.91 ( p < . The skills portion of the CCS-R showed an interrater reliability of . Helper Competency Scale (HCS) (Continued) Near Exceeds Meets Expectations/ Below Expectations/ Expectations/ Developing Expectations/ Demonstrates Demonstrates toward Insufficient/ Building Block Specific Helping Skills Competencies Competencies Competencies Unacceptable Harmful Score Helping Skill(s) and Descriptors (5) (4) (3) (2) (1) Advanced Summarizing Uses summaries Uses summaries Uses summary Summaries Summaries are Reflecting content. Swank. discussion. and future at the end of the during the of the session. words and/ Balance of challenge or actions in and support. and record here for comparison with other sessions. feelings. signal understanding. _______: Total Score (out of a possible 40 points) *Number of: OQ___ CQ___ P___ ROF___ ROM___ CON____ *Count the number of each building block skill in the transcript or video.001). are not accurate understanding. Mullen. a supportive fashion at once during the session. & Blount. it was an accident. and Termination Homework 3: Evaluate the Depth of Your sideways pointing arrow S next to that line. Reflection. Although there is no ratio that dif- of your session. family. Con- duct a practice session with a client and record your JOURNAL STARTERS conversation. or meanings behind the story. are they judgmental. place an upward pointing arrow c next to that ship? Are good-byes hard for you? If these transitions line indicating that the response is more superficial. How response. helper’s ability to enable the client to explore new where do the majority of your responses fall? feelings. place a a helper? TABLE 11. do you think you (2) If the response by the helper is supportive. letting go? How might these experiences affect you as or basically keeps the conversation going. They may helping observations as follows: (1) Do the helper’s be associated with leaving or losing a job. values. school. is an will be able to relate to someone who has difficulty open question. cST Example: I’m sure you didn’t mean to hurt his feelings. Helper’s words as close to verbatim as possible (13 possible answers) Depth Example: You feel that by revealing his secret you were letting yourself down. Tally the number of Table 11. have always been smooth for you. cST _______________________________________________________________________________________ cST _______________________________________________________________________________________ cST _______________________________________________________________________________________ cST _______________________________________________________________________________________ cST _______________________________________________________________________________________ cST _______________________________________________________________________________________ cST _______________________________________________________________________________________ cST _______________________________________________________________________________________ cST _______________________________________________________________________________________ cST _______________________________________________________________________________________ cST _______________________________________________________________________________________ cST _______________________________________________________________________________________ cST _______________________________________________________________________________________ cST Tally: . is a paraphrase. is an encourager.2) is a tool for judging the overall depth each kind of arrow. a signifi- words lead the client to make a more superficial cant other. do they change the do you think these experiences might affect how you subject. (3) If the Session helper response reflects unacknowledged feelings or meanings or in any way moves the client deeper. rate each of your own Reflect on your personal loss experiences.2 Depth Scale Make additional copies of this sheet for practice sessions or use lined paper. or a group of friends. place As described in Chapter 6.296 Chapter 11 • Evaluation. The concept of depth refers to the ferentiates a deep session from a superficial session. cST Example: So. After the session ends. the Depth Scale (see a downward pointing arrow T. or do they merely fail to respond to the client? deal with clients who are ending the helping relation- If so. Young and Dalena Dillman Taylor Differences Make a Difference • Mismatch between Client and Helper • How Can You Become Culturally Competent? • What Is Culture. DIFFERENCES MAKE A DIFFERENCE Individuals who are culturally diverse benefit less from traditional therapy types. 2009). you will be able to: Summary Exercises 12. • Journal Starters 12. For example.3 Identify the basic skills or therapeutic building blocks for working with children. • Small Group Discussions 12. they drop out more readily (Alberta & Wood.1 Identify the most important ways a helper can become • Group Exercises culturally competent.2 Identify ways in which the helper can avoid ruptures caused • Self-Assessment • Homework by differences in gender. they do not seek help as often and when they do. CHAPTER 12 Skills for Helping Someone Who Is Different Mark E. 297 . and What Should We Do About It? Skills for Helping Someone Who Is Culturally Different • The Skill of Cultural Study and Cultural Immersion • A Tutorial Stance: The Skill of Understanding the Client’s Culture by Listening • Tapping Cultural Support Systems • Achieving Credibility and Trust • Culturally Adapting Treatment: Tailoring Your Approach to the Client • Acknowledging Differences by Broaching Skills for Dealing with Gender Issues • Challenges Caused by Differences in Gender • Skills for Addressing Gender Issues • When the Difference Is Gender Skills for Helping a Child • Identifying Helping Skills for Working with Children • Using Basic Skills as a Guideline for Working with Children LEARNING OUTCOMES • The Case for Play Therapy By the end of this chapter. traditional gender training can be a road- block for men who see asking for help as a weakness. etc. There. Sometimes the client may not be able to point to a particular problem. The focus of this chapter is on skills we can use in three areas: helping when there is cultural difference. 2011. the helper may see a lack of progress and lack of participation in the therapeutic session. member of the military. Client feedback and progress monitoring are crucial so we can sense impending premature termination and identify any rifts that have slowed progress. describes two incidents that may help to illustrate how culture can make a difference. In addition. and other multicultural issues in Chapter 8 on assess- ment. and develop specific skills that can help you bridge the gulf between client and helper when you encounter differences. Moreover. the client may not show up for appointments or complete home- work. but either way. Alternately. For example. and these groups are reluctant to seek and con- tinue with help. There are numerous examples about language. and helping the client who is a child. How Can You Become Culturally Competent? In order to be competent to help someone who is different. The symptoms of a mismatch include the client’s feelings of distrust and lack of self- disclosure. Throughout this book in the “Culture Check” sections. age and developmental differences. Mismatch between Client and Helper One way of conceptualizing the problem is that differences can create a mismatch or a difference so great that it causes a rupture in the relationship or nips it in the bud. One of the reasons for this underutilization and client attrition is that the basis of the Western version of helping is our values and the European and American culture. other areas of potential mismatch between helper and client include gender. and experiences (refugee. 2012). Cheng. In order to reach clients beyond the narrow mainstream culture. Besides cultural differences. & Chu. This chapter will help you gain some generic skills and basic approaches to difference that ben- efit every helper.298 Chapter 12 • Skills for Helping Someone Who Is Different Asian Americans utilize mental health services at about half the rate of the overall popula- tion. receiving foster care. journaling and supervision are helpful in this process yet skills are also necessary. the client senses that there is no common ground. Besides culture. a client senses that the helper is subtly criticizing her family’s tendency to con- trol her life. and the therapeutic relationship does not gel. you need to develop certain attitudes. Hannah Acquaye. personality and values.). Analyzing and continually reflecting on your attitudes and mind-set is absolutely crucial. Saad. Before considering these specific domains. . let us look at some of the key differences between client and helper that can affect the success of treatment. I have stressed the importance of considering the unique background of the client when employing helping techniques. gender. gain knowledge about your client. so she begins to pull away from the helper/client relationship. sexual orientation. Sue. a Ghanaian counselor. In her culture. and they tend to seek help more from medical providers than from mental health providers (Chu & Sue. dealing with gender differences. we must adapt our therapies and achieve cultural competency. history. no one outside the family is allowed to do that. The aim of many of these illustrations is to help you reflect on your own attitudes. Let us begin with culture in the “Culture Check” section. This view has not always adapted to the needs of different cultural groups. everything about our system of helping has adults in mind and works best for those who possess fairly strong cognitive abilities. Hannah becomes a student to her client. and when my professor informed me that I should not have done that. When I presented this case in class. when people cry in your presence. she glowed with confidence when she was teaching me. Chapter 12 • Skills for Helping Someone Who Is Different 299 CULTURE CHECK Counseling in the United States by Hannah Acquaye About Tissues and Crying I came to the United States from Ghana as a doctoral student. I automatically gave this young lady a tissue to wipe her tears and nose to let her know she was invited to use them. I can now say it was my best session. She set out to be my teacher about American culture. language. I was not sure I was qualified to be the client’s counselor. and artistic products that a group of people transmits from one generation to the next and that mem- bers of the group use to understand their world and each other. I had an adolescent client who became emotional in session. I had worked with adolescents back home but never heard of anything like this. Questions to Consider 1. Is it important for the helper to always to be in a position of power and authority? How would you have reacted to Hannah’s admission that she needed help understanding the culture if you were her client? What Is Culture. I realized I had committed a taboo in US counseling. In addition. The first couple of sessions. it is not proper to use anything there unless I have been given permission. do you think? Do helpers usually operate without considering the client’s background? How can the helper prevent these kinds of missteps? Were the other students in this situation overemphasizing the risk of creating dependency by reacting to a small gesture such as offering a tissue? 2. reli- gion. However. Her mother felt she was moody but in session. In the culture where I grew up. They felt that I was taking too much responsibility for the client. Thus. In the first story about tissues. Client/Teacher I had an adolescent client who presented with obsessive-compulsive disorder. if I go to some- one’s house. I saw the surprise on my colleagues’ faces. My client realized this was my first time in the United States and that I had no idea of some of the things she dealt with on a daily basis. I read all types of articles just to understand what the client was experiencing. taboos. In the second story. behaviors. I decided that I would use my past experience with adolescents with this one as well and see if adolescent behavior transcended borders. and What Should We Do About It? Culture is the system of shared beliefs. Family. My ignorance became a foundation for a beautiful and healing relationship. I had no idea how to help. values. In Chapter 8 . Helper/Student. was Hannah applying her own cultural expectations to the American client? How common is this situation. you give them something to wipe their tears as an indication that they can trust you and be vulnerable. In my first semester practicing counseling in the US system. I understood the shocked looks my colleagues were giving me. I realized I had to improvise and fit the new learning into my practice without violating the American counseling code and still be true to myself. She later admitted she looked forward to our times together because it was in session she felt an adult was actually listening to her. and other institutions are the primary vehicles for cultural transmission. I now recognize that my assumptions about what is polite and appropriate are different and that I cannot assume much when counseling across cultures. customs. we mentioned that the culturally competent helper possesses special knowledge. In short. 2015)? If the culture is important to the client. do not necessarily eat Italian food. it is important to appreciate each client’s unique background and his or her cultural alle- giance rather than relying on stereotypes to understand the client. third-generation Italians in the United States do not usually speak Italian. your learning about any group of which you are not a part may always be somewhat superficial and built on stereotypes. while you are gaining knowledge about helping and addressing your own biases. 2009). Let us talk about how you can gain cultural knowledge without merely developing stereotypes. To what extent are clients embedded in the family’s historical culture and how important (salient) is their culture to them (Blount & Young. therapist. For example. Certainly. language. and to recognize the differences in sexual orientation. it does not make sense to imagine that all African Americans respond to therapy in a certain way. you need to know how your individual client has acculturated. One way to become more culturally fluent is to immerse yourself in another tradi- tion by living for weeks or months in that cultural milieu (Barden & Cashwell. consider the possible worldview of a client who is bicultural. we know that everyone is not fully immersed in it. and they read novels and accounts about these places and people. they take the time to learn about that culture and about the client’s acculturation. working on such a project is a good thing but you need to be on the same level as the people you are helping to overcome . may not go to Catholic Church. attitudes. therapists. In my opinion. 2014). or helper of the future to understand and recognize the major cultural groups within one’s country. They speak more than one language. whose parents are from two contrasting cultures. Then when they encounter a client who is culturally different. as a helper. it can be overwhelming. that is. to understand the tenets of the world religions. it is important for the counselor. Of course. to recognize the history of discrimination of women. and helpers I know have traveled and consciously exposed themselves to a variety of ethnic traditions. SKILLS FOR HELPING SOMEONE WHO IS CULTURALLY DIFFERENT The Skill of Cultural Study and Cultural Immersion Earlier. this really does not happen when you visit a destitute area to build a school and then stay with your own people. At this juncture. and skills to cross cultural barriers.300 Chapter 12 • Skills for Helping Someone Who Is Different on assessment. the realization that many clients identify with more than one culture has spawned a new term. In recent years. social worker. But you will probably be seeing clients long before that kind of learn- ing is complete. they travel to unfa- miliar places. and probably have not visited their grandparents’ homeland. The culturally knowledgeable coun- selors. Thus. When immigrants move into a different dominant culture. In addition. When the trainee realizes the myriad ways that clients can differ. Mem- bers of a cultural group can differ in terms of how much they accept their cultural condi- tioning. we made a case for taking the time to explore the client’s family of origin. multiple heritage (Henriksen & Paladino. it should be important to the helper. they tend to take on the values of the new culture gradually. Likewise. and his or her religious/spiritual background. When assessing culture. here is an oppor- tunity to develop some basic skills to employ when encountering a client who is different from you. For example. 2016). Does the client believe that you have the skills to help? There are two kinds of credibility: ascribed and achieved. For example. Lowe. This may mean a referral to churches and to culture-specific support groups. Achieved cred- ibility is when the client sees the helper as having the ability to help because the helper has demonstrated these skills. Consider being involved in a non-helping cultural immersion experience. She had sought help for her anxiety only at the urging of . 2009). Matthews. She said. I can never be prepared for all the different experiences that have shaped a client. a caseworker in an alcohol treatment center who is not a recovering alcoholic may be ascribed little credibility at first. A Tutorial Stance: The Skill of Understanding the Client’s Culture by Listening In my own experience in a hospital. Achieved credibility begins by conceptualizing client problems within the client’s cultural frame of reference and doing something that helps him or her find immediate relief from some aspect of the problem. & Ahn. Chapter 12 • Skills for Helping Someone Who Is Different 301 stereotypes and truly understand their lives. I told my supervisor that I did not know anything about what my clients were going through and I felt lost. Ascribed credibility is not as powerful and may not last if the client is not making progress. The World Health Organization recommends working closely with traditional and even folk medicine providers. Although her English was good. Once an older Mexican woman sought help due to her anxiety over a serious medical finding that suggested cancer. This tutorial stance has become something I fall back on when I realize that no matter what I do. Achieving Credibility and Trust Credibility is the confidence that the client has in the helper and the client’s perception of the helper’s expertness and trustworthiness (Sue & Sue. Alcoholics Anonymous offers Spanish meetings. Let me give an exam- ple. but it will also sensitize you to the challenges of living as a member of a culture. Ascribed credibility is the status given to someone who is older. 1978). but that I can learn what it is like to be that person by asking and then listening. Wampold. and experienced. Some research has even suggested that speaking the client’s language and being a member of the client’s ethnicity does not necessarily make the helper credible (Atkinson. For example. I sometimes worked with dying patients. Not only will that help you to understand that particu- lar culture. she could not understand the medical terminology and the seeming reluctance of the medical group to explain the results of the tests. Tapping Cultural Support Systems One way to provide culturally appropriate help is to enlist the aid of community support people such as clergy and family members. “Why don’t you ask them?” I found that asking a client what he or she is going through rather than trying to fix the unfixable situation was the best possible advice. Ramos-Sánchez. Helpers who encounter someone who is culturally different may not have much ascribed credibility if they do not meet the client’s cultural expectations. 1998. and therefore the helper must strive to find tangible ways to help (Sue & Zane. credentialed. When we change the treatment to include elements of the client’s culture. In this case. changing its intake procedure to match client differences. “If your parents don’t like it. her therapist. She is embarrassed because many raise their eyebrows when she tells them she is living at home. Rodriguez. But it need not be so formal. who had been born in the United States. However. The helper went beyond listening and found a way to provide practical help. The greater the number of cultural . In their meta-analysis. in her culture and family. although her parents were from northern India. and put many of her fears about her health to rest. Don is a therapist practicing in a small town near Denver. As you read the case. 2015). STOP AND REFLECT A helper is not always aware that his or her assumptions about good mental health are culturally bound. My colleague. Culturally Adapting Treatment: Tailoring Your Approach to the Client Throughout this book. it is called “culturally adapted treatment. age 25. with the client’s permission. we have made the case for tailoring the treatment to the client’s unique needs and background. called the physician.” • If the client were from an American background. and building in a systematic way to consult with representatives of the community. having been raised in that area. think how you might help such a client solve the problem in a way that is best for her. One of his clients is a 25-year-old woman named Mira. A previous helper had encouraged her to move out of the house and told her. too bad. Smith. any other living situation would be considered unacceptable before marriage. She describes the difficulties she has been encountering with friends because she still lives at home. how might you begin helping this client? What more would you like to know about the client and her culture? Jot down your answers to the questions raised here and discuss them with your classmates. An agency or clinic can culturally adapt its services by providing translation. and Bernal (2011) examined 65 studies of culturally adapted treatment and found that clients will benefit when helpers match the treatment with the client’s culture. a therapist named Don may be tempted to encourage a client to accept a West- ern concept of maturity even though the client comes from an Eastern culture.302 Chapter 12 • Skills for Helping Someone Who Is Different her daughter and was wary about being in a mental health clinic.” Sometimes this means taking a proven intervention such as cognitive behavior therapy and customizing it for a particular ethno-cultural group (Helms. still living at home. Colorado. what is Mira communicating to Don? • What cultural values do you imagine Don might possess that would conflict with the client’s upbringing? • If you were Don. That intervention overcame the client’s initial concerns and set the stage for her to deal with her fears. what assumptions might you make about her? Do you think you might be tempted to make these same assump- tions about Mira? • In talking about her previous therapist. 2010). Many writers are now identifying broaching as an impor- tant skill that should be used even in the first session (Day-Vines. 4. & Griffin.” Earlier in this book. del Prado. 3. it is the first thing we ask about a new baby. In the next section. In doing so. the better. Andrew Daire. 1999. not to all culturally different clients. Chapter 12 • Skills for Helping Someone Who Is Different 303 a daptations the helper uses. Bryan. 2015. Would you feel that vital data were missing? Most of us would. & Richardson. 1975). In other words. You are African American. we turn our attention to helping clients when differences in gen- der and gender training arise. Mallinckrodt. These differences might be in race. in the assessment stage the helper might say to the client. we are not finished with cultural issues because gender training takes place within the cultural context that we have been discussing. Every .. React to client feedback right away and adjust the treatment accordingly. Knowledge of our gender is fundamental to our identity (Bem. 2015). Use methods that are appropriate and acceptable within the client’s culture. who broached the cultural differ- ences between himself and his White rural client. gender relates to the roles that each sex is taught (Gilbert & Scher. and it also paves the way for the client to discuss the role of race or culture in the therapeutic relationship and in relation to the client’s problems. The researchers give several other concrete sug- gestions for helpers including: 1. Sex refers to basic physiological differences between men and women. Day-Vines et al. Broaching is an invitation to discuss cultural differences. 2007). I wonder what you think about getting help from someone whose background is quite different from yours. Taylor. Acknowledging Differences by Broaching Broaching is the skill of continually talking about obvious differences with the client (Choi. Sanchez. know- ing someone’s sex does not give us all we need to help that person. My parents came here from China. For example. Establish a strong therapeutic relationship and let the client know that you respect him or her. ethnicity. or culture. We need to know a person’s attitudes about gender and something about the particular communication patterns and values that can separate men and women. MyCounselingLab Video Exercise 12. “My background is Asian. & Davis. 2013. make it a regular part of the treatment to check in on how the treatment is meeting client expectations.1 Balancing Act SkillS for DeAling with genDer iSSueS Challenges Caused by Differences in gender Let us suppose that you were helping a client over the Internet and the client refused to identify his or her gender. Yet just as we noted in the arena of cultural differences. We must also under- stand the degree to which an individual has been trained as traditionally male or female. Failure to under- stand gender issues can put the therapeutic alliance at risk (Anderson & Levitt. we mentioned the case of an Afro-Caribbean counselor. 1994). 2. Adapt your treatment to a specific ethno-cultural group. 1992) may be reinforcing these stereotypes. 2003). Martin. Popular books such as Men Are from Mars. participating in group discussions. Mitchell. 2015. 2014). Training should also allow the helper to examine his or her personal assumptions about gender (Anderson & Levitt. Just as cultural groups tend to stereotype each other. 2003). Vogel. 2002). 5. Utilize supervision to discover your attitudes about a client that may be the result of your own gender socialization. If you recall from that discussion. & Johnson. Nayak. Skills for Addressing Gender Issues Every helper needs to have the skills of the reflective practitioner that we talked about in Chapter 1. For example. here are some general strategies or skills that helpers can develop to avoid gender becoming a wall between them and their clients: 1. it is a common belief that women are more emotional and men less so. 1999). credible.304 Chapter 12 • Skills for Helping Someone Who Is Different culture has different expectations for men and women. Just as when dealing with cultural differences. We run the risk of stereotyping when we assume that someone is a typical man or woman and communicates in a certain way. These stereotypes can affect how we diagnose a person and how much weight we give to his or her symptoms (Lopez. Epting. Byrne. the same process occurs be- tween men and women. Women Are from Venus (Gray. 1997. using a journal. part of gaining knowledge about a person is through the assessment process when we look at his or her unique characteristics. we will look at some elementary steps that helpers can take to deal effectively with gender difference and gender issues. Most of the male/female contrasts we are dealing with are those of attitude or perception rather than substantial divisions in behavior. How can we use reflection in dealing with gender issues? These assumptions about others and ourselves are so deeply ingrained that it is very difficult to get free of them. Understand the importance the client places on gender identity. However. . In addition to reflection. Recognize that clinicians may hold gender stereotypes about what defines a mentally healthy man and a mentally healthy woman (Gold & Hawley. Be particularly aware of how gender affects attitudes about family roles and family violence (Anderson. Despite this. boys and girls. Holland. being reflective is particularly important when differences between helper and client produce misunderstandings. 2001). Grover. and consulting a supervisor are all reflective ways of getting to a point of view that is broader than your own. 3. and influential than women. Training programs should teach helpers to address the issues of gender differences directly with clients and to continue to talk about these matters throughout the therapeutic relationship—but they do not (Vogel. & Pressly. the dominant culture has historically portrayed men as more powerful. a big problem arises when you realize that not everyone of either sex has learned the same gender roles. In the United States. there appears to be no plausible evidence of variability in how men and women express and react to emotions (Wester. Reflection is the process of identifying a puzzling issue and looking at it from different angles. 2. Be willing to discuss gender issues that surface in client/helper interactions and misunderstandings. 4. Thus. & Abraham. Address gender in the assessment process. 1989). Gender bias in career counseling is a major issue that can potentially stunt an individual’s develop- ment (Kerka. In this section of the chapter. & Wester. Empowerment (Zerbe Enns. feel about a woman trying to manage both work and family? • Ask yourself. FEMALE CLIENT If you are a man counseling a woman: • Read Psychological Practice with Women: Guidelines. are you treating partner issues any differently than if she were heterosexual? Are your ideas about what makes a healthy relationship or healthy person any different in this case? SCENARIO 2: FEMALE HELPER. how do you. This may mean that your client will experience fear or mistrust that can be dealt with in the thera- peutic relationship or may require a transfer. Chapter 12 • Skills for Helping Someone Who Is Different 305 When the Difference Is Gender Let us examine two basic scenarios: men counseling women and women counseling men. At the same time. MALE CLIENT If you are a woman counseling a man: • Consult Holly Sweet’s book. Gender in the Therapy Hour: Voices of Women Clini- cians Working with Men (2012). controlling one’s emotions. The issue is how to prevent and repair ruptures in the therapeutic alliance that might arise due to different approaches to communication. seeking help is in opposition to masculine values such as maintaining status and power. Rice. “How much work am I doing compared with the effort the client is putting forth?” As a male. Wester & Vogel. 2015). In the same vein. 2002. & Nutt. 2011. differences and prejudices about gender can also cause a rupture. • For a man. as a male helper. • Understand and discuss the role strain and role conflict a woman experiences when she tries to fulfill personal and societal expectations that she be the perfect mother and wife while also trying to meet the demands of her employer. Englar-Carlson & Stevens. ideas. Schaub & Williams. For example. when women help women and men help men. or has the client come to receive insight. 2001). • Be aware of “androcentrism. are you feeding into the social expectation that you will lead and the woman will follow? Would you be doing this much for a male client? When are you helping too much? Could you be creating a dependency in the client? • Consider: “Am I treating the client as fragile?” Is this what the client wants. This has . and being independent (Bedi & Richard. or confrontation as well as support? To what extent am I letting the client off the hook because of my own beliefs about her inability to handle strong statements? • If the client is a lesbian. SCENARIO 1: MALE HELPER. 2002)? • Understand that many women have had experiences of sexual abuse or misuse.” or the belief that male experience is normal and is our common experience (Robinson & Watt. 2007). and other concerns related to one’s personal gender role training. Diversity. This view has shaped our ideas about what is mentally healthy and unhealthy. do you think that main- stream culture views an aggressive woman in a business setting less positively than a male counterpart? If so. She describes both the challenges and opportuni- ties for cross-gender collaboration. These experiences can elicit a sense of guilt and failure when one finds it is impossible to be every- thing to everybody. is it possible that you might pathologize in a woman what is acceptable or healthy in a male (see Okamoto. 2006. and these memories can be evoked if the relationship becomes intimate. . • Many men prefer female therapists because they feel they can be more honest and do not have to hide weaknesses. SKILLS FOR HELPING A CHILD Not every helper imagines working with children. • Are you. 1999). the practitioner may be tempted simply to use adult-oriented skills but then be stumped when that strategy does not work with the child. One of the reasons that helpers shy away from helping children is that their training has been primarily. 2. Tager. Children are not miniature adults. p. Can you help a male client recognize that this is an impediment and an issue he may need to deal with in other situations? Can you do it in a way that does not destroy the therapeutic relationship? • Are you comfortable with a man expressing feelings of weakness or powerlessness? How would you feel if your male client cried? Would you see this as more indicative of pathology than if a woman were to express an emotion in this way? • If your client is gay. with adults. They may also believe that they can more easily influence a woman. When faced with an actual child. Besides there being developmental differences. Some methods of working with children propose that these adult skills be adapted or simpli- fied (Erdman & Lampe. & Mackowiak. & Tyndall-Lind. 2005) because it is not mentally healthy.. if not exclusively. 3. adapting an “adult verbal process” to children fails to recognize their unique methods of relating (Landreth et al. as a female therapist. prejudiced against men who are not highly motivated or driven to succeed? Are you sending subtle messages to a male client that he needs to accept the male “harness” and make career the most important thing in life? (Mahalik.306 Chapter 12 • Skills for Helping Someone Who Is Different sometimes been called “toxic masculinity” (Kupers. Landreth (2012) makes a number of general observations to guide helpers when they are begin- ning to work with kids: 1. we focus on the skills needed to help clients who are children. 272). and therefore. Therefore. it is cru- cial to understand the uniqueness of children in order to match their developmental level and then use approaches (such as play) that are best suited to their needs. Children are people. 1999. critics say such an approach ignores the basic fact that children not only think differently but also communicate differently than adults. are you treating partner issues any differently than if he were heterosexual? Are your ideas about what makes a healthy relationship or healthy person any different in this case? In the next section. Levant. This developmentally inappropriate approach assumes that chil- dren are cognitively identical to adults (Landreth. The ability to express thoughts and feelings is fun- damental to the helping process. Good. Still. virtu- ally every helper ends up dealing with children in some capacity whether in a family meeting or by referral from a client/parent who trusts the helper. and some actually dread it. Children are unique and worthy of respect. 1996). Baggerly. 2012) • Understand that a man’s respect for a female therapist may turn into romantic affec- tion. 4. Language is not yet the primary medium of the child mind. Children are resilient. On the other hand. facilitating feeling heard and relationship responses supported Advanced Reflecting Understanding the Reflecting meaning. Landreth is suggesting that children are capable of self-change and the helper’s job is to create a therapeutic environment that the child can direct. In Table 12. goal set- ting. reflecting client’s story/client reflecting feelings content and feelings. In summary. Limit setting. reflecting skills. challenging. immediacy facilitating decision making/returning blind spots responsibility responses Goal-Setting Skills Developing the Using questions to Parent consultations. sharing power working alliance identify a goal. confrontation.1. adults guide children. Reflecting meaning and meta- Skills client’s story/client summarizing communicating feeling heard and supported Challenging Skills Bring awareness of Giving feedback. challenging could take the form of asking the child to take responsibility for what he or she is doing. but in the therapeutic environment. for a child. Thus. discrepancies and confrontation. these groups of skills are identified along with the purpose of each skill and the building block tech- niques that are used to accomplish the tasks of inviting. Identifying Helping Skills for Working with Children In this book we have broken down the basic helping skills or therapeutic building blocks into the following five categories for adults: invitational skills.1. children can grow if given some opportunity to express themselves naturally. In most areas of their lives. Children are capable of positive self-direction. each of these skills categories is described in terms of its purposes. Children’s natural language is play. 7. challenging skills. Children have a built-in inclination toward growth and maturity. or producing change. 6. tracking. 8. In Table 12. boiling down the problem . you might confront a discrepancy between a client’s behavior and his or her stated goals. Children have a right to be silent. and each is matched with building blocks (smaller TABLE 12. Chapter 12 • Skills for Helping Someone Who Is Different 307 5. and goal-setting skills. advanced reflecting skills. reflecting. if you are using challenging skills for an adult client.1 Basic Skills for Working with Adults and Children Compared Therapeutic Building Purpose of the Blocks for Adults Therapeutic Building Blocks for Skill Category Skills (examples) Children (examples) Invitational Skills Communicating Nonverbal skills such as Nonverbal skills such as meeting acceptance and eye contact and opening the child at his or her physical level developing trust skills such as minimal and opening skills such as minimal encouragers and open encouragers and giving explanations questions and details about the helping process Reflecting Skills Understanding the Paraphrasing and Encouragers. facilitating decision making. if used improperly.e. and (4) facilitating relationship responses to demonstrate the “be-with” attitudes (Landreth & Bratton. accepting. asking too many questions can be overwhelming to the child. However.308 Chapter 12 • Skills for Helping Someone Who Is Different TABLE 12. These short responses elicit a collaborative relationship. countering. modeling. meditation. role-playing. can sound like a sports announcer. puppet gratitude. encouragers.. (2) tracking. In tracking. confidentiality.” the helper can paraphrase. “My dad does not live with us anymore. brainstorming. art techniques. (3) reflections of content and feelings. encouragement. (3) explaining the process of helping. and limits) and ask why the child thinks he or she is there. Giving advice. role-playing skills) for both children and adults. On the other hand. in Table 12. if the child says. “You are moving that from there to here. what it is. It is important to explain the process (i. both nonverbal and verbal. asking change questions. A 5-year-old may not understand a reflection of feeling overwhelmed or feeling inadequate as an adult would. For instance. These building blocks illustrate the difference between children and adult basic skills. The therapeutic building blocks for children are develop- mentally appropriate and do not merely translate adult skills into simpler language.2 Some Adult Change Techniques and Child Techniques Compared Purpose of Change Techniques Adult Change Techniques Child Techniques Change thoughts. mutual storytelling. metaphors. Then the child may view you as yet another adult interrogator rather than the supportive helper you hope to be for him or her.2. 2006). didactic teaching. when used appropriately. giving Self-esteem–building responses. REFLECTING SKILLS The primary reflecting skills for working with children are (1) encouragers. (2) introducing oneself to the child in the par- ent’s presence. reframing.g. discussion. “Would you like to skip or walk to the playroom?”). feelings. thought stopping play. brainstorming. deep custom-designed therapeutic muscle relaxation. that let the client know you are listening. these feelings can be reworded to reflect the child’s feelings of worry or sadness. and genuinely inter- ested in him or her. Reflections of content (paraphrases) and reflections of feelings are similar processes as they are with adults. and behaviors information.. Finally. however. the helper narrates the child’s behavior. we show a comparison of some adult change techniques and their counterparts for working with children. but it important for the helper to use age-appropriate vocabulary for the child client. You are already familiar with encouragers. “Your dad moved somewhere . tracking shows the helper is actively following the child’s play and communicates involvement. on the other hand. For example.” This skill helps the child recognize that you are present. and (4) offering choices even at the first contact (e. INVITATIONAL SKILLS Inviting the child means creating a safe space from the beginning: (1) moving to the child’s level (physically). Tracking. demonstrating to the child that he or she is important and matters to the child helper. but the doll is not for breaking.” Of course. the child also begins to develop a feeling vocabulary for the emotions expressed in the moment.” When children experience the helper as understanding and empathetic. both verbal and nonverbal.” “I hear you. A similar skill is meta- communicating. providing listening. and (3) target alternatives. Here is a wooden block. or hurting the self or the helper. Ray.” Limit setting challenges the child’s inclination to respond to situations using his or her old behaviors.and/or parent-identified goal. 2015. and facilitating decision making/ returning responsibility responses. The helper does this to foster “be-with” attitudes. such as breaking toys or materials. “Sometimes you yell at me when I don’t do what you want me to. For example.and socially appropriate ones. it is critical to be accurate and to be sure you have enough data before making a reflection like this. enabling the child to see what aspect of the problem is working and what part is not for his or her self.” By reflecting feelings. “You are moving some of the things next to me” or “You wanted to put those together closer to me.” and “I understand. (2) communicate the limit. “You seem to get mad when the picture you draw is not what you want it to be. helpers communicate trust and acceptance of the child and provide opportunities for him or her to change those behaviors to more age. Landreth and Bratton (2006) outline these attitudes as “I am here. depending on the age of the client. This skill enables the helper to communicate about the relational communication. “I am mad. and feelings of care and presence. the helper may also use a reflection of feeling. Mom.” Depending on the child’s tone. “You feel angry and want to hit the doll with the hammer. or you can choose to hit the Bobo [inflatable bag]. Through this process. Be-with attitudes communicate to the child that the helper is with him or her in the moment. 2011). understanding. Through the play therapy process. Using the same example from reflecting skills. Helpers use limit setting when the child does something outside the acceptable limits. that is occurring in the play session. Helpers can fol- low the ACT model (Landreth. “You’re sad your dad doesn’t live with you anymore.” Finally. they begin to feel freer to express their innate thoughts and feelings throughout their play to work through their presenting issue and overcome the obstacle(s) that may be impeding their full potential. the helper may reflect meaning in the following way: “You are sad that your dad doesn’t live with you anymore and you think it is because he does not love you. which is a kind of interpretation of the child’s behavior or the unspoken messages in what the child says or does. 2012): (1) acknowledge the feeling.” CHALLENGING SKILLS Helpers use challenging skills to provide the child with insight into his or her problem.” This type of response communicates to the child his or her desire to form a relationship and connection with the helper. . Chapter 12 • Skills for Helping Someone Who Is Different 309 else. For example. ones that have typically elicited negative consequences. high- lighting the child’s grief that her father moved out. confrontation. children learn to generalize these skills and tell adults how they are feeling such as. not only does that child begin to feel that the helper understands him or her. You can choose to hit the wooden block with the hammer. those who work with children learn to make relationship-facilitating responses such as. Helpers utilize these challenging skills to encourage increases in self- control and self-esteem: limit setting.” “I care.” Or. ADVANCED REFLECTING SKILLS Helpers can use advanced reflecting skills such as reflection of meaning or meta-communicating to highlight the underlying belief that the child expresses through his or her words or behaviors (Kottman & Meany-Walen. 2015. Ceballos. “What would happen if you were to play with matches and the rug caught on fire?” Returning responsibility is when the helper reminds the child that he or she can choose and decide. self-worth. In this case. 2012. increasing their internal locus of control. they are likely to have an answer to the question worded differently: “Your parents said you were having trouble at school.” The child may then respond. During parent consultations it is critical to share information about a child’s progress in the helping relationship and to gain infor- mation from the parents. the helper responds. GOAL-SETTING SKILLS The most common goals that child helpers construct with their cli- ents are to increase their self-esteem. or helper. and self-control (Kottman & Meany-Walen. but don’t want me to see. Par- ents may report that their child does not follow rules. Besides limit setting. The helper can confront the discrepancy by stating.” Helpers can also use the skill of facilitating decision making/returning respon- sibility to aid the child in developing self-control and self-efficacy within the session. You are a little scared.” Many times children do not want to get in trouble anymore but are unsure of how to change their behaviors. the helper could say. For example. which can benefit them into adulthood. & Penn. and this can create rifts between the child and parent.” or “That’s up to you.” In turn. “You would like things to be different. “Yeah. helpers can also use confrontation to address the discrepancies between the child’s behavior and words. the helper has established a working goal with the client at his or her developmental level. For more on parent consultations. children learn to stop or redirect themselves when acting inappropriately. Chil- dren may not be able to answer the question “Why did your parents bring you here?” How- ever. Facilitating decision making is a technique similar to brainstorming. the helper could reflect. In the beginning of the helping process. but it asks the child to consider the consequences of decisions. a child is burying people in the sand and smiling.” At this point. secure. and cared for prior to expressing feelings and thoughts. For example. It is also crucial for the helper to create a working relationship with the parents to maintain improvement at home. For example. they desire autonomy. Establish boundaries that will maintain the child’s confidentiality as much as possible even though there is no guarantee of such confidentiality because the law considers the parents to be the clients. except the smile. Can you tell me about what’s going on?” For exam- ple. Another aspect of goal setting is power sharing. does not listen. As children grow. Children need to feel safe. Ray. “The people are scared and you’re smiling. “It’s not any fun. 2011). one child stated. teacher. sometimes I get in trouble for hit- ting. see Ray (2011). The child’s body language.” This goes along with the idea of giving the child responsibility for directing the session and communicates faith in the child. “You are sad about getting into trouble. This skill helps children develop awareness of their actions and feelings so they can begin to develop self-control. and gets into . Children are typically aware of why they are in therapy and helpers can use goal-settings skills to establish co-constructed therapeutic goals.” or “It is your choice. 2012). when asked this question. too. “That is something you can decide. children may be leery of disclosing information for fear that the helper will repeat that information to their parents. Goal setting becomes tricky given that parents play a role in setting the goals of the therapy process (Post.310 Chapter 12 • Skills for Helping Someone Who Is Different Therefore. Landreth. you want to act differently. Helpers can outline to the parents the importance of confidentiality within the therapeutic process. when the child shows uncertainty. communicates to the helper that this scene is highly charged and emotional. The helper then implements the skill of teaching the child to share power. the helper returns to these “joining skills. does one person have all the control. Ray. However. 2009). we focus on the case for play therapy as an appropri- ate modality for working with children. one goal in therapy is to work with the child on learning to share power. Still. we recommend that practitioners whose primary population is children specialize in play therapy. the child knows that doing so is a collaborative effort. Therefore. 2013). 1993. 2005) and it is the most commonly used model for young children (Sweeney & Landreth. feel- ings. encouragers. the essentials of play therapy can be taught to helpers of all kinds. art techniques. Rhine. and advanced reflecting skills forming the nucleus of the interactions with the child. the helper uses change techniques to help the child change thoughts. and role-playing. Change techniques are more complicated than inviting the child to complete an activity or play a therapeutic game. when it comes to setting goals. and skills of play therapy in a relatively short time (Carnes-Holt & Weatherford. 2012). Most important. for example. & Homeyer. Landreth.” Chil- dren learn to take turns and. then they learn to generalize this to home and school through the collaboration and encouragement of the helper. including school counselors and even teachers. and behaviors. reflecting.1 Identify the Building Block Skills for Children The Case for Play Therapy Play therapy has been shown to be an effective treatment (Bratton.” Although we find that every practitioner needs foundational skills for working with children. In life. Kagan & Landreth. Although becoming a registered play therapist might be the ideal. if ever. brainstorming. helpers who do not specialize in children probably would not want to go through the somewhat lengthy process. especially in the first sessions. MyCounselingLab Application Exercise 12. This approach is a developmentally responsive approach focused on children ages 3–9. CHANGE TECHNIQUES FOR CHILDREN After the therapeutic alliance is established and goals are set. Change techniques used with children. Using Basic Skills as a Guideline for Working with Children The basic skills as we have described them here form something of a hierarchy with invi- tational. attitudes. custom-designed therapeutic metaphors. in 2–3 days (Bratton. thus. One quick way to establish this rule in play therapy is to state from the first session. facilitating decision making. rarely. discussion. . Basic skills are not enough. puppet play. Similarly. didactic teaching. modeling. In the next section. See Kottman and Meany-Walen (2015) for an in-depth description of these techniques. When a rupture in the relationship occurs. sometimes you can be in charge of what we do and sometimes I will be in charge of what we do. those individuals who choose to work primarily with this population should consider certification in play therapy and review the Best Practices of Play Therapy (Association for Play Therapy. share power. are more complex and require addi- tional training. “In here. Change techniques include self-esteem- building responses. Chapter 12 • Skills for Helping Someone Who Is Different 311 trouble at school and home. mutual storytelling. 2009). & Jones. they can develop the basic knowledge. went into a little more depth on three potential sources in this chapter.” • Even if you already know something about the volunteer. political Round 1 party. tural differences. What was accu- of paper. veg. or in one’s own needing a specific treatment plan tailored to his or her personal reflections. On a blank sheet about his or her characteristics. For example. so pletely inaccurate? that when the paper is torn. such as His- • Participants take turns being the volunteer. we have emphasized the can do to deal with these differences without ignoring importance of recognizing each client as unique and them in the session. or “tile. The volunteer is listening and silent Training during this process. gender differences. we tried to emphasize the need to con- of rupture in the therapeutic relations relationship: cul. Why? Do you think helpers shy away from talk- unteer’s pile and place them face up in the mid. Next. ing about these characteristics for the same rea- dle of the table. For example. and work out a lot. Because this is a background. and the like? • Were there some characteristics. sons? • The members then share their conclusions about • Do any of the characteristics you heard today the volunteer based on the tiles that they have suggest possible roadblocks for you in the thera- flipped over. one person’s paper remaining tiles to convey more personal infor- might include female. This may have . In this chapter. base the conclusions solely SMALL GROUP DISCUSSIONS on the characteristic. and what was com- his or her identity on different parts of the paper. what was surprising. mation that may contrast or confirm the stereo- etarian. Hispanic. and to make yourself a student of your client’s special tal differences when helping a child. we helper differences that can disrupt the relationship so.312 Chapter 12 • Skills for Helping Someone Who Is Different Summary Throughout this book. “You are a volleyball peutic relationship? Your emotional reaction player so you are a jock and you must like sports might be a clue. least as many characteristics as there are people in the group. in supervision. Make sure you write down at types or comments made by the other members.” Participants then place their Group Discussion own tiles text down in a pile in front of them. volunteers may wish to flip over one characteristic. not the person as a Discussion 1: Remembering Your Gender whole. book about skills. Obviously there are many client/ specific goals and background. to be mindful of your own attitudes. each person writes down different aspects of rate. and developmen. each piece contains only • As they talk. volleyball player. tear the paper so each aspect of identity is on its own piece. and so forth. we tried to focus on what the helper Exercises GROUP EXERCISES Round 2 Exercise 1: Pieces of Me (by Shainna Ali) • One at a time each volunteer reacts to the con- clusions that the other members have made Form groups of five or six students. that you felt uncomfortable talking about? other members each take one tile from the vol. tinue to learn. proper way for a boy or girl to behave. • How often do we stereotype a person based on a single characteristic such as religion. The panic. • Everyone in the group has a chance to be the Identify two or three scenarios in your childhood volunteer and have peers share reactions to his where you learned or someone instructed you on the or her characteristics. or are some direct? Homework 1: Minority Experience • Based on your experience. privilege that he or she has enjoyed. ignore the homeless person on the street so that . _____ Your client views his or her grandparents JOURNAL STARTERS as wise and often defers important decisions to them. can lead to defensive reactions. Did you have this No helper can expect to have the knowledge. she feels comfortable. Shame arises as one realizes the client considers her family structure to misdeeds of one’s ancestors and the amount of include her children and her mother. invite each person. training have to deal with is shame (Parker & ent fathers and has never been married. or a cultural event where you are SELF-ASSESSMENT a minority. 2002). For example. Spend 30 minutes with someone whom you con- _____ Your client does not speak English very sider quite different from you. What might the person have trouble understanding _____ Your client is GLBT (gay. skills. you will run into a variety of situations that may cause you Homework 2: Clients Who Are Different discomfort or confusion. Incident 1: _____ Your client’s nonverbals seem to suggest Incident 2: that she is cold and unresponsive. we sively harsh. skills. 1. and attitudes you need to deal discuss. how would it feel to deal with this on a and attitudes necessary to deal with all kinds of cli. As you proceed on your helping journey. consider the following: with the situations you have identified? • What method was used to teach you this lesson? • Why do you think someone taught you this lesson? HOMEWORK • Are all methods of teaching gender behavior subtle. or transgender) with relationship issues. The Schwartz. to describe these situations and What sort of training would help you develop get reactions from the other group members. One of the emotions that White helpers-in- _____ Your client has four children from differ. in the teachings of Islam. You are not certain whether this assessment is accu- Incident 3: rate because she has strong relationships In a small group. She believes that ground. This person might be well and wishes to stay outside of the main. Consider. Are You a Culturally Competent Helper? One of the things that those in the minority talk about is the sense of being observed. dures from China. from a different socioeconomic or educational back- _____ Your client is a Muslim. a play. Read the descriptions below from You and check those that might currently be a challenge for you to accept. culturally different or religiously or politically at the stream culture—not interacting or really opposite end of the spectrum. Write a few words that will remind you cine and prefers traditional medical proce- of the incident. Go to a church. how do you want to If you have never been a minority. He or she may be accepting the dominant culture. lesbian. about you? ual. daily basis? ents. sense? If so. if he or with family members. what the answers to life’s problems can be found it would be like to work with this person as a client. Would you be able to develop an egalitarian rela- _____ Your client is a nontraditional male who tionship? What do you think you would find to be stays home with the children and has little the most difficult things about this person to accept? interest in career. Chapter 12 • Skills for Helping Someone Who Is Different 313 been the result of your having violated a social norm _____ Your client does not trust Western medi- about gender. consider placing raise your children? yourself in that position by attending an event where your ethnic background is not highly represented. Shame and _____ Your client has culturally different ideas feelings of helplessness to change the situation about child discipline. You find them exces. bisex. As you the knowledge. Write a brief reaction to this experience. after talking with him or her. what messages helping. When you experience these feelings of about men and women do you think you received? shame or helplessness in working with clients. Thinking back on your upbringing.314 Chapter 12 • Skills for Helping Someone Who Is Different we do not have to face the fact that we should be 2. how will you be you and a client? What kind of training or support able to spot this bias in your own work? How can will you need? you get feedback? . Look at Discussion 1: “Remembering Your Gender how do you plan to deal with them? Could they Training” section above. If we are right that this make you defensive and create a barrier between training is sometimes quite subtle. feedback and con- helper is eliciting and recording data and the client is frontation are the two challenging skills you will learn. and formal testing. the client has stopped drinking. providing it. and recording any sensations in his or her body from head to toe to influence of hallucinations and delusions. books assigned for the client to read as a method of Coaching Coaching is counseling with an emphasis treatment. Booster sessions These are used when the client is For example. observation. program. building blocks. use memory. make good judgments. It involves a free flow of ideas with an skills. Aide Aides are friends or family who serve as allies to Building block skills Each skill category. Aides goal-setting skills. expertise. solve problems. or entered a treatment progress. In this case. Ascribed credibility The status given to a helper by Catharsis Catharsis is an experience caused by stimu- the client because of age. to get information. disclosure from the client. Closed questions These questions require short. clear goal Action The stage of change in which we find clients statement. Body scan A body scan is a client’s internal review of maintain attention. effective invitational skills but are important for elicit- Bibliotherapy Bibliotherapy refers to the use of ing key pieces of information. 315 . or a specific answer. “How long were you married?” and the number at the beginning of treatment against “Are you angry?” Closed questions are not the most which change can be measured. tual responses. ior that a client wants to increase or decrease. such as the client in accomplishing a therapeutic goal. not use of assessment instruments. Attentive silence This is small periods of silence Change techniques In this book. Achieved credibility The status given to the helper Boiling down the problem This skill involves by the client because he or she has helped the client in reducing the problem into several subproblems and a material way. GLOSSARY Acculturated The degree to which a person is identify any areas of tension or disturbance. For example. of relaxation training. Cognition Cognition refers to thinking and in assess- Blind spots Things others may know about us but ment involves understanding the client’s ability to we do not know about ourselves. the problem are used to help the client develop goals. lating emotional arousal and encouraging emotional Assessment Assessment is the general name for the expression. It is a part immersed in a particular culture. yes/no responses. This can be achieved through conversa. Brainstorming This is a skill that originated in the Advanced reflecting skills In this book reflecting advertising world to generate ideas in a group envi- meaning and summarizing are advanced reflecting ronment. technique. Bibliotherapy is a psychoeducational on encouragement. fac- Baseline Baseline refers to the frequency of a behav. This is Examples include. Change questions or strategic questions Those tion. of using questions to identify a goal and boiling down ber to take medication regularly. started invited to return for help after termination to maintain attending AA meetings. then further distilling it into a simple. who have already made some changes in their lives. is made of smaller skills called supply both help and encouragement. understand. or credentials. information from other sources. These periods of silence allow time for client and action phase that are designed to create move- and helper contemplation and may encourage further ment and growth. emphasis on quantity and creativity. change techniques when the helper remains present and attentive to the are helping skills employed during the intervention client. interaction between client and helper wherein the Challenging skills In this book. the questions designed to persuade a client to change. the building block skills some clients use family members to help them remem. behaviors. customs. Besides the relationship. For example. of help they need or want. enhancing self-esteem. because he Cognitive therapy A theoretical position that states or she has had difficulty handling domineering people that emotions are mediated by thoughts. tinction between counseling and psychotherapy. those that are common to a particular period of life. are planning to change within 6 months. in this book Cultural/ethnic identity The cultural. Counseling The goals for counseling are usually to They may be the result of physical. damaging to self-esteem and replace them with more sessing conflicting values. Customers Steve de Shazer’s term for clients who are Compound response Giving two responses together seeking immediate help and are committed to the such as two questions or making a reflection of feeling process. value. issues to address in the helping relationship are the crepant elements of a client’s story and asking the client’s sense of hopelessness. By assessing the client’s Counseling goals are growth oriented and emphasize stage of life. attitudes. For example. nic background with which the client identifies. a confiding relation. appreciate it. Cultural competency The possession of skills. alienation. Helper responses that seek to uncover negative consequences of potential change. Developmental issues Developmental issues are and life that affect multiple areas of one’s life. At this point Depth Depth refers to the fact that every client’s story they have become conscious of both the positive and has layers. values. racial. or problems into a category so also involve helping people with mental disorders. apies emphasize. or eth- we discuss increasing motivation and expectations. The dis. on to the helping relationship. taboos. Core beliefs General beliefs about the self. in an assertive manner. Yet clients unspoken or hidden thoughts. feelings. We productive and realistic messages. one can identify expected obstacles and the therapeutic relationship as a major factor. an extended period of time in order to understand and ship is a common therapeutic factor. is difficult to draw because counseling may sonality. tence. tudes. and then asking a closed question. Generally. . practicing new behaviors. tional or erroneous thinking and you improve emo. raising and lowering emotional arousal. and beliefs. Countering Countering is a cognitive behavioral the term refers to a category in the DSM list of mental technique that teaches the client to challenge thoughts disorders. and artistic products that a group of people transmits from one generation to the next Complainants Steve de Shazer’s term for clients who and that members of the group use to understand their have a complaint but are ambivalent about what kind world and each other. others. responds very passively toward the client. resources for helping a client. Demoralization hypothesis The demoralization hypothesis is Jerome Frank’s idea that the primary Confrontation Confrontation is presenting the dis. religious. atti- tional health. that appropriate treatment can be applied. and loss of self-esteem when he or Contemplation The stage of change in which clients she enters a helping relationship. Normally. symptoms. help clients overcome normal developmental hurdles. These originate in past relationships Cognitive distortions Learned thinking patterns that or personal issues and are transferred to the client or are false or irrational. tions to a client. feelings of incompe- client to resolve the inconsistencies.316 Glossary Cognitive dissonance Discomfort caused by pos. providing new learning experi- ences. in Diagnosis Diagnosis is the placing of a client’s per- practice. Change irra. that probably underlie the effectiveness of different Cultural immersion Living in a particular culture for systems of helping. social. the client ignores the first response and responds to the second. Transference reactions are cog. and meanings at this stage are ambivalent about making a change are deeper responses than those that keep the conver- and are not ready to take direct action to address the sation going or move it to more superficial or irrele- problem. the helper nitive distortions about the helper. are motivated to reduce the dissonance by resolving or Countertransference This refers to the helper’s reac- ignoring the differences. which most ther. and knowledge that allow the helper to effec- Common therapeutic factors These are the things tively help someone who is culturally different. or ego development. and Culture The system of shared beliefs. vant topics. bility In this book. Evidence-based practice This means adopting those Giving information Supplying data or facts to help methods of helping that have been proven. parenting. refers to a helper behavior that Direct instruction or psychoeducation Teaching includes reminding the child of his or her ability to clients skills such as assertiveness. what will change are put off until later. When tional knowledge to make decisions and determine we have identified the frequency. This means that ideas are not judged at hidden suggestion: For example. It may be appropriate . Focusing summary The helper often uses this kind formed. a shy 15-year-old boy focusing summary can also be used when it appears may set a goal of talking to a classmate for 2 minutes. that this skill be used sparingly. of summary in the beginning of a session to remind tion of a new behavior or decreasing the duration of a client and helper of previous sessions and goals. It is the expectation weeks or months after termination to check on the cli- that one can perform a specific task. involvement.” and “Go on. Diaphragmatic breathing is Facilitating decision making/returning responsi- used to produce bodily relaxation. is facilitative when it communicates interest. Some client goals involve increasing the dura. It is a very commonly utilized technique in which the helper Giving advice Giving advice is a change technique in gets involved with the client and enthusiastically which the helper tells the client what to do. other interpersonal skill. another person gain faith in himself or herself. skill of responding to the client by emphasizing the parts which lists mental disorders and other diagnoses along of the story that relate to the client’s experience rather with their criteria.” about how you perceive him or her. Gestures can facilitate client communication Encouragement Encouragement involves helping or become distractions for the client. This allows for a free-flowing in your family?” atmosphere where creative and unusual solutions can Emotional intelligence The ability to recognize emerge. and behaviors in a client’s story. “When you let go of the time they are generated. The negative behavior. or any choose and decide during the session. increase or decrease the frequency of the behavior.” Examples include. that one is ent’s progress. by the client attain his or her goals. Efficacy or self-efficacy Efficacy is a component of Follow-up Refers to brief contact the helper makes self-esteem identified by Bandura. one’s own emotions and also those of others. that the session has gotten off track. tion and comfort. to be effective. the emotionally intelligent person uses emo- behavior is to note the number of times it occurs. we can set a goal to behavior. than the actions of other people or the environment. It is also referred to as a “posture of They are requests for the client to continue or expand. It encourages the client’s communica- Door opener Door openers are invitations to talk. grasp the facts. Glossary 317 Diaphragmatic breathing This breathing practice Exposure A technique for helping clients approach a consists of inhaling and exhaling below the ribs rather feared object by slowly exposing them to the situation. competent. Facilitative body position A helper’s body posture Discrepancies Inconsistencies in thoughts. giving is mostly misused. It is recommended research. DSM The Diagnostic and Statistical Manual of Mental Focusing on the client Focusing on the client is the Disorders of the American Psychiatric Association. Practical considerations your anger and forgive your father. and body movements when they are used as commu- nication. feelings. Duration The amount of time a behavior is per. Freewheeling Freewheeling is one of the rules for Embedded questions These are questions with a brainstorming. and significance of another’s story and convey this understanding to him or her. It is Gestures Gestures are facial expressions and hand the ability to “feel oneself into” another’s experience. than in the upper chest. In addi- Frequency One way of determining a change in tion. relaxation. feelings. “Help me understand more about Feedback Providing another person with information that. Empathy The ability to communicate understanding Gender Learned behaviors associated with being a of a client’s feelings and worldview. The ability to particular sex. Advice pushes the client to achieve the established goals. For example. and openness. individuals who have already changed their lives and Internal critic ”The voice in one’s head” that finds behavior. reckless- Gratitude The feeling of thankfulness for an unde. for example. Homework Homework is out-of-session practice by not to get an answer but to persuade the client with the client. served benefit.e. ideation. ness. Limit setting Limit setting means making the client graphic information. Global measures This refers to standardized assess. logic to adopt a particular solution. these are the basic parenting. corpo. helper is paying attention and understands the client. historical data. time. such as having quit smoking or instituted fault and reproaches the self. feeling down the problem. they do not intrude and distract. self-destructive ideas about the functioning and that are used both to track progress self or the world. or placement. verbal and nonverbal messages that encourage a cli- mation regarding accessing social services. Examples include “I must Goal-attainment scaling A subjective worksheet in be competent in everything” and “I must be approved which client and helper evaluate the degree to which of by everyone. trapped. and the interviewee is not necessarily a client of the Minimal encouragers Minimal encouragers are interviewer. refers to the degree of discomfort that an individual Maintenance The stage of change that characterizes experiences due to a symptom. anger. ent to open up. client problems by encouraging the client to see the Interviewing Interviewing is not necessarily helping. or to provide infor. therapeutic relationship is focusing on the deepest After experiencing this event. are using questions to identify a goal and boiling substance abuse. occur within or outside of a professional environment. better communication in their relationships. or drug use. goal-setting skills assess in a potentially suicidal individual. such as an agency. ideas erode our self-esteem. therapy involving breaking toys or injuring the self or Intensity Intensity in the helping professions usually the helper. Intakes normally record contact and demo. Increasing gratitude is associated with Journaling Journaling is a homework assignment in a variety of positive effects on clients. and a preliminary limits of the helping relationship. which the client writes about specific topics as a way Helping Helping is the broadest possible description of solidifying learning. Inner circle strategy A technique devised by Arnold Learned helplessness The effects of exposing Lazarus that asks the client to consider whether the someone to a situation in which he or she cannot win. thought. Often developed in childhood. The client may be an entity other than the short supportive statements that indicate that the person being interviewed. inter- they have committed to. anxiety. these and to evaluate suitability for treatment. seeks to escape or solve the problem even when Intake form An intake form is the paperwork a escape is possible and solutions are available because helper completes after seeing the client for the first he or she has learned that it is futile. withdrawal. This may iors or in vivo practice. Examples include hiring. “Okay” and “I’m with you. or school.” client goals have been reached. Metaphors Helpers use metaphors to help reframe cal constructs of the helper. Sometimes journals are used to of the relationship between any two people where keep records of improvement in specific client behav- one gives and the other receives assistance. purposelessness. a brief notation about the cli. problem in a different context. and mood.” .318 Glossary for correcting erroneous ideas about topics such as Invitational skills In this book. What cli- ents need in this stage is to maintain the changes that Interpretation Derived from psychoanalysis. the client no longer issues or remains superficial.. Irrational beliefs This is Albert Ellis’s term for ment tools that give an overall picture of the client’s deeply entrenched. IS PATH WARM This is an acronym for areas to Goal-setting skills In this book. ration. pretation is explaining to the client the meaning of a symptom. i. hopelessness. The purpose may not be to help the They are useful to nudge the client to continue yet interviewee but to make a decision about treatment. aware of behaviors that are outside of the acceptable ent’s problems. Leading questions When the helper uses questions. or dream in terms of the theoreti. sexuality. in play diagnosis. games. physical dis- conditions and behavioral problems. Parent consultations Meetings with parents to share Multiple heritage A term that describes clients who information about a child’s progress in the helping identify with more than one culture. for Outcome evaluation or outcome research Out. under the category of Praise Praise means positively evaluating another invitational skills. Poor body image Poor body image is the perception of oneself as physically unattractive and therefore less Observation Observation involves noticing and worthy. This type of issues to feelings and then to meanings. What are the first things what the client is trying to communicate. under the category of Play therapy The use of play including toys. Nonhierarchical stance When the helper empha. The NLC usu- summary includes a capsule version of the story but ally ends with a summary. They are used to invite the client to tell Precontemplation The stage of change where the his or her story. in comparison to closed questions. a miracle occurred and the Overshooting Overshooting is a common error of problem that brought you here for help was completely accuracy in reflecting feelings. ing is a synthesis of person-centered and cognitive Paraphrase A paraphrase is a distilled version of the therapies that is aimed at enlisting the client in the content of the client’s message. helping the client. and questions. not even thinking that he or she needs to comes are the desired beneficial effects of helping. A good reflect- empowers the client to be a partner in the helping ing response uses slightly different language. For example. A poor body image may cause low self- recording a client’s verbal and nonverbal behaviors as esteem and severe problems. The content includes sig- treatment process and removing blockages by enhanc. attentive silence. confrontation. moving the client from factual ning summaries at the end of a session. person is not even thinking about taking action. opening skills include encouragers person by giving compliments and noticing progress. Parroting Parroting is the error of reflecting feelings sizes equality in the therapeutic relationship and by repeating the client’s exact words. also identifies agreed-upon plans for future work. Positive psychology A term used to describe a focus Open questions Open questions direct the client to on positive character traits and positive emotions talk about a particular subject. Although they may suggest an area for exploration. Opening skills In this book. the helper is overshooting. Because of this. the author’s way of mapping helper responses in a Planning summaries Helpers usually make plan- typical progression. But because you were asleep. and intentions. “Can you tell me about your a way of learning about what works and what does marriage?” is an example of an open question. including unhealthy and these provide information that might be useful in dangerous eating patterns. invitational skills. It is particularly useful in that helpers need to be focusing their efforts on tech- getting clients off the problem-saturated story and onto niques that work to help clients make progress toward the solution. Glossary 319 Miracle question The miracle question was devised The new emphasis on outcome evaluation suggests by solution-focused therapists. you did not know response that exaggerates the client’s feeling beyond the problem had been solved. relationship and to gain information from the parent. Helpers use the ing the therapeutic relationship and utilizing gentle skill of paraphrasing to allow clients to feel understood. accept a person regardless of his or her actions. Placebo effect The psychological effect of expecting Nonjudgmental listening cycle (NLC) The NLC is a treatment to work. and other nonverbal messages to invite the client to open up. not work in helping. Practice-based evidence Using clinical evidence as ply a single piece of data. while you were asleep. body position. tance. It is widely used in addictions treatment. quit smoking or drinking. . helpers learn the skills of eye con- and creative arts to help children cope with emotional tact. nificant facts. process. Motivational interviewing Motivational interview. example. The question is as follows: “Imagine that these identified outcomes. they encourage the client to open up rather than sup. Nonverbal skills In this book. It refers to a helper solved. but are less demanding instead of a pathological focus. that you would notice if the problem were gone?” if a helper reflects anger when a client is only annoyed. thoughts. they give the client a Positive regard The ability to suspend judgment and wider range of possible responses. “First. Reflecting is fully attending and real with a client. empathy. thoughts. to Questioning cycle When a helper finds himself or intervention and action. developed Relationship immediacy When helper and client by Moreno. ents who have taken some steps toward change dur. messages. therapy is a type of helping that relies on accurate Road map of the helping process The road map is diagnosis. and emotions as deeply as possible. meaning is an advanced reflecting skill. and finally to evaluation and herself asking question after question rather than reflection. Role-playing Role-playing is a technique for re- Readiness Readiness is a different way of looking at creating past events or enacting future events in a dra- client obstructionism. posture. Primum non nocere Part of the Hippocratic oath Reflective practitioner A reflective practitioner is a that states. involves the re-creation of a scene in the share here-and-now feedback about their present individual’s past. niques. plans. using encouragement. or future to explore his or her relationship. It was devised by the author to allow helpers assertiveness. and homework. include presence. to select a general category of techniques based on Psychotherapy Compared to counseling. Helpers experiment with different behaviors before in vivo can increase client readiness by educating clients. record them in a journal or discuss them with a super- mount and the helper abides by professional ethics.320 Glossary Premature interpretations Psychological insights Reflecting feelings A reflection of feeling (ROF) is a made before adequate data have been collected to helping response that accurately identifies the client’s support these interpretations. emotions based on his or her verbal or nonverbal Preparation The stage of change that describes cli. Presenting problem The client’s stated reason for Reflection in action Applying insights gained in initially seeking help. and is a graphical depiction of the process of helping from more concerned with treating mental disorders. therapeutic factor that underlies counseling tech- chological issues such as better communication. etc. relationship building. self-disclosure. Each letter of REPLAN stands for a different treatments that involve educating a client about psy. visor or colleague. a program. physical cal jargon to sound credible. to assessment. a client who needs back to the client the underlying meanings based on to exercise has joined a gym and is planning to begin the client’s worldview and values. The client’s goals are para. do no harm. REPLAN system REPLAN is a system of treatment Psychoeducation Psychoeducational methods are planning. Clients can try out different roles and are not unwilling though they are unready. Relationship enhancers Helper behaviors that Psychobabble A term to describe using psychologi. and examining the precursors Scaling questions These are questions designed to to change what may be lacking in their preparation. seeing it from a more positive and constructive niques used during the session toward the goal. clients matic way. and warmth. For example. reflection to real problems and situations. decisions. reflecting. psycho. the client’s needs. closeness. focuses on eliminating pathology. It is the art of record client progress toward goals. to goal setting. auto- describes a contractual relationship between a helper matic reactions. encourage action and motivate change. dreams. and identify tech. From this vantage point. practice.” professional who makes a commitment to personal Professional helping relationship A term that awareness by monitoring his or her thinking. Reflecting meaning Reflecting meaning is an ing the last 12 months and are ready to consider a advanced reflecting skill in which the helper feeds specific action plan. Psychodramatic This powerful method. Progress notes Written records completed by the Reframing A change technique that helps the client helper after each session that name the client goals. Reflecting skills In this book. present. change perspective about a situation. future viewpoint. and prejudices by taking and client who agree on compensation for the helper time to think back on these reactions and perhaps to and goals for the client. reflecting skills Presence The quality of a helper in which he or she include paraphrasing and reflecting feeling. They ask clients . stress. sensing others’ intentions and feelings. which focuses on the needs of that one is “okay. Clients Tutorial stance In order to understand a client’s situ- rate the intensity of their current general distress or ation or background. For Social intelligence Social intelligence means being example. and meanings that covers everything the client Self-confrontation Identifying and becoming aware has said up to that point. sobriety. book. evaluate the effectiveness of the technique. in self-downing thoughts. Sex In this context. feel free to go on and explore other issues. For example. Therapeutic faux pas Therapeutic faux pas are ent is asked to become aware of some behavior or helper responses that may weaken or disrupt the thought and keep records.” the client and involves compensation for the helper. client’s story. Self-help groups Self-help groups are leaderless community groups that help clients maintain gains in Thematic summary Sometimes the helper notices areas such as weight loss. In this clothes if they are able to lose 25 pounds. and due to past abusive experiences with men. honesty. the helper becomes a student the intensity of a specific symptom and then. they way that bonds with him or her. When the client answers. the helper asks. “I am feeling a little bit in the dark. feel- “What would help you raise that to number-one point?” ings. etc. . This may be done unilaterally when thought to lead to greater self-knowledge. There are 19 therapeutic building Self-management Self-management means using blocks described in this book. Self-involving statements When a helper shares his or her feelings with the client as a way of connecting. It seems ing blocks are the basic or elementary helping skills that you don’t want to share the whole story with me. Self-disclosure Self-disclosure reveals information Termination Termination is the ending of the help- about the self to others. self. and deeper interpersonal relationships. Glossary 321 to rate some quality such as his or her motivation for Summarizing Summarizing is a technique in which change. Signal summary Helpers use signal summaries to Tracking A skill used primarily in play therapy that send a message to the client that the story has been involves narrating the movements of the child in a grasped. For Therapeutic factors These are the common curative example. behavioral principles to self-reward and self-punish in order to make and maintain desired changes. it refers to the basic physiological Thought stopping A technique that is a variation of differences between men and women whereas gender countering in which the client stops troubling thoughts refers to the roles that a person learns. Self-monitoring Self-monitoring means that the cli. Therapeutic building blocks The therapeutic build- For example. client’s problems in priority order. It friendship. feelings.” that one learns in the beginning to build more com- plex techniques. When clients receive a signal summary. by startling the self and changing focus. a client might helping relationship. and asks the client to instruct the helper about the treatment. at the same time having the social skills to respond Treatment planning list This is a simple list of the appropriately. three domains. For example. endings are usually jointly agreed upon when goals are accomplished. Positive acceptance. the helper provides a distilled version of facts. this is a professional relationship involving is the global feeling that one is good and has a right to a good working alliance. trust. criticizing the client write down each time during the day when engaging is generally considered inappropriate. either party is dissatisfied with the outcomes. we recognize six therapeutic factors. It can be summarized as a fundamental belief ise of confidentiality. culture or specific situation or illness of the client. and meanings in the Weight Watchers and Alcoholics Anonymous. Examples are repeated experiences. Transference Transference refers to client feelings Situational interview Interviewing someone in a from past relationships or personal issues that are car- particular setting to see how he or she reacts to it. post. and the prom- exist. clients will reward themselves with new forces that underlie the helping techniques. Deeper self-disclosure is ing relationship. ried over to the helper or helping relationship. the client feels anger toward a male helper empathic. Better summaries include all of discrepancies in one’s own life. SUDS Subjective Units of Discomfort Scale. Therapeutic relationship As differentiated from a Self-worth Self-worth is one aspect of self-esteem. A helper identifies a theme and feeds it back to the client. peutic benefit.322 Glossary Ultimate meanings technique A technique created current thinking is that a cognitive change must by Leontiev that uses questions to track down the most accompany emotional expression for maximum thera- important meaning and values issues in a client’s life. and the ability to help is dependent on the what the client expects of himself or herself. others. Ventilation fallacy An erroneous belief that express- ing emotions purges them from our system. Warm-up can be Values These are assumptions about what is right and enhanced by mental imagery and role-playing. wrong. is too mild. Visitors Steve de Shazer’s term for clients who are racy in reflecting feelings. browsing but not motivated to commit to a helping mating a client’s emotion and reflecting a feeling that relationship. The . Values are a person’s basis for self-evaluation and the Worldview affects how clients assign meaning to evaluation of others. Undershooting Undershooting is an error of accu. Undershooting is underesti. A client’s values tell us about events. vidual’s beliefs about self.” ness to engage in an activity. how his helper’s ability to identify techniques that are accept- or her ideals and aspirations are defined. By understanding a client’s values. For example. if a client is shocked and the Warm-up Warm-up refers to a client’s state of readi- helper describes the reaction “mildly surprised. and the world. and what is able to the client’s worldview or else risk a rupture in important. the relationship. we begin to Worldview Worldview is the sum total of an indi- grasp his or her internal struggles and moral dilemmas. DC: Author. 323 .. 8. interpretation. A.. & Hilsenroth. K. Alberta. son data. Culture. D. health under routine clinical conditions. & Rounds. S. R. A. J. 893–909. ed. 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M. 268–269 Cavanagh. 267–268 Castelnuovo.. 234 Burgoyne. 154–155 Busch. 66 self-confrontation and. 159–161 Callanan. N. D. 155 cultural differences and.. N. M.. 266–269 Common therapeutic factors Bruce. 264 play therapy for. 298 creativity and.. 266 change techniques for. L. 156 tips for. D. 273 Ceballos. C. L. N. 27 therapeutic.... A. R. J. W. W.. M. J. 127 Brodsky. 212 REPLAN system and. 168–169 Burton. S. J.... S. C. 282 Bratton. 216 (Jongsma. 66 self-. 158–159 Bussell. 205 Carnabucci. assessment of... H. 303 relationship immediacy and. D.. G.. 258 Cheatham. 22–23 (See also practicing new behaviors and. 290 Constantino. 214–218 Nonverbal communication) importance of... T. 24 explanation of. 279 Clance. 300 desires for helping relationships. K. L. 311 humor and. 63 when to use. 150–153 Clothing. J. 23 Closed questions.. 38 exercise for. B. H.. 303 humor and. S. 165–166 Coffey.. 284 Canipe. D. 13 Child Psychotherapy Treatment Planner cognitive dissonance and. 233 309–310 Cohn. 286 ... C.. 215 Clemence. J. roadblocks to. F. 148.. 287 305–306 tips for. K. 154 Busse. steps in. S. 11 Brockett.. K.. 231. M. 197 for children. 230. 223 240–255 Bradley. J. 247 Change techniques Combs.. 107. 227 Chawla. K. assessment of. T. C. 40 Children explanation of. 164–165. 164–165.. 282 Carrington. J. C.. 17 cautions related to. F. 155–156 Burton. W. J. 231 confrontation and. 233 College students. R. A. R. 166–167 Client satisfaction scales.. 174 Call. T. W. R. R. 261 skills for helping. S.. A. 174 Cognitive assessment.. 297 as a challenging skill. 17. S.. 182 enhancing efficacy and self-esteem nonverbal. 187. 51 cultural mismatch between helpers Brainstorming Carver... A. in relationships. 195 brainstorming. 77 relationship immediacy and.. 281 for working with children. 233 Cheng. 62. A.. 311 explanation of. 166 Butler. P. 154–163 talking too long. P. S... 212 Carlson.. 43 focusing on. 169 Cameron. P. 266 Chandler.. 88 Build.. 147–148 Cogar. 61 activating expectations of. K. 182 Broaching. S. C. 252 and. H. K.. J. 192 emotional arousal and. 218–221 Communication Buchanan. J.. M. 166 Coaching. 195. P. G.. C. 311 identifying effective. 162–163 Burns. 64–65 Brandon. of discrepancies. 150. 75. A.. 273 Cashwell.. K. L. 234 categorizing. N.. 17 Bruce. 12. 95 overview of. 149–150 Cognitive therapy.. 311 explanation of... J. 212 Contracts. T. Brace.. 36 Conus.. C.. 14 for irrational beliefs. C.. G. 209–210 one-way vs. P.. O. L. R. 65 REPLAN treatment and.. B. 210–212 Bryant. I. 169–170 Butler.. J. J. B. 210–214 Compton.. 231 gender differences and. 226 and Bruce). C Chu. 186 feedback and. 53 Claiborn. M. L. 135 Challenging questions. 282 assessment of.. 96 Brammer. 48 Therapeutic building blocks) 221–230 Compound response.. M. A. K. 303 common therapeutic factors and. 307. V. 18. N. two-way. 231 Campbell.. 197 ethical issues related to. 194. 262. 297 163–164 Caffarella. T.. 230–237 dimensions of. Peterson.350 Index Boyd-Franklin.. 185 how to conduct. A. L. M.... 158 Bushman.. 76–77 Breitholtz. 197 Carmack. C. E.. D.. 184–185 Brooks. P. 223 Bruce. S. 218. V. 310 judging.. M. 194 Carter. A. C.. T. J. K.. 61.. 74. 262. Y. 234 Confrontation Burns. 194. J. 66 Clarke. N. 266 Cashwell. J. 215 Challenging skills helpers and. A. 184 nonverbal communication between Branden. B. 21 Bryan. C. 75 steps to. 47. 247–249 Collins.. art of helping and.. 124. 68 Daly. P... R. L.. L. 156 Developmental issues.. R. 17. 165. A. L. E. 69 Corey. K. 266 244–245 Emmelkamp. A. 166–167 Dickson. U. P. 261 Credibility.. 195 de Shazer. 215 Elert. J. 197 REPLAN system and enhancing. J. A. 70. J. A.. 164 Eisenberg.. 286 cultural/ethnic differences and. 298 Dimond. 258 Empathy 300–303 Dixon. H. 104–106 in nonverbal communication. J. 32–33 Davis.. P.. 211. 303–306 Dinkmeyer.. 244–245 Ellis. G. M. 250 explanation of. 21. 11 Cormier.. 146 Encouragement Curtis. 10.. 70–71 identification of. R.. C. N. 299 and. A. 233–234 Crying. 156... 43 Dowd. F. challenging skills and. 230–237 Croyle. 63 Denman. J. R. G. J. E. I. H.. F. 101 children and.... F. D. 231. S. M. 75 40. 92 Divorce Busting (Weiner-Davis).. 218 clients best suited for. H. 303 explanation of. 52 Danby. 102 assessment and.. P.. T. 247 Emotions. 212 lowering and raising. C.. 221 de Groot. 159 thought stopping as variation de Figueiredeo. W. M. 101–102 nature of... 73–74 what empathy isn’t.. 42 relationship with. A. 65.. Embedded questions. 241 importance of understanding. 234 Drug use. 111 patterns. 230–237 Cultural differences. client’s recollection of Davis. R. 234–235 Csikszentmihalyi. 219–220 de Armas DeLorenzi. D.. 237 Cromarty.. 39 Devine. C. C. E. 68 dealing with. 110 types of. N.. 262. M. C... 120 skills for helping clients with. 230–231 self-disclosure and. 154... 109.. 181. G. See also Reflecting feelings between client and helper. 235 Donovan. 216 Davis). 40 Culture. 40 REPLAN system and. 188 Dugas.. J. 234 214–218 precautions related to. M. 94 Dakwar. 261 put into words. 231. 33. 232 Corn. R. 40 Cummings. L. 223... 54 Dekel. 244 Eiden.. E. M. 220–221 Decety. 187 Corey. 50 de Jong. 24 creating positive.. P. 264 Dupey. 40–41 Dinger. 52–54 De Hullu. 40–41 Cultural immersion. 215 Elderkin. Discrepancies reducing anxiety and stress and.. L. 288 Emmison. A. V. J.. 303 e psychotherapy vs. 263 Countertransference de Haan. 10 Davis. 70 231–233 reflecting feelings and..... 33 Ekman. 261 Dyer. S. S. 231.. S. 195 Dahl.. 11 Door openers. B. D.. 299–300 Donovan. S.. 111 gender issues and. S... 6 Dalenberg. 232 helper. 39 Cultural support systems.. 236–237 empathy and. M. 68 The Courage to Heal (Bass and del Prado. 17. 245. M. M. 53. M. R. P.. 108–109 cultural competence and. S. 18. R. A. D. D. 197 Couture. 221 Edwards. 108 historical background of. 313 de Waal. 258 Eaves. 298. K. 298 Diehl. 215 explanation of.. 261 Cooper. 217 Covey.. 261 Corsini. 21 Darg. 286 Daley. M. A. R. C. W. 259 Counselors. 228 Counseling Darwin. 218–219 Deane.. 39–40 Cummings.. D. See also Gender Diagnostic and Statistical Manual–IV techniques to stimulate. 251 . 178 Emotional Intelligence (Goleman). J. J. L. R. 258 Emotions diary. 306–311 DiClemente.. 235 differences (DSM–IV) (American Psychiatric Emotional intelligence. 235 Dryden. 303 Elliot. 185 methods to raise. 156–157 reducing negative.. 301 Donegan. E.. C. 41–42 Cunningham. 258 Del Re. L. R. D.. 288 importance of.... M. 69 on. D. J. 288 neuroscience and.. E. 53. 264 Crespo. Sr.. E. 77. K.... 216 Duncan. 245–248 Emotional arousal Cronin. 215 Cormier. M... 55 Dubois. 39–40 Demoralization hypothesis.. 297–298 Direct instruction. 300–301 Dixon. 284 Elfenbein. 94 Daldrup.. J. 52. 303 Droney.. 227 Detweiler-Bedell. 66 Corey. 156 d Downing. 186 Association).. 190 Driscoll. M. 263 Demoralization. 234 Dostoyevsky. R. R.. assessment meditation to lower. 248 Creativity. 38 Efficacy Countering Day-Vines. D. 36 cultural differences and. E. J. S.. 231. 301–302 de Niet.. Index 351 Cooper. N. S.. P. B. T. G. 156 relaxation training to lower. W.. 286 Dallos. 287 DuBrin.. 280 Corradi. M.... T. method for. 127 Emmons.. J. 11 Davis. A. C. M. 18 Cormier. 240 Cultural competence. W.. 267 categories of. J. 287.. L. B. T.. Divorce Remedy (Weiner-Davis).. 108. T. 40 Egan.. J. 258 explanation of.. 94 Daire... G. 53. 36 Elliott. 180. 17 Goldman... 211 201 evaluation) Frank. J. 42 Gardner. G.. G. 69 objectives for. J. 179 differences Granello. J..352 Index Encouragement (continued) Fennig. 233 Gladding. 69. 60 that are important to client. 116.. 222. 258 Epictetus. C. 201–203 fostering hope and increasing. 23 Eyckmans.. S. L. 286... S. B. C. 4. 17 Goldstein. E... 278 . 231 Goodyear. 306 Focusing summaries.. 36 Gait. 64 Erceg-Hurn. C.. 177. F. 183 Gender differences. 16 of helper.. 223 for working with children. H. 235 Good. C. R.. 68. D. E. 260–261 Fretz. C. S. 190... 303–304 Gottman. D. 244–245 use of progress notes to track Evans.. of helping process.. 231 Englar-Carlson. 215 Gladding. 16. R. E. D. B.. G. 101. 51.. 155 reflecting feelings and. 306 Feedback Garrett. 221 Fonagy.. G. B. 51 explanation of. M. 287 how to give.. practice-based.. 164 skills for addressing.. J.. See also Cultural Graber.. 195–196 for helpers.. 69 blind spots and. 187 Frank. 168 Gilliland. R. 261 Gomez. 277 F Frydenberg. See also Emotions. 304–306 methods for. 278 Fraser. 129 using questions to identify... S. E.. L. 215 Facial expressions. 66 Goleman. S. C. 42. J. 182 Goldstein. 261 Fagen.. 158 Foster.. C. 150–151 Gee. D. 36.. 153 Garwood. A. P. J. 61 boiling down the problem for. H. J. 287 setting simple and specific. 17 Epstein.. S.. 194 Evaluating and reflection stage. 69 Fair. 104 focus on positive as.. 21.... 230.. T. 279 Evans. 261 Goodman. 25 Fromm-Reichmann. 71 Golosheykin. C. F. 2 Goal-setting stage.. 286 Erford. J. 234 Gordon.. B.. 227 Gordon. 236 reasons for. A. 75 timing for. 261 Global measures. 305 praise vs.. 195 Evans. H. 104 Feeling Good (Burns). M. P... P.. I. T. Frederickson. J. S. 115 Gender.. 68 Encouragement/encouragers Finkel. 39 Family history. F.. T. R.. 196–197 Evaluation Fox.. 304 Facilitating decision making/returning Furukawa. R. M. 47–49. E. E. J.. S. 260 feelings Geluk. A. 182 Functional analysis.. 191–192 placebo effect and. R. 305 Fisher. 121 Flay... A. W. 5 Feelings. F. 281 resources to identify and clarify. 33 Gordon. 223 Fedotchev. 251–252 Fiddelaers. S. 287 Epting. 33 Gilbert. 194 importance of. C. A. 190.. 223 Felix.. 74–78 Fishbowl activity. R.. A. J. 192 questions as. 270 Giles. 193–194 related to confrontation. P. 277–279 Fragkiadaki.. 94–95 G Goldin... 231 Goguen. J. E. 259 Goldberg.. 53 Goal-setting skills Exposure. outcome. E. 251 Fink. 282–283.. 66 Frieden. 33.. 188. 307. E. 304 Flückiger.. 231 Farber. W. 231 Foa. 277–283 (See also Outcome Frances. 235 Fanning. M. 215. 73 Finney.. 289 Eshelman.. 253–255 Fiedler. A... 33 Gender in the Therapy Hour (Sweet). A. 192–193. S.. 26 Fox. 66 Goal setting Expectations Frattaroli. 259 Follow-up. 266. A. 183 Facts. D. 218. A. 197 efectiveness... B. 246 use of questions to identify. 249 Festinger. 74 Fisch. L. 261 explanation of. 244 improvement on. 212. 195 Frank. C.. B. J. K. 188 explanation of. B. A. L. 249–250 Field. G.. 234. 15–17 Fordyce. L. 21. J. R.. D. 102. M.. L.. E. 262 minimal. E. 69 Freud. 246–247 Fremont. 179. 180 Gladstein. M. 231 Gaff. 288 Goal-attainment scale. L.. G. 78. 155 Gestures. 150 Gass... 278 Goals Esplin. E.... 166–167 changing problems to. 261 Falkenström. 279–280 Erdman. J. 215 Gaff. P. 202–203 Ethical guidelines Forbes... 21.. 76 Fong. M. S. R. 63 responsibility skill. 180.. P. M.. 186 Galanti. R. 303–304 explanation of. G. J. 135 Glover.. 68.. 40. 249 collaborative. M.. C.. 235 types of. 43 Gendlin. 151–153 Gatchel.. 198–200 Evidence-based practice. 52. 188–191 246–255 Freeman. A.. C. 234 Giesen-Bloo.. 42 Goates. 40 positive statement of. S. T. Y.. 284 challenges caused by. V. 283 Gordon. 261 Frank. 263 confusing thinking and. 258. A. 290–291 Gold... E. N. 36. A.. P. 310–311 Eye contact. 180 Fletcher. B. S.. A. J. R. 278 Frankl. reciting. 122. 66 Goodrich. 39. M. 69 Gladding. Reflecting Gelso. 258 Galsworthy. 310 Goldberg.. B.. J. 46 Goodyear. 147–148. S. 258 Gelderloos. D. M... K. 63. L. T. 177. J. M. M.. 231 Garofalo. 198–200 Evidence.. D.. T. G. 21 realistic. 164 behavioral assessment and. J.. P. M.. A. C. 76 Greenberg. 194 Hermans. 235 Hinton. M. 33. M. 265–266 Hackney. A. 33. 300 Intake form. 215 professional. R. S. S. L. 226 Grant. 231 Hevey. M. B. S. R. 69 background and. S. 2 clients and.. L. H. 215 Holland. W. 292–295 Holtforth. Jr. R. E. 179.. 186 Harris. Index 353 Granello. B.. 288 Hill. B. G.. G. 164 cognitive assessment and. L. 184 Hargie.. A. E.. R. 155 Holden. 218. 197 Hess. M.. 200 opening. 215 Interpersonal reflexes. H.. M. 68 Hofmann. S.. R. 228 Herink. See also development and.. 226–227 Green. 286 Hiester.. 184 Harel. 221 reaction to termination. 180 Heslin. 21. 156. C. 298.. 241–242 Granström.. 258 Intimacy.. K. M. T. T. 46 native talents and. 61.. 280 Greenberg.. P. 192... B.. 277–279 Imber. 261 Helsenroth. M. J. L. 36 finding mentors for.. H. J... T. 102 Gregersen. 130 explanation of... M. D. 40 Guerney. L. 199 Green. M. J... 14 problems and precautions.. 14 explanation of.. M. 124 Helpers Hovav. 264 Intake interview Hanson. L. T. 247. M. 15 Homework assignments for working with children. K. E. 302 Holmes.. 46 intake. A. B. 231. 6. 182 Helping I Grover. E. M. 188 Invitational skills Heckman. 185 Harris. P.. 178 Hannan.. D.. 278 challenges of. D. 23.. 36 Henriksen. S.. 86. 192 Hill. 156 experience.. 74. W. 313 Humor. G. 234 benefits of. P.. 303 nonverbal communication between Hutchinson. M. R. 195 Interpretation. R. 21 affective assessment and.. W. 36. J. 308 . 36. I. 289 Interviews Hayes. 64–70 Helper process Holtz.. 284 finding techniques for.. 8 Imes. 61. 234 Hoffman.... Gratitude. P. 305–306 Hunter. P. 232 situational. 304 Hinkle. A. D. 61 Heidenreich. 232 explanation of.. 180 Greenspan. 257–258 Havens. 108 stages of. 258 Instruction. 34 explanation of. 75 Hermans. 42.. 156 Hershkowitz.. 184–187 Hays. H. 237 individual differences and. 217 characteristics of effective.. O. E. 17–20 Hughes... M. 17 Haberstroh. 232 Grizzard.. 12. 227–228 Granello. F. R.. 261 Greisinger. 231 psychological. 245 Hazlewood. 284 categories of.. 148 184–185 Harmon-Jones. 177–178 Blau). 76 cultural and religious/spiritual Harniss. 6. S. 25. R. 221 factors of. G. 286 Hagen. self-tracking of. J... E. S... L. G. 8 The Imperfect Therapist (Kottler and role of assessment in. 234 Hohenshil. 62. 246 Hewitt. 61–63 170–173. A. direct. 155 Hoffman.. E.. 61 gender differences and.. S. R. 221 evaluating effectiveness of. 17 228–230 Greeley. G. 14–15 reasons for using. 13 motivational. I.... 24–26 Hoppock. A. 26 Hawley. A.. 186–187 Hasty. 284 Herman. 8–9 Hayes.. B. D. 281 Høglend. N.. 16... 9 Health. 43 developmental issues for. M. C. 61 Helper Competency Scale (HCS).... D. H. 261 Handler. 258 and. 12–14 Horton. 33 terminology for. M. M. H. S. 183 challenges related to. M. K. 195 Heyerdahl. when to give. R. 65 Heard. L. 227 Helplessness. Harmerling. S. F. K. 304 building blocks for.. O. 40 Guerney.. S. L. 33 Guerney. 227 Therapeutic relationship Information. J. M. R. G. F.. 67. M. W. R. 304 basic skills and common therapeutic Iacomboni. 69 Griffin. 278 ethical guidelines for. 287 Grooming. 184 Hargate. E.. 307. 215 physical challenges and strengths Hart... 245 Meditation (Singh).. 68 friendship vs. 21 Ickes. 277 culturally competent. 15–17 exercises for. 155 background of. A.. 43. 43 H ways of. 67 Helping relationship. 237 Griffith. 38 Intervention and action stage... M. 24 Hilsenroth. K. 127.. J.. 234 Hancock.. 64–65 Hynan. 283. E. A. M.. assessment of. 62 accepting feedback as. T. O. 179 taking responsibility for. 11–17 Ilgen. 13 Hubble.. 13 Horvath.. H..... M. helper Haase.... S. 35 Inner and Outer Peace through Halgin. A.. 12 examples of. A. 34–35 Ingersoll. 183 Hatch-Maillette.. as a new learning Hauenstein. 69 Gutierrez.. 186 Harrington. D. 36 listening as. D. Holmqvist. J.. 62 Helms. 246 Gurman. 258 family history for.. H. 69 Greenberg.. 7 Individual differences.. learned.. A. 122 Hersey. 197 nonverbal.. 221 Hepburn. C. L.. 42 Lopez. N. N. S. 183 Majors. K. L. M. G. R. 47 Lent. 104 Keen. R.. 234 Levy. J.. W. R. 234 Kolcaba.. A... 289 IS PATH WARM?. 4 Leontiev. 34 MacLeod. 262 258 LeCroy.. L. 286 K Lampe.. K... M. L. M.. 65 Jana-Masri. 2... H. D. 262 Levine. A. M. R. R. 67. 227 Lazarus. C. S. H. D. G. A. S. 13 Levin.. 180 Levant.... 303 Jacobi. 95–96 LaFollette. S.. 233 Long.. F. 14–15.. 42 John.. E.. 42. S. R. 180 Jourard. 179 LaFrance.. 197 Koehler. 155 Koltko-Rivera. L.. H.... C. 127 Learned helplessness. W. 154. 123. 127 active. T. 234 Izard.. 267 Koocher.. 287 Learning experiences. 231 Liang. G. A. 304 Kottman. D. 75–76 Magnuson. 104. W. M. 156 Lee. 75 J Kleinman. G. B. 179 Kiselica. T.. 231 Kitchener. G. 33 MacCluskie. 227 Manzoni. M. M... J. L.. E... H... 33 Kroner-Herwig. C. J. 74... W. S. 66 Kicking Your Stress Habits (Tubesing). 190 Kominiak. 39. K. 42.. 21. 24 Kress.. 179 Mallett. 235 Jackson. 306. A. 306 Israelashvili. R.. E. L. D. 62 Johnson. J. B. E. 304 Jouriles. 233 Mackrill. 287 Lambert. 227 Macneil. 205 Levenson.. J. L. 194.. 282 Letter writing... F... 4 Ishwar.. 103 Ivey.. A.. 42. A..... A. J. J... 231 Kolander. J. 235 235–236 L’Abate. E.. 152. 231 Kohn... 42 Kim. G... M. R. P. 231 Macowiak. 92 Lopez. 223 LeShan...... L Lowen. 227–228 Low.. 177 Joyce. 40 Lillis.. 258 James. 261 . 277 Maccarelli. J. J... 287 Landreth. M. 77 Jensen. 126. 234 Judgmental paraphrase... S. 234 Love’s Executioner (Yalom). 223 Kupers.. J. J.. L.. 251 Levy.. 188 Krantz. 258 Laska. 47 Jones. Jr.. 63 Lamb.. N. K. L. 163 Lee.. R... 33 Lawson. W.. 306 Kenny. P. J. 289 Little. S.. 33. R. 41 Kordy. J. 192 Karges-Bonee.. A. M. C. 303 Kiesler. F. 238–239 Kipper... L. A. A. 233 Maples. 66 Kleinke. R. J. E. A. 66 Juriga. D.. 231. C. 186 Jacobson. E. R. R. 288 Listening Johnson. C.. J....... D. G. 65 Jenks. 285 Kerr.. T.. 231 King.. A. C. D.. M. 258 Knox. J. B.. E. H. B. 67 Kabat-Zinn... A. M.. 304 experiences Maholich. 282 Jongsma. 164 Juhnke. S. L. A. 134 method to identify. L.. 108 Klein.. 197 Kantor. K. C. G. C. D. 215 Lenderking. H. 104 Lane. P. 262 Konrath. M. M.. L. M.. 76 M Justice. J. 158 Klein. K.. 197 Karson. 70 Kopp.. 155 Kiesler. R. 226 Lukas. 306 Kazantzis. S. 287 301 Jones. 287 Judge... C.. R. 104 Lyddon. 234 Li.. 195 Kerka. 270 Jong. 152 Leary. 307.. J. K.. 280 Kottler.. R.. D.. V. 101. F. R... 227 explanation of. 221 Ladouceur. A. A. 24. N.. 233 Maltross.. R.. 226 MacEwan. S.. F. 69 Lambert. 197 Lopez.. S. R.. B. 212. 233. 18. E. A. 67 Lund. D. S. 234 Kring. 148 Kooiman. C. T. 309–310 Johnson. 43 Kindsvatter. J. E. A. A. 158. F. 270 Lemberg. N. T. 66..... 235 Limit setting. 235 Mallinckrodt. H. 104 Logue... C. 301 to increase emotional expression. M. B. T. 286 Levitt. J. 75. C. M.. 2 Kelly. 197 Ku.. C. 284 Levine. 249 Luoma. A. 245 Mahalik. K.. 216–217 Kinsella. D. 129 Lichtenstein.. J. A. 38. E. L. D. A. 234 Johnson.. 284 Ladany. K. K. 226. 234 Johnson. 234 Lampropoulos. A.. 307. A. 311 Kristeller. K. 43. A.. S. C. 21 Lawrence. S... 284 Lilliengren. S. 62 Linz.. 65 Leighton. 2 function of. E. 92 Levis.. 43. 310 Mack. 51 Linehan. J. W... H... 251 Journaling Kushner. B. 51 Johnson. E. A. A. R. K. W. J. S. S.. M.. S.. 221 Madrid.. Y. Johnstone. A. 197 Jones. 306 Losoncy. 195 Malone.. P. 286 Katzow. R. Lebrón-Striker. 111 Kiresuk. M... See New learning Maher. K. 186 Mannix.. S..354 Index Irrational beliefs The King’s Speech (film). T. 309. 150 Kubinski. M. U. 309–311 cultural understanding through. 227 Kanfer. C. R... 148 Leading questions. K.. M. S. 306 MacDonald. 231 Norton. 258 Milan.. E. H. J. L. M. E... 266–269 O’Connell. C. 46 Norem. 70–71 Masson. M. P.. 177. 249 brainstorming as... 300 Norcross. G. 235 Motivation... 12 New learning methods explanation of. 226 Nonjudgmental listening cycle (NLC) Marlatt.. F. 18. 257 Observation McLennan. 279 cultural differences in. S. R. R.. 235 eye contact as. 91–94.. W. J.. J. 194. 33 McHenry.. S.. 221 direct instruction as. 197 New learning experiences O McKay. G. 287 Miller. 69 Morden. K. A. L. 223 Nauta. 156 Medical diagnoses. 231 Nauta. 62 Masuda. 223 Mitchell. 226 Miracle questions. 72 Menninger. 271 Martinez. T.. S. B.. 61. M. 234 Moreno. 103 Mosak. 190 Morgan. J.. D. 192 Nietzsche. 245 construction of. K. 215 94–95 Ornston. 67 McKenna. 233 Moline. 260 Noar. M. 284 Nichols. 262 Noise. 182–183 McMakin. 68 Minimal encouragers. 221. P. F. 231 body position as. 64–65 Mattei. 254 Martin. 24 Motivational interviewing.. D.. L. 185 Meany-Walen...... assessment of.. 146 McCullough. 65–71 Matthews. 144–145 Marsh. 181 McLeod. 280 challenging skills and. R. 42 Open questions. 223. 66–67 Massion.. M. P.. N.. 231 for follow-up sessions. 235.. Mayo.. J. 226 Nin. 287 Murdock. 66 Natural helper. 164 Nordstrom. 51 McInnis. 301 Mullen. 231 Newton. L. 222. I. 258–259 O’Neal.. 234 Michalak. K.. F.. 231 McDonald. B... J. S. E.. 68–69 Matthews. 278 bibliotherapy as. C.. 66 Mehrabian. 67 Massfeller..... 212. Y. 257 Nelson. B. J. P. 237 Nash. R.. 232 Murray. 223 for first session. 67. 261 O’Grady. 277 Mayo-Wilson. 227 McConnaughy. 190 McArthur. H. 132 260–261 O’Hanlon. 64 reframing as. A. 246 Orcutt. P.... H. 130 giving advice as. K.. 215 McCart... A. 66 Mundy.. 284 examples of reflecting. E... 69–70 Maurer. 245 physical distance as.. 245–246 in helping relationship... 78–79 The Novel Cure (Elderkin & McDonald. M. 261 Older.. K. 258 problems helped by. K. A.. 215 Nutt. G. M. K. 262 attentive silence as.. S. 231 Meyer. 103 n (Dostoyevsky). C. A. H. 304 Nuttall... S. 154. 186–187 modeling as. K. 231 reframing and. 262 Newman. Index 355 Marble.. 246 Novaco. 248–249 explanation of. A. 47 Markell... 76 Metaphors. J... 257–258 Older people... L. J. M. A. L. 236 Mohan. P. B.. R. E. 245... A. A... M.. J.. 33. M.. L. Z. J. 180. 5. C. M. C...... 257 Neta. A.. 218. O. 2 McCarthy. E. 47 Nonhierarchical stance. 139 Merrick... 262–265 O’Hearn. W... M. 282 explanation of.. W. W. H. 228. E. 67–68 Mayer. 72–73 Mermelstein. 42 Nordahl. J.. J. D. 63 facial expressions and gestures as. J. 180. E. 267 touching and warmth as. 259 Nonverbal communication. B. 265–266 Okamoto. 74 ending with summarizing. E. 288 Nayak. Ogrodniczuk. 305 McGarry. D. E. 231 Nickel. A. E. A.. H. 269–271 Opening skills Mehta. 305 reflecting. H. 18 Notes from the Underground McCoy. 33. 256–257 O’Brien. A. 68 Matsumoto. J. 258–259 Communication Maslow.. readiness and. M. K. 284 voice tone as.. A. 248 McMullin. 69 explanation of. R.. M. K.. 66 Matre. 43 Myers... D. 77–78. 102 Multiple heritage.. 195.. E. 156. R. H. R. 133 interpretation as. K. 258 McEvoy. S. 260 Olson. 69 use of open questions to uncover. 259 relationship.. T. 231. L. 156 Meaning exposure to avoided stimuli as. T.. P. E... 195 Murray. D. 212 as personal. R. 258 Minuchin. 180.. T... 258 Microaggressions.. 122 Orbach. 149 Marlatt. E.. 304 Miron.. 117. Martin. 69 encouragers as. 130–131 humor as.. A. 73–74 Meichenbaum. Orme-Johnson. W. 309–311 metaphors and stories as. 42. 61.. K. J. D. 87. A. 258 explanation of. 227. See also Marx. D. 129–130 giving information as. 71 Mennicke. 227 Molinari. H. 258 strategies for. P. M. 62. 223 Nutt Williams. 215. W. in therapeutic Markell.. B.. 74–78 Merrell. 75 . 261 between helper and client. M. 148 137–138 Martin. 218. W. S. 164 Berthoud).. 21. H. E.. S. D. D. 212 265. J.. 68 Mullin. 258 Miller. 188 McHenry. 17 Modeling. M. 234 Miller.. difficulty listening due to. P. A. P. 262 Nilsson. 42 questions as. 198 how to uncover. 43 Psychological Practice with Women: Otto. G. E. 195 progress notes for. G. J. G.. J. 305 explanation of. 223 Reflecting feelings Patanaik. motivation and. 46 Premature interpretation... B. 304 focusing on client and. 112–113 Perry. J.. M. 102–103 Patock-Peckman. 21 Posture. 97 Polster. J. Phares. L. H. 258 Pietrofesa. 85 scaling.. 40–41 cultural differences and.. F. 236 Positivity (Frederickson). 102 Pek. 301 Park. 140 Polster.. J. R. S. 311 why. 312 for assessment. 104 Perls. 310 Primum non nocere. 311 Parloff. A. 139. H. 138–139 for. 156 Placebo effect. 143 explanation of. 40 Power sharing. 281 Psychotherapy. counseling vs. 233 Empowerment (Zerbe Enns.. L. N. 192 Rahe. D. 250 leading. S. D. 106 Penn... E. 75–76 Paladino.. 234 tips for. 197 Powers. H. 282 Peterson. 282 Pieces of Me exercise. 310 Positive psychology. 136–137 as opening skills.. 231 Piselli. 180 Presence. M. Diversity.. 261 vocabulary for. 87. 233 for brainstoming. T. 104–106 Perry. 109–110 Perry.. as narcissism or self.. 280–281 Phillips.. L. W.. 15 gender differences and.. effects of.. E. L.. C. 248–249 Pallak. D. 264 Readiness.. J. M. D. W. 42 282–283 Phelan. J.... 247 Praise. 232 Peterson. 186–187 Outcome research. 227 interrupting too soon. S.. 197 Nutt). 287 embedded.. J. M. 182 Razzhavaikina.. 156 Professional helping relationship. J. 65 Psychodramatic method. 310 Ray. 227. K. 50 109.. P. 87 Play therapy... 186 specific measures for. as narcissism or self-absorption... 95–96 Polster. 74–75 Paraphrasing Plato. 270 Petersen. L. B. 61. 265 identification of feelings and. 10 global measures for.. S. 215 Practice-based evidence. S. P. 234 formula for. 87 Personal projects analysis. 76–77 P Pilling.. 17. O. 249 closed. client satisfaction scales for. I. B. 227 Potter. 91 Ramos-Sánchez. 287 Planning summaries. R.. 233 absorption. 289 reflection of. 278 Prejudice. 104. 287 factors in. M. 284 Priester. M. 281 Physical closeness. P. 45 ongoing assessment for. C... 279–280 Phan.. J. T. 187 Questioning cycle. 259 Protivnak. W. M. assessment of. B. See also steps in. H. P. 221 Rabago. 156 miracle. 110–116 Patterson. 113 Paul. 115–116 Pierce. 245.. S. 113–114 Pekarik. 310. 45 Q subjective scaling and self-report Physical disabilities. 222 challenging.. N. G. 236 Guidelines.. 114 Pal. 268–269 Overshooting. 248 Paez. 284 to identify goals. 108 Pbert. 2 Parkins. S.. 288 Presenting problem. T. Pead. D. J. 104 Post. 187 Park. 68–69 Questions use of other people to monitor. 235 Racism. M. J.. 90–91 Pollack. 249–250 antidotes for. F. 247. D. 223 turning paraphrase into. Outcome evaluation Peterson.. 270 Piper.. L.. J. M.. F. 183–184.. 223.. 108–109 Peter. J.. 247–249 Pietrzak. J. 246 compound response and. 235 40–41 Paraprofessionals.. D. 186 R judgmental. 119–120 . J. 228 Parr.. 236 Raimirez. 150. G. 310–311 benefits of. G. L.. L. C.. 248 common problems in. 106–107 PET: Parent Effectiveness Training Role-playing timing for. 151 Psychoeducation. J. A. 75 explanation of. 46 change. N. 246–247 open. 77–78 Paquin. 288 Purcell. S.. 251 goal-attainment measures for... 94–96 Platt. 91–94. 18. 112 (Gordon). A. 197 Psychobabble.. 39 difficulty of. 261 Punished by Rewards (Kohn). Rice. C. E. 198–200 Pagnini.. C. A. 184 Owen. 197 Pybis. 288 Ponte-Allan. W. when to use. D. 61 Psychological helping. D. 231 Prochaska. 300 Pittman. L... M. 35 as question. 96 example of. J. 89–90 Pollak... encouragement vs.. S.. M. E.. 263 Precontemplation. put into words. 110 Pearson. 69 Purkey.. J. 103 Peavy. connected to content. 235 Positive regard. M. 235 Proctor. 130 Parent consultations. 49–50 self-assessment of. K.. 277–278 Pew Research Center.... J. 104 Pennebaker. 262 Pitsounis. E. 154. 232 how to perform. 277 Pieper. 278 common problems and their Patterson... 120 Persuasion.. 234 Pressly...356 Index Osborn. 279 Physical challenges. 194 multiple. 8 in writing. 236 Ratkowski. 281 Physical distance. 245–246 Pascual-Leone.. T. 46 Schön.. P. C. 124–125 Robinson.. 235 (Covey). 87 phases of. J. D. Saad. 224 face and. 223 Self-confrontation. McKay... P. 226 Self-efficacy. 297 Sermat. F. W. W. D.. 287 Roufa... 311 Schauenberg.... 210–212 Santorelli. D. 3–4 elements of. 197 practicing new behaviors and. P. M. J. J. L. 284 Sciscoe. Salmela-Aro. S. 240 S Sembill.. 122–140. 261 tips for. H. 288 Rupert. L. 13 214–221 Salovey. A. 195 Remembering Your Gender training. 92 opportunities for. 183. F.. 4–5 Rogers.. 122–124 Rodriguez. 197 helping situations. L.. 234 to help clients with different Role-playing Seggerstrom. 269–270 Rose. 288 Ross.. 102 Shafii.... C... 277 efficacy and self-esteem and.. 125. 305 Schuldt. 307–309 Rodriguez-Bigas. 125 Ritchie.. 303 Schefft.. D.... 116 for relapse prevention. J. 289–290 self-involving statements vs. D. F. 262 Self-monitoring activities self-help groups for. J. T. L. 127 Schroeder.. A.. H... 245. 103 Rosenberg. C. 303 Shannon.. 69 about yourself.. M. 223 Schiraldi. 66 Scher. 235 identifying. 226 mistakes in helper.. 86 Robey. M. T.. 179 in. 5 to push client to go deeper. 180 importance of. 88–89 124. 69 for relapse prevention. K. 42–43 Reframing Ronan.. M.. 178 Self-involving statements. 231 Shapiro. 230–237 Sanchez. S. 221 methods to increase.. 125 Richardson. 244 Schaefer. T. L. P. K. 270 Schaub. S.. 33 The 7 Habits of Highly Effective People activating client expectations in. 281 Relationship enhancers. 236 Segal.. 5 Sharkey. 248 Sharpley. 288 follow-up for. 39–40 244–255 Sajatovic. 212–213 Schare. D. 64–65 Rosen. 261 Seals. 289–290 Rüge.. 234 emotional arousal and. J. 5 to practice new beliefs. 174 to help overcome challenging explanation of. 164–165. 231 providing new learning experiences Sax.. M. 223 Self-management strategies. M. J. 42 Reflection Roe. K. 68 types of. D. 12. 103. J. 195 reasons for. 68.. A. 288 Rupani. P. S. 215 sources of low.. 89–97 Ritter.. A. 221 uncovering next layer of. J. 285. 214–215 method for. 270–271 Rosen.. 50. D. 245 therapeutic relationship and.. 61 Schumate. 236. E. V. 224–226 Self-disclosure of meaning. 215 relationship enhancers Seligman. 217–218 Regulators. 252. 46 Self-Esteem Workbook (Schiraldi. 183 function of.. M.. 66 to reflect meaning. S. R... 252 explanation of. M. T.. 252 backgrounds. 305 Schectman. Z. 218 booster sessions for. 141 Reuter. 143–144 treatment planning using. D.. R. S. 197 Shadboldt. 33. 152. 195 Scherer. 180 Self-recording. 256–271 Scaling questions. 43–45 that goes on too long.. 261 Scheier. See Therapeutic Rytting.. 44. 67 . K. 210–211 Salas. 156. G. 233 Shapiro. 228 version. 216–217 Relapse prevention Rosner. Sebold. N. T. Z.. D. M. 210. 4. J. See also Efficacy exercise for. J. 302 Schumann. 210. 309 Rice. C.. 43 Reflective practitioners... R. M. 242 Self-esteem explanation of. 86 problems and precautions for.. 288 Relationship building stage. E. 262 for working with children.. 86–87 Rockenbaugh.. M. 235 Self-esteem personal inventory. 36 Seskevich. A. 158 to emphasize story is client’s Richard. 288 Roth. H. 303 to lead to deeper self-understanding Ritchie. N. 287 to examine concept of depth. M. 195 Schöttke. M. 69 Self-worth. L. 215.. J. M. E. M. H. D. 125–128 Robert.. M. 52. 151 REPLAN system and.. 36 advanced.. engaging paraprofessionals for. 239–240 function of. 223 Self-Development Project List-90. 43 letter writing for. 233 REPLAN system Safran. 221 Schultz. 195 dimensions of... 180.. 243. 305 Scheel. 266 Relaxation training. 187 Sex. 195 function of. G. 221–230 Saulsman. 303 components of. 23 Ridley. 214–221 Reik. M. S. 25 Ryser.. 195. B. 222. 3 method for.. G. 258 paraphrasing as.. J. 278 and Fanning).. 267 Sexton. 95. P.. 125–1261 Ricks. R. S.. M.. 289 Rowe. J. 258 explanation of. J. Index 357 Reflecting meaning therapeutic factors in. 2–3 Rollnick. E. 290–291 role-playing for.. T.. P. L. 272–273 Roosevelt..... 42 312–313 Sachsse. D. P. Saint... A. 288 Rounds. 234 in client. 42. B. 215 Self-help groups. T.. 227–228 self-monitoring activities for.. V. J. 61 reasons for. C. A. 305 Reflecting skills Rhine. T. 287 to accommodate new information Roehrig. P. L.. . W. 301 Therapeutic factors. J. 231.. 192 thematic. 22 Silence. G. M. J. 306 Thomas.. 307–311 Signal summaries. 282 Strassberg. 23 Siegel. J. B. V... 283. confusing feeling and. G.. G. 33 Sternberg.. 142–143 clients’ views of. 136 facilitative office environment and.. S. L. F. 36 presence as. F. 23 Silk... M. 156 Symonds. L.. L.. G.. L. 215 Steer. D. C. 47 Smythe.. S.. C. J. B.. 18 Tan. 33–34 Sjaastad. S. T.. H. 65 Sweeney. 227 Tesser. T. 307 Shulman. Ø. R. 16 nonhierarchical stance in.. 179 explanation of. C. L. G. R. W. G. 42 Sutherland.. See Change questions for adults. E... See also measure. 24 (Beier and Young). A.. 301 Therapeutic faux pas Simplified Personal Questionnaire Suicide. P. J. 135–136 elements of. 43 Strack. S. R. 258 137–140 creation of.. M.. C. J.. 69 signal. 235 Thompson. 104 Teachman. A. 281 Taylor.. 222 list of. 155 Sue... 69 Teasdale. J. H. 232 Tepper.. A. 67 Timman. M.. 281 invitational skills as.. J. 215 Timm. T. 38–39 Small. 286. J. K. T. 223 Taves. 249 Thomas. C. H. A. 23 Simek-Downing. S. 249. S... 236 Tavris. 34 Sørbye. A. 156 Stenzel. 127 Stampfl... T. C. R. 281 goal-setting skills as. 258 dealing with loss at. 288 Thinking. 142–143 distractions and. E.. 222. 246 helpers’ reactions to. 260 preventing relapse following. 249 Substance abuse.. 217 Steen. J. H. L. 212 Tichenor... 47. 135–136 Struve.. 305 Teismann. 47 Procedure.. S. C. B. 217 Strong. 69 termination of.. D. P. 156 Thompson. L.. 34 Simmons. 21. S. J. D. M. O. 218. R. D. 263 power of... M.. J. 179 Thompson.. 187 reflecting skills as. 42–45 Splete. 23 The Silent Language of Psychotherapy Subjective Units of Discomfort Scale importance of.. A. 234 Tiet. 222 suicide or harming others. 286 Termination Tindall. S. R. 249 Strang. 64 Stone. E. 221 Stone. S. S. P. R. 284 explanation of. 69 premature. 180 Stevens. J. 262. 260–261 determining necessity for. A. notifying if member of 45–46 Smith. S. 154 . 67. M. 197 Stollack. J. M.. 197 for goal setting. 231 explanation of. 47 Smokowski. Smith.. 262 REPLAN system in.. 136–137. 115 Sportel. exposure to avoided. 221 explanation of. 234 training group is contemplating microaggressions in.. 151 Sherman. R. 288 Stewart. 286 Strauss. 24 Sights. D.. J. B. 247 Ströhle. 303 Countering Steinfeldt. M. 182 Sweet... 68 Sticking Up for Yourself (Kaufman). W. A... D.. B. 36 Therapeutic building blocks (Carnabucci). A. 46 T Thibodeau... T.. 261 Spurling. 260 Summaries appearing credible and.358 Index Shaughnessy. 48 Simplified target complaints Suiter. Shcherbakova. 36 287–289 Sheeber. T.. A.. P. 258 Stroebe.. B.. N. 22 Siegel. 9 nonjudgmental listening cycle and. 297. 42 Thematic summaries. 39 Spiegel.. 261 St. 69 explanation of. 234 focusing. 285–286 Todd. 281 Thompson. S.. 280–281 Singh. 251 Therapeutic relationship enhancers Speech. E. M.. 37 Soukara. 262 Taborsky. 286 Tonigan. J. M.. 36–37 Smith.. 39 Spinhoven. 305 empathy as.. P. J. K. 161. C. Jr. 231 Spokane.. 51 self-disclosure as. 180 Sutton. 156.. 195 for children.. 46 Singer. 69 Therapeutic relationship... D. J. 66 Stevens. 235 Tanner. B.. A. A... 195 Stimuli. 197 Suinn. H... 223 Strategic questions..... T. 259 Tanigawa. K. 69 Time line.. 215 change techniques as. M. 52. attentive. 267 challenging skills as.. See also Steinfeldt. 227 Thought stopping.. A. 283–285 Tomm. 258 Swade... F. K. 302 Supervisors. W. 39–42 Spicer. 46 Smith.. Onge. 126. R... V. 67 Subjective scaling. 234 Taylor. 154 Sue. 46 (SUDS). 286 Tjeltveit... A. B. 5 preparing clients for.. L. 215 Tager. 217 Starr. 287 Tolin. 183. P.. M. R. 287 categories of. 221. 136 Show and Tell Psychodrama Strassle... 155 planning. A. 231. T. Q. J. 47–51 Situational interviews. 261 Stories. 242 Helping relationship Sims. 67. A.. observation of. J. creating change as role of. R. 283 Todorov. 197 Sullivan. B. D. 197 Swift. B. 76 Teicher.. 38 Singh. 180. A. K.. 248 Stone. 134 assessment of. 135. Z. 33 Snyder... 201–203 communication roadblocks in. K. 221. C. 69–70 Vermeiren. M. M.. Jr. 223 Truax. 221.. D. 45 195. 158 Turner.. P. 180. 21.. M. 45 Wachtel.. 301 Y Truant.. G. P. 306 Weigel. M. Tyndall-Lind. H. C.. 215 Wolff. D. L. R. G. H. 179 232. R... 54 Vrij. See also 147–148 Wolberg. P. L. 262 Wedding. imposing your own.. 67–68 Wong. 308 for. G. S. K. L. 161 van Dyck. 251 patterns in. 261 Trepal.. R. 180. F.. P. A. 103 Watkins. S. 270 Young.. 261 Tuemmler.. 187. 50 W Woody. C. R. 234 Zinbarg. J.. L. 124 Yang. 156 Vance. S. 258 Watson. C. 212 Trautt.. 233–235. 305 Zeman.. L. 197 Winograd. A.. C. N.. D... 156. 231.. 230 Wierzbicki. 75 Z Vaillant. 42 Youngstrom... S. M. 33.. M... J. 221 Zerbe Enns. G.. L. M. 50 Worley. 34. 304.. 277 Trope.. 198. L. 306 Vincent. H.. 235. P. 259 Tsai. A... R. 50–52 Vriend. 155 Violence. E. S. E. A. 52 Voice tone. H. 42.. T. identifyiing potential Witmer. A. 305 Yuan. 215. 227 Walz. E. 234 Williams. 262 Wester. G. C. 305 Vang. J. 38. 38 .. Wofsy. S. 33. 134 Whipple. M. D.. R. D. J. I. 249... S. J. C. 194. G. 302–303 Walder-Biesanz. 305 Wong. 180. N. 237... B. 21. 259 Tymms. D. M. 215 Williams. S.. 12. T. C. 2 Toxic masculinity. N. 261 Williams. 300 U Werbart.. 231.. M. G. 262 Williams. 297 Traumatic issues. 21 Young.. 69 Touching. E. G. 261 Velten. 51 Williams...... R. 261 Willison. J. 40 Weakland. 165 Williams. L. 122 Wüsten. B. P.. 279 Watzlawick. 226 culturally adapted. 197 Turtle-Song.. J. 305 Yanov. S... Weiner-Davis. L.. H.. 227 Zanna.. 16 Wiggins-Frame. 195 Vital Lies. J. 164 Ulbricht... A. 108 Uken. 231. G. M. M. C. K. B. G. 180 explanation of.. Y. D. 151.. P. 52 Yang. 18 Ward. 283 probing. client resistance to Woodhouse. Index 359 Torres-Rivera. A.. J. G.. J.. 54–56 Vogel. 127 Ultimate meanings technique. Y. G... I. 178 Ward. 301 Values.. K.. 65 Wood. E. 270 Young. 285 Watts. 251 Trame. 277 Yudilevitch. 261 Worthington.. E. 284 Yuan... Tracking. T. L. 104. W.. S. M.. E.. 262 Tryon.. 11 Treatment plans Wadsworth. 196 Warmth.... 33 Willow.. 26 Walton. S. 195 West. E. 68 Watt.. E. R. J. Y. T. 235. 286 Yadav.. 183 Twenge.. 92 Tubesing. 61 from client. 284 Zane. 270 Yablonsky.. 249 Yeryomenko. D. 43.. 92... M. D. M... Z. R. 122 as cognitive distortion. D. E. 51. 250. 222.. 270 Yowell.. C.. 228 Wong. A. P. 222. I.. A.. L. 279 Zhao. 261 Zgierska. 152. K. E... 13. L.. Y. G. Simple Truths (Goleman). 180 Vereen... L.. M.. L. G. 288 Countertransference Vocks. 61 Undershooting. 196 Tracey. 289 V Why questions. 261 Vereen. A. 2. A.. 258 270. R. F. 102. E. 49. J... 234 Wyatt.. C. 64 Wampold.. 212 Transference. R. 63. 115–116 Whiston. 152 explanation of. J. 234 Van Tuijl. 304. 76 White. 39. 70 Yalom.