Basic Counseling., self care, essential skills and context of counc
LizaCloze1
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Sep 12, 2024
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About This Presentation
Basic counselling skills
personal characteristics of effective counselors
new research
important
counselor self care
mental health
ba careful with burn out
Slide Content
BASIC COUNSELING
SKILLS
SKILLS
PERSONAL CHARACTERISTICS OF
EFFECTIVE COUNSELORS
(Corey, 2006)
EFFECTIVE COUNSELORS
(Corey, 2006)
1. Effective counselors have an
identity.
They know who they are, what they are capable
of becoming, what they want out of life, and
what is essential.
identity.
They know who they are, what they are capable
of becoming, what they want out of life, and
what is essential.
2. They respect and appreciate
themselves.
They can give help and love out of their own
sense of self-worth and strength.
themselves.
They can give help and love out of their own
sense of self-worth and strength.
3. They are open to change.
•They exhibit a willingness and courage to
leave the security of the known if they are not
satisfied with what they have. They make
decisions about how the would like to change,
and they work toward becoming the person
they would like to become.
•They exhibit a willingness and courage to
leave the security of the known if they are not
satisfied with what they have. They make
decisions about how the would like to change,
and they work toward becoming the person
they would like to become.
4. They feel alive, and their choices
are life-oriented.
•They are committed to living fully rather than
settling for mere existence.
are life-oriented.
•They are committed to living fully rather than
settling for mere existence.
New Research (Dissertation)
•LIKAS NA LAKAS: ON-SITE EMOTIONAL CARERS
OF OVERSEAS FILIPINO WORKERS (2017)
–Their childhood was full of laughter especially
during family meal conversations
–They grew up in a happy family where joys are
simple and focus was always for others or the
genuineness of helping the people in their
community.
–Their mother was their best friend and that they
had a close relationship with her.
•LIKAS NA LAKAS: ON-SITE EMOTIONAL CARERS
OF OVERSEAS FILIPINO WORKERS (2017)
–Their childhood was full of laughter especially
during family meal conversations
–They grew up in a happy family where joys are
simple and focus was always for others or the
genuineness of helping the people in their
community.
–Their mother was their best friend and that they
had a close relationship with her.
5. They are authentic, sincere
and honest.
•They do not hide behind masks, defense,
unproductive roles, and facades.
and honest.
•They do not hide behind masks, defense,
unproductive roles, and facades.
6. They have a sense of humor.
•They are able to put the events of life in
perspective. They are not forgotten how to
laugh, especially at their own mistakes and
contradictions.
•They are able to put the events of life in
perspective. They are not forgotten how to
laugh, especially at their own mistakes and
contradictions.
7. They make mistakes and are
willing to admit them.
•They do not dismiss their errors lightly, yet
they do not choose to dwell on misery.
willing to admit them.
•They do not dismiss their errors lightly, yet
they do not choose to dwell on misery.
8. They appreciate the
influence of culture.
•They are aware of the ways in which their own
culture affects them, and they respect the
diversity of values espoused by other cultures.
They are also sensitive to the unique
differences arising out of social class, race,
sexual orientation, and gender.
influence of culture.
•They are aware of the ways in which their own
culture affects them, and they respect the
diversity of values espoused by other cultures.
They are also sensitive to the unique
differences arising out of social class, race,
sexual orientation, and gender.
9. They have a sincere interest in
the welfare of others.
•This concern is based on respect, care, trust,
and a real valuing of others.
the welfare of others.
•This concern is based on respect, care, trust,
and a real valuing of others.
10. They become deeply involved
in their work and derive meaning
from it.
•They can accept the rewrads flowing
fromtheir work, yet they are not slaves to
their work.
in their work and derive meaning
from it.
•They can accept the rewrads flowing
fromtheir work, yet they are not slaves to
their work.
11. They are able to maintain
healthy boundaries.
•Although they strive to be fully present for
their clients, they don’t carry the problems of
their clients around with them during leisure
hours. They know how to say no, which allows
them to keep a balance in their lives.
healthy boundaries.
•Although they strive to be fully present for
their clients, they don’t carry the problems of
their clients around with them during leisure
hours. They know how to say no, which allows
them to keep a balance in their lives.
Important!
•Caring is extremely important, yet it can
sometimes be detrimental if the counselor
cares too much and does not know how to
handle these feelings appropriately.
•Caring includes the notion of respect.
•Caring is extremely important, yet it can
sometimes be detrimental if the counselor
cares too much and does not know how to
handle these feelings appropriately.
•Caring includes the notion of respect.
•One of the main skills of a counselor is to help
the client to become empowered. The more a
counselor tries to take over for a client , the
more likely the client will give up
responsibility for her own actions and put that
responsibility onto the counselor.
the client to become empowered. The more a
counselor tries to take over for a client , the
more likely the client will give up
responsibility for her own actions and put that
responsibility onto the counselor.
Counselor Self Care
How do you take care of yourself?
How do you take care of yourself?
In order to be able to help
others, counselors must
have something to give.
This means that counselors
should be aware of
themselves and when they
are moving on a positive or
negative track.
One of the ways to get on a
positive track is to take
care of one’s own self.
others, counselors must
have something to give.
This means that counselors
should be aware of
themselves and when they
are moving on a positive or
negative track.
One of the ways to get on a
positive track is to take
care of one’s own self.
Counselor and Mental Health
Like other people, counselors have their own personal
conflicts.
What separates them from people in other professions
is that they need to be more in tune with their own
personal issues so they do not bring them into the
counseling room.
Like other people, counselors have their own personal
conflicts.
What separates them from people in other professions
is that they need to be more in tune with their own
personal issues so they do not bring them into the
counseling room.
Therapy for the counselors
–Geller, Norcross, and
Orlinsky (2005)
explained, “personal
treatment for
psychotherapists –
receiving it,
recommending and
conducting it – is at the
very core for the
profession of
psychotherapy”
–Geller, Norcross, and
Orlinsky (2005)
explained, “personal
treatment for
psychotherapists –
receiving it,
recommending and
conducting it – is at the
very core for the
profession of
psychotherapy”
Careful with Burnout
Kottler (2003) stated, “There
are tremendous risks for the
therapist in living with the
anguish of others, in being
so close to others’ torments.
Sometimes we become
desensitized by human
emotion and experience an
acute overdose of feeling;
we turn ourselves off”
Kottler (2003) stated, “There
are tremendous risks for the
therapist in living with the
anguish of others, in being
so close to others’ torments.
Sometimes we become
desensitized by human
emotion and experience an
acute overdose of feeling;
we turn ourselves off”
Supervision
Supervision might be
one of the most
important components
in helping to ensure that
the counselor is
competent (Corey,
Corey, & Callanan,
2007).
Supervision might be
one of the most
important components
in helping to ensure that
the counselor is
competent (Corey,
Corey, & Callanan,
2007).
Essential Skills and Contexts of Counseling
•There is no one right way to conduct a
counseling session. This is both freedom and
restriction. Counselors can operate in a
variety of ways to achieve a positive outcome.
counseling session. This is both freedom and
restriction. Counselors can operate in a
variety of ways to achieve a positive outcome.
A counseling session is an
interview, but distinct from
other types of interviews
because the goal is POSITIVE
CHANGE.
interview, but distinct from
other types of interviews
because the goal is POSITIVE
CHANGE.
The counseling interview occurs within a unique
context of human interaction because it
primarily deals with extremely personal issues of
people’s lives, such as their hopes, fears,
feelings, and pain.
context of human interaction because it
primarily deals with extremely personal issues of
people’s lives, such as their hopes, fears,
feelings, and pain.
The process in which the therapeutic interview is housed
has been called many things over the past century,
including psychotherapy, therapy, counseling, and
helping.
One of the key components of the
therapeutic interview is that its main purpose is
POSITIVE CHANGE. Therapists use all of their skills
and knowledge to assist clients in moving in a
direction of change (be it behavioral, emotional,
relational, or psychological). The intent of this
change is for it to be lasting, so that the client does
not have to keep coming back to therapy.
has been called many things over the past century,
including psychotherapy, therapy, counseling, and
helping.
One of the key components of the
therapeutic interview is that its main purpose is
POSITIVE CHANGE. Therapists use all of their skills
and knowledge to assist clients in moving in a
direction of change (be it behavioral, emotional,
relational, or psychological). The intent of this
change is for it to be lasting, so that the client does
not have to keep coming back to therapy.
Cormier and Hackney (l999) provided four
conditions in which the helping process occurs.
1.Someone is seeking help.
2.Someone is willing to give help.
3.The person willing to give help is capable
and trained to give that help.
4.This interchange occurs in a context and
setting that permits this type of interacting
to occur.
conditions in which the helping process occurs.
1.Someone is seeking help.
2.Someone is willing to give help.
3.The person willing to give help is capable
and trained to give that help.
4.This interchange occurs in a context and
setting that permits this type of interacting
to occur.
The
therapeutic
alliance is based
on safety.
Individuals must
feel safe to
express
themselves as
they are.
therapeutic
alliance is based
on safety.
Individuals must
feel safe to
express
themselves as
they are.
Disliking Clients
If therapists find that they dislike a client, they are
encouraged to:
(1) engage in self exploration to figure out what it is about the
client that is bothering them,
(2) possibly discuss what they are experiencing in the
therapeutic relationship with the client to see if some new
perception can come to the surface,
(3) talk with a colleague or supervisor to attempt to move past
these feelings, and
(4) refer the client to someone else if, after trying to work things
out, the negative feelings continue to impact the therapy in
detrimental ways.
If therapists find that they dislike a client, they are
encouraged to:
(1) engage in self exploration to figure out what it is about the
client that is bothering them,
(2) possibly discuss what they are experiencing in the
therapeutic relationship with the client to see if some new
perception can come to the surface,
(3) talk with a colleague or supervisor to attempt to move past
these feelings, and
(4) refer the client to someone else if, after trying to work things
out, the negative feelings continue to impact the therapy in
detrimental ways.
Characteristics of Effective
Therapeutic Relationships
Therapeutic Relationships
When clients are asked what was helpful for them in
therapy, they tend to say that the therapist “was nice”,
“listened to me” and “was supportive rather than
discussing the techniques or theory”
therapy, they tend to say that the therapist “was nice”,
“listened to me” and “was supportive rather than
discussing the techniques or theory”
Carl Rogers (l961)
outlined his view of the
characteristics of a
helping relationship:
•emphatic
understanding
• unconditional positive
regard, and
•congruence
(genuineness)
outlined his view of the
characteristics of a
helping relationship:
•emphatic
understanding
• unconditional positive
regard, and
•congruence
(genuineness)
Part of an effective
therapeutic relationship is
allowing the other person
the full range of emotional
expression. Usually,
outside of the therapeutic
relationship, people are
not given the freedom to
really explore themselves.
therapeutic relationship is
allowing the other person
the full range of emotional
expression. Usually,
outside of the therapeutic
relationship, people are
not given the freedom to
really explore themselves.
Fox (2001) summed up the
therapeutic relationship through the
acronym of AGAPE:
•A=acceptance
•G=genuineness
•A=actuality
•P=positive regard
•E=empathy
therapeutic relationship through the
acronym of AGAPE:
•A=acceptance
•G=genuineness
•A=actuality
•P=positive regard
•E=empathy
Goal of Therapeutic Interviews
•Perhaps the primary goal of therapy is for the client to
no longer need therapy.
•In therapy, however the goal is to get the client, as
quickly as possible, to not need the service.
•Further, the goal is to have the client never come back!
•This goes counter to most business models.
•Perhaps the primary goal of therapy is for the client to
no longer need therapy.
•In therapy, however the goal is to get the client, as
quickly as possible, to not need the service.
•Further, the goal is to have the client never come back!
•This goes counter to most business models.
Use of Self in Therapy
•One of the most important aspects of being a therapist is
being genuine.
•Carl Rogers said:
–“It has been found that personal change is facilitated
when the psychotherapist is what he is, when in the
relationship with his client he is genuine and without
“front” or façade, openly being the feeling and attitudes
which at that moment are flowing in him.”
•One of the most important aspects of being a therapist is
being genuine.
•Carl Rogers said:
–“It has been found that personal change is facilitated
when the psychotherapist is what he is, when in the
relationship with his client he is genuine and without
“front” or façade, openly being the feeling and attitudes
which at that moment are flowing in him.”
When do we self-disclose to clients?
•A rule of thumb is to task: “Who is this self-
disclosure for, me or the client?”
•Therapist self-disclosure can help the therapeutic
process in many different ways. These might include
giving clients permission to open up while also giving
them permission to feel what they feel, providing a
sense of universality for feelings or actions and
effective role Modeling (Welch, 2003)
•A rule of thumb is to task: “Who is this self-
disclosure for, me or the client?”
•Therapist self-disclosure can help the therapeutic
process in many different ways. These might include
giving clients permission to open up while also giving
them permission to feel what they feel, providing a
sense of universality for feelings or actions and
effective role Modeling (Welch, 2003)
Beginning Conversational Skills
Three types of attending/joining skills:
–Internal Attending
•Is a mind set that the therapist “needs to put aside
personal concerns including any physical discomfort or
immediate worries before beginning the counseling
session and be present for the client” (Sperry et al.,
2003., p. 38)
–Internal Attending
•Is a mind set that the therapist “needs to put aside
personal concerns including any physical discomfort or
immediate worries before beginning the counseling
session and be present for the client” (Sperry et al.,
2003., p. 38)
–Physical Attending
•It is important that one’s body conveys one’s interest,
connection, and desire to continue in the process of
the therapeutic interview.
•Face the client, give proper eye contact, have an open
body position.
•Crossed hands and legs give off a closed stance.
•Do not sit behind desk,
•Do not hold the client’s chart during the session, even
note taking can potentially distance therapist and client
•It is important that one’s body conveys one’s interest,
connection, and desire to continue in the process of
the therapeutic interview.
•Face the client, give proper eye contact, have an open
body position.
•Crossed hands and legs give off a closed stance.
•Do not sit behind desk,
•Do not hold the client’s chart during the session, even
note taking can potentially distance therapist and client
–Verbal Attending
•Is the words, phrase, and times of silence, counselors
use to indicate they are attending to the client”
•Greeting the client
–A handshake that is not too hard or too soft
–Be culturally sensitive (e..g, kiss on the cheek in some South
American or European countries or a bow in some Asian
countries)
–Therapists will need to make a determination of what they
want clients to call them based on the context in which they
are providing services as well as who the client is.
–Therapists should come across as friendly, but not overly
friendly, caring but not overly caring, and reserved (so as not
to dominate the other person) but not overly reserved.
•Is the words, phrase, and times of silence, counselors
use to indicate they are attending to the client”
•Greeting the client
–A handshake that is not too hard or too soft
–Be culturally sensitive (e..g, kiss on the cheek in some South
American or European countries or a bow in some Asian
countries)
–Therapists will need to make a determination of what they
want clients to call them based on the context in which they
are providing services as well as who the client is.
–Therapists should come across as friendly, but not overly
friendly, caring but not overly caring, and reserved (so as not
to dominate the other person) but not overly reserved.
Important!
During the discussion of
confidentiality, therapists should
inform clients of when they would
need to break confidentiality.
Further, if later in the course of
therapy there is time when therapists
do need to breach confidentiality,
they should explain to the client why
they will be breaking it and what type
of information they will relay to the
other person.
During the discussion of
confidentiality, therapists should
inform clients of when they would
need to break confidentiality.
Further, if later in the course of
therapy there is time when therapists
do need to breach confidentiality,
they should explain to the client why
they will be breaking it and what type
of information they will relay to the
other person.
Therapeutic Distance
•Therapists need to balance how much intimacy they feel or
show and how much detachment they feel or exhibit.
•Leitner (l995) discussed the notion of optimal therapeutic
distance and defined this as “being close enough to the other
to experience the other’s feelings and while being distant
enough to recognize them as the other’s feelings-not the
therapist's own (p. 362).
•Therapists need to balance how much intimacy they feel or
show and how much detachment they feel or exhibit.
•Leitner (l995) discussed the notion of optimal therapeutic
distance and defined this as “being close enough to the other
to experience the other’s feelings and while being distant
enough to recognize them as the other’s feelings-not the
therapist's own (p. 362).
Door Openers
These are nonjudgmental ways to begin a conversation.
Examples:
–“On the phone when you made the appointment, you
stated that you were really concerned about your child.
Could you tell me about that?”
–“I see you’ve been crying. What’s going on?”
–“Tell me what brings you in today.”
–“What brings you in to talk to someone like me, a
therapist?”
–“What was it that led you to make this appointment?”
These are nonjudgmental ways to begin a conversation.
Examples:
–“On the phone when you made the appointment, you
stated that you were really concerned about your child.
Could you tell me about that?”
–“I see you’ve been crying. What’s going on?”
–“Tell me what brings you in today.”
–“What brings you in to talk to someone like me, a
therapist?”
–“What was it that led you to make this appointment?”
PLEASE DON’T SAY THESE:
–“Oh it’s you again. What do you want this time?”
–“You don’t want to talk about your boyfriend
again, do you?”
–“My day has been miserable. What about your
day?”
–“Oh it’s you again. What do you want this time?”
–“You don’t want to talk about your boyfriend
again, do you?”
–“My day has been miserable. What about your
day?”
Basic Conversational Skills
•Skills to help keep the conversation going so that the client feels
comfortable enough to go into greater depth.
Minimal Encouragers
–“Okay”
–“Go on”
–“I see”
–“Tell me more”
–“Keep going”
–“Mmhmm”
–“All right”
–“Explain that some more”
•Skills to help keep the conversation going so that the client feels
comfortable enough to go into greater depth.
Minimal Encouragers
–“Okay”
–“Go on”
–“I see”
–“Tell me more”
–“Keep going”
–“Mmhmm”
–“All right”
–“Explain that some more”
•Minimal encouragers can also be nonverbal.
–Head nods
–Keeping eye contact with client
•Minimal encouragers also consist of using as word or phrase
the client has just used.
Example:
Client: “I just can’t get past this awful feeling.”
Therapist: “Awful feeling”
Client: “Yeah, it has been bothering me for so long. This feeling is…..”
–Head nods
–Keeping eye contact with client
•Minimal encouragers also consist of using as word or phrase
the client has just used.
Example:
Client: “I just can’t get past this awful feeling.”
Therapist: “Awful feeling”
Client: “Yeah, it has been bothering me for so long. This feeling is…..”
Nonverbal communication
Attending Checklist
–Face the person fully
–Communicate intense interest
–Give undivided attention
–Maintain natural eye contact
–Be sensitive to cultural preference
–Make your face expressive
– Nod your head, a lot
–Present yourself authentically
Attending Checklist
–Face the person fully
–Communicate intense interest
–Give undivided attention
–Maintain natural eye contact
–Be sensitive to cultural preference
–Make your face expressive
– Nod your head, a lot
–Present yourself authentically
Body Posture
Egan (2006) provides an acronym that therapist
can use as a framework of proper body
position:
S = face the client squarely
O= open posture
L = leaning forward
E= eye contact
R =relaxed
Egan (2006) provides an acronym that therapist
can use as a framework of proper body
position:
S = face the client squarely
O= open posture
L = leaning forward
E= eye contact
R =relaxed
•Therapists change positions many times during
the therapeutic interview, and many different
body positions are quite appropriate . However
avoid the following:
–Sitting Indian style on the chair
–Using a body position similar to the client's
–Crossed arms
–Crossed legs
–Taking one leg and twirling it around their other leg
–Sitting on their hands
the therapeutic interview, and many different
body positions are quite appropriate . However
avoid the following:
–Sitting Indian style on the chair
–Using a body position similar to the client's
–Crossed arms
–Crossed legs
–Taking one leg and twirling it around their other leg
–Sitting on their hands
Eye contact & Voice Tone
Use natural eye contact. Do not stare at the client
The therapist might match the voice tone of the client.
(e.g., If a client is talking about the possibility of very big
promotion at work and is saying this in a very excited
manner, the therapist can give the client some type of
congratulations in a a more excited manner than usual.)
Voice tone should be genuine.
Use natural eye contact. Do not stare at the client
The therapist might match the voice tone of the client.
(e.g., If a client is talking about the possibility of very big
promotion at work and is saying this in a very excited
manner, the therapist can give the client some type of
congratulations in a a more excited manner than usual.)
Voice tone should be genuine.
Note taking
•It is recommended that
therapists should stay
away from taking notes
during the session.
•Anything the therapist
has, including a pen,
mug of coffee, or
notepad, is a barrier to
the open flow between
therapist and client.
•It is recommended that
therapists should stay
away from taking notes
during the session.
•Anything the therapist
has, including a pen,
mug of coffee, or
notepad, is a barrier to
the open flow between
therapist and client.
When taking notes in session,
the therapist should allow the
clients to see what is being
written or offer the clients the
opportunity to take the notes
home with them. Otherwise,
note taking becomes a
situation in which the client
can think that the therapist is
“analyzing” them, which puts
distance in the relationship.
the therapist should allow the
clients to see what is being
written or offer the clients the
opportunity to take the notes
home with them. Otherwise,
note taking becomes a
situation in which the client
can think that the therapist is
“analyzing” them, which puts
distance in the relationship.
Therapists are
encouraged to take very
detailed notes of what
occurred in the session
immediately after the
session.
encouraged to take very
detailed notes of what
occurred in the session
immediately after the
session.
But if you really want to take notes, please
say….
Therapist: “I am going to take some notes just to make
sure I am getting all of the important points. If, at the
end of the session you would like, I can make a copy of
them for you.”
say….
Therapist: “I am going to take some notes just to make
sure I am getting all of the important points. If, at the
end of the session you would like, I can make a copy of
them for you.”
Listening
•This is not the same as hearing.
•Types of listening:
–Non-listening happens when someone may physically hear
the sounds from another person but not consciously
become aware of what the other person is saying.
–Pretend listening happens when the person who is
supposed to be listening looks as if he or she is listening
but the persons conscious awareness is elsewhere.
•This is not the same as hearing.
•Types of listening:
–Non-listening happens when someone may physically hear
the sounds from another person but not consciously
become aware of what the other person is saying.
–Pretend listening happens when the person who is
supposed to be listening looks as if he or she is listening
but the persons conscious awareness is elsewhere.
–Selective listening refers to paying attention to only
bits and pieces of what the speaker is saying.
–Self focused listening happens when the person who is
listening does so through a lens that is so self focused
that person has trouble being able to take the
perspective of the other person.
–Empathic (other focused) listening is being able to hear
what the other person is saying along with that
person’s perspective. It is the type of listening that
effective therapeutic interviewers engaged in during a
therapy session.
bits and pieces of what the speaker is saying.
–Self focused listening happens when the person who is
listening does so through a lens that is so self focused
that person has trouble being able to take the
perspective of the other person.
–Empathic (other focused) listening is being able to hear
what the other person is saying along with that
person’s perspective. It is the type of listening that
effective therapeutic interviewers engaged in during a
therapy session.
Listening Barriers
•Environmental
–Lighting, room is too dark, too bright, too glaring or too harsh
–Chairs are uncomfortable
–Therapy room too cold, or smells
–Cluttered desk
–Hungry (rumbling stomach)
•Psychological
–Client said that upset the therapist
•Physical
–Headaches, soreness,
•Cultural
-languages, accents, or colloquialism
•Environmental
–Lighting, room is too dark, too bright, too glaring or too harsh
–Chairs are uncomfortable
–Therapy room too cold, or smells
–Cluttered desk
–Hungry (rumbling stomach)
•Psychological
–Client said that upset the therapist
•Physical
–Headaches, soreness,
•Cultural
-languages, accents, or colloquialism
Silence
•Don’t be anxious. The anxiety
from the silence seems to
build on itself so that the
therapist wants to say
something, anything, so that
the silence is broken.
•Silence can be an excellent
tool to utilize and is
appropriate in many
instances during a
therapeutic interview.
•Don’t be anxious. The anxiety
from the silence seems to
build on itself so that the
therapist wants to say
something, anything, so that
the silence is broken.
•Silence can be an excellent
tool to utilize and is
appropriate in many
instances during a
therapeutic interview.
Doyle (l998) described four states in which a
client might use silence.
1.In the resistive state, the client might not want to
talk about something because of the uneasiness
of it, such as pain or embarrassment.
2.In the reflective state, clients are silent because
they are thinking about what has been discussed
in the interview.
3.In the inquisitive state, the client is silent
because he is waiting for the therapist to give the
interview and the conversation direction.
4.In the restive state (also known as the exhaustive
state), the client is emotionally spent and needs
time to recuperate.
client might use silence.
1.In the resistive state, the client might not want to
talk about something because of the uneasiness
of it, such as pain or embarrassment.
2.In the reflective state, clients are silent because
they are thinking about what has been discussed
in the interview.
3.In the inquisitive state, the client is silent
because he is waiting for the therapist to give the
interview and the conversation direction.
4.In the restive state (also known as the exhaustive
state), the client is emotionally spent and needs
time to recuperate.
Using obescenities
•Therapists are trained to use the clients language. If the client
uses curse words to describe his situation, the therapist can
use the same or similar curse words.
•The use of curse words can be joining mechanism for people.
Swearing can help increase a sense of intimacy, which then
signals a certain connection between people (Winters &
Duyck, 2001).
•By swearing the therapist sends a message that things can be
talked about during the therapeutic interview in any manner
the client deems acceptable.
•Therapists are trained to use the clients language. If the client
uses curse words to describe his situation, the therapist can
use the same or similar curse words.
•The use of curse words can be joining mechanism for people.
Swearing can help increase a sense of intimacy, which then
signals a certain connection between people (Winters &
Duyck, 2001).
•By swearing the therapist sends a message that things can be
talked about during the therapeutic interview in any manner
the client deems acceptable.
•Sometimes clients will hold back
swearing because they do not want
to offend or shock the therapist, yet
if the therapist has used some of
these swear words, the client can
more freely use them.
•The standard is for the therapist to
hold off until the client uses that type
of language, unless the therapist
believes that the use of curse words
will help the client more quickly and
more effectively toward his goal.
swearing because they do not want
to offend or shock the therapist, yet
if the therapist has used some of
these swear words, the client can
more freely use them.
•The standard is for the therapist to
hold off until the client uses that type
of language, unless the therapist
believes that the use of curse words
will help the client more quickly and
more effectively toward his goal.
Use of Humor
•Humor is becoming more
commonplace in
psychotherapy (Fry, 2001).
Therapeutic interviewers can
inject humor into the session
to join with a client, to show
the client that life does not
have to be taken so seriously,
and to reframe situations.
•Corey (2005) cautioned,
however, that sometimes
laughter can be used to cover
up anxiety or experiencing.
Therapist should learn to
distinguish between useful and
non-useful laughter.
•Humor is becoming more
commonplace in
psychotherapy (Fry, 2001).
Therapeutic interviewers can
inject humor into the session
to join with a client, to show
the client that life does not
have to be taken so seriously,
and to reframe situations.
•Corey (2005) cautioned,
however, that sometimes
laughter can be used to cover
up anxiety or experiencing.
Therapist should learn to
distinguish between useful and
non-useful laughter.
•The use of humor can be extremely therapeutic.
•However, different cultural groups value humor to varying degrees. When
working with clients from a different cultural group, therapists should
avoid using sarcasm and should hesitate to use jokes with individuals
from certain cultures, especially Middle or Eastern Europeans.
•However, different cultural groups value humor to varying degrees. When
working with clients from a different cultural group, therapists should
avoid using sarcasm and should hesitate to use jokes with individuals
from certain cultures, especially Middle or Eastern Europeans.
Confrontations
•It might seem that the therapist should be all accepting of the
client. However sometimes, client talk is not grounded in
what is actually going on in the client’s life. At these times, it
might be useful for the therapeutic interviewer to confront
the client about the discrepancy between what the client is
saying and what actually is occurring.
Example:
“Last week you were working toward not drinking anymore.
Now this week you are drinking.”
•It might seem that the therapist should be all accepting of the
client. However sometimes, client talk is not grounded in
what is actually going on in the client’s life. At these times, it
might be useful for the therapeutic interviewer to confront
the client about the discrepancy between what the client is
saying and what actually is occurring.
Example:
“Last week you were working toward not drinking anymore.
Now this week you are drinking.”
•Confrontation is not going against the client, it is
going with the client, seeking clarification and
the possibility of anew resolution of difficulties.
Think of confrontation as supportive challenge.
(Ivey & Ivey, 2003)
•Examples:
–“I’m a bit confused. In previous sessions, you said that
you don’t want anything to do with George. Yet now
you are saying you want to see how things can work
out. Could you explain this?”
–“You say you are doing fine, but your voice is so sad
when you say it.”
going with the client, seeking clarification and
the possibility of anew resolution of difficulties.
Think of confrontation as supportive challenge.
(Ivey & Ivey, 2003)
•Examples:
–“I’m a bit confused. In previous sessions, you said that
you don’t want anything to do with George. Yet now
you are saying you want to see how things can work
out. Could you explain this?”
–“You say you are doing fine, but your voice is so sad
when you say it.”
Important!
Confrontation should not be used early in the
therapeutic relationship as it can be perceived
as too domineering and rude. Therapist should
first support the client and then challenge the
client through a confrontation (Neukrug &
Schwitzer, 2006).
Confrontation should not be used early in the
therapeutic relationship as it can be perceived
as too domineering and rude. Therapist should
first support the client and then challenge the
client through a confrontation (Neukrug &
Schwitzer, 2006).
•Ivey and Ivey (2003) suggested that confrontation can be
viewed as having three steps:
•The first one is to identify what incongruity the client is
exhibiting.
•The second step is discussing with the client, in a clear and
overt manner, what the incongruity is and then helping
the client to resolve the discrepancy.
•The third step is evaluating whether the confrontation
helped the client to move toward growth.
viewed as having three steps:
•The first one is to identify what incongruity the client is
exhibiting.
•The second step is discussing with the client, in a clear and
overt manner, what the incongruity is and then helping
the client to resolve the discrepancy.
•The third step is evaluating whether the confrontation
helped the client to move toward growth.
REFLECTING SKILLS
Exploring Content, Feelings, and
Meanings of the Client's Story
Exploring Content, Feelings, and
Meanings of the Client's Story
Content
•It is the story the client is telling (who, what, where, when, and
how).
•These are the facts as the client knows them
•They do not have to be “truth” but are simply what the client says
occurred.
•The content refers to the client’s actions and thoughts.
•Most people, when they begin to express themselves and tell their
story, they begin at the content level.
•It is the story the client is telling (who, what, where, when, and
how).
•These are the facts as the client knows them
•They do not have to be “truth” but are simply what the client says
occurred.
•The content refers to the client’s actions and thoughts.
•Most people, when they begin to express themselves and tell their
story, they begin at the content level.
What is paraphrase?
•It is restating, in the therapist's own words, the behaviors
thought, and facts of what the client has just said.
•The therapist does not give his own opinion of what is right,
wrong, good, bad, or proper.
•The therapist is not giving advice to the client, to trying to
sway the client. It is a means of trying to follow along and
understand the client’s story.
•It is not a nonjudgmental statement of what the client has
just said.
•It is restating, in the therapist's own words, the behaviors
thought, and facts of what the client has just said.
•The therapist does not give his own opinion of what is right,
wrong, good, bad, or proper.
•The therapist is not giving advice to the client, to trying to
sway the client. It is a means of trying to follow along and
understand the client’s story.
•It is not a nonjudgmental statement of what the client has
just said.
Example
•Client: I told her over and over that I didn't want to go with her. But she
kept on saying I had to or else she’s feel so alone. But there were going to
be people there that I didn’t want to see.
•Therapist: She kept on trying to get you to go.
•Client: Yes, and I kept telling her I didn’t want to go. That’s not my scene.
She’s my friend, but those people aren’t.
•Therapist: You don’t want to hang around with those other people.
•Client: No, I told her I didn’t like them. But she didn’t listen. I don’t know
what I needed to say to her to get her to hear me.
•Therapist: She didn’t hear you.
•Client: No, she didn’t. I told her over and over, but she didn’t.
•Client: I told her over and over that I didn't want to go with her. But she
kept on saying I had to or else she’s feel so alone. But there were going to
be people there that I didn’t want to see.
•Therapist: She kept on trying to get you to go.
•Client: Yes, and I kept telling her I didn’t want to go. That’s not my scene.
She’s my friend, but those people aren’t.
•Therapist: You don’t want to hang around with those other people.
•Client: No, I told her I didn’t like them. But she didn’t listen. I don’t know
what I needed to say to her to get her to hear me.
•Therapist: She didn’t hear you.
•Client: No, she didn’t. I told her over and over, but she didn’t.
•Therapist should not interrupt the client to provide a
paraphrase. It should come in the natural flow and
breaks in the conversation.
paraphrase. It should come in the natural flow and
breaks in the conversation.
General and Specific Paraphrases
Client: Can things get any worse? Today, I woke up and stubbed my
toe on the way to the bathroom, the hot water was not working on
the shower, I cut myself while slicing a bagel, I got caught in traffic for
an hour and was late for work, and then at work I forgot to bring in the
report that was due. After work, I got takeout for dinner, and after I
drove away, I realized that they gave me the wrong order.
Therapist: Wow, it seems like it was a rough day. (general paraphrase)
Therapist: You stubbed your toe and cut your hand. Traffic was so bad
you were late for work, and to boot, you left a work project at home.
Then to top it off, they gave you the wrong food order. (specific
paraphrase)
Client: Can things get any worse? Today, I woke up and stubbed my
toe on the way to the bathroom, the hot water was not working on
the shower, I cut myself while slicing a bagel, I got caught in traffic for
an hour and was late for work, and then at work I forgot to bring in the
report that was due. After work, I got takeout for dinner, and after I
drove away, I realized that they gave me the wrong order.
Therapist: Wow, it seems like it was a rough day. (general paraphrase)
Therapist: You stubbed your toe and cut your hand. Traffic was so bad
you were late for work, and to boot, you left a work project at home.
Then to top it off, they gave you the wrong food order. (specific
paraphrase)
Nonjudgmental paraphrases
•Client: I loaned Stacey a book. She said that she lost it. I’m not
sure I believe that, but she has not offered to buy me a new
one.
•Therapist: Stacey lost the book she borrowed from you, or
maybe even something more than lost, but now won’t buy
you a replacement. (judgmental)
•Therapist: You let Stacey borrow a book and now you’re not
sure what is going on or whether she will reimburse you for it.
(nonjudgmental)
•Client: I loaned Stacey a book. She said that she lost it. I’m not
sure I believe that, but she has not offered to buy me a new
one.
•Therapist: Stacey lost the book she borrowed from you, or
maybe even something more than lost, but now won’t buy
you a replacement. (judgmental)
•Therapist: You let Stacey borrow a book and now you’re not
sure what is going on or whether she will reimburse you for it.
(nonjudgmental)
Therapist can help avoid judgmental paraphrases by assuring
that clients know that the response, and the therapist’s
understanding of the situation, is the client’s understanding of
the situation rather than the therapist’s. This can be fostered
through certain phrase such as the following:
–“In your mind…”
–“For you…”
–“You think that…”
–“It seems to you…”
–“You get the sense that…”
that clients know that the response, and the therapist’s
understanding of the situation, is the client’s understanding of
the situation rather than the therapist’s. This can be fostered
through certain phrase such as the following:
–“In your mind…”
–“For you…”
–“You think that…”
–“It seems to you…”
–“You get the sense that…”
Use of metaphors
•The use of metaphors in therapy can be very
powerful way of understanding and relaying back to
the client the therapists perception of the clients
situation.
•Metaphors produce a vibrant picture that can pique
a client’s interest and ensure the clients knows the
therapist has a good grasp of the situation.
•The use of metaphors in therapy can be very
powerful way of understanding and relaying back to
the client the therapists perception of the clients
situation.
•Metaphors produce a vibrant picture that can pique
a client’s interest and ensure the clients knows the
therapist has a good grasp of the situation.
•Client: My parents said that I either have to get a job or get
out of the house. I went out today to look for a job but
nothing interested me. I looked in the newspaper, but all the
job ads were blah.
•Therapist: It’s like you were floating down a river with no
interesting docks, but you knew that your boat was slowly
sinking and you had to dock soon.
•Client: I don’t know what I’m supposed to do. I have to work
to keep food on that able for my family. I have to take care
of my parents because they are getting older. My younger
sister is having problems with drugs, so I am trying to help
her out. And at work, they expect me to do everything.
•Therapist: It’s like you’re trying to juggle five different knives
and there seems to be too many of them and they are
starting to slice you and give you pain.
out of the house. I went out today to look for a job but
nothing interested me. I looked in the newspaper, but all the
job ads were blah.
•Therapist: It’s like you were floating down a river with no
interesting docks, but you knew that your boat was slowly
sinking and you had to dock soon.
•Client: I don’t know what I’m supposed to do. I have to work
to keep food on that able for my family. I have to take care
of my parents because they are getting older. My younger
sister is having problems with drugs, so I am trying to help
her out. And at work, they expect me to do everything.
•Therapist: It’s like you’re trying to juggle five different knives
and there seems to be too many of them and they are
starting to slice you and give you pain.
Advanced Reflecting Skills
•Reflection of Feeling
–By reaching the feeling level of the client’s
discourse, client and therapist can both try to
achieve a richer understanding of the client’s
contextual frame for the problem.
•Reflection of Feeling
–By reaching the feeling level of the client’s
discourse, client and therapist can both try to
achieve a richer understanding of the client’s
contextual frame for the problem.
•Defining Empathy
–Empathy is the combination of accurately
reflecting content, feelings and meanings, along
with a therapist mind-set of perceiving the client’s
phenomenological worldview.
–Therapists must “be present” during a therapeutic
interview to be able to connect to the material
and processes occurring in the therapy room.
–Empathy is the combination of accurately
reflecting content, feelings and meanings, along
with a therapist mind-set of perceiving the client’s
phenomenological worldview.
–Therapists must “be present” during a therapeutic
interview to be able to connect to the material
and processes occurring in the therapy room.
•Emotional empathy, the therapist gains an
understanding of what the client’s feelings are and
responds to the client so that his understanding is
known.
•Cognitive empathy, the therapist gains an
understanding of the values, worldview, and
intentions of the client and responds so that this
understanding is known .
understanding of what the client’s feelings are and
responds to the client so that his understanding is
known.
•Cognitive empathy, the therapist gains an
understanding of the values, worldview, and
intentions of the client and responds so that this
understanding is known .
•There are many ways to respond in a reflection to let the
client know the therapist heard the emotive expression.
When the client provides her own feeling word, the therapist
then has a choice of using this word in the reflection .
Client: “I am just so angry, I can’t believe it.”
Therapist: “You are very angry.”
Client: “Yes, I can’t believe he did this to me.”
client know the therapist heard the emotive expression.
When the client provides her own feeling word, the therapist
then has a choice of using this word in the reflection .
Client: “I am just so angry, I can’t believe it.”
Therapist: “You are very angry.”
Client: “Yes, I can’t believe he did this to me.”
Responding with Reflections
•The first step in the reflection of feeling process is getting into
tune with the client’s experience- how the client is currently
feeling about the situation.
•The second step is for the therapeutic interview to let the
client know that her emotional position is understood. This is
done by taking the client's communication (both verbal and
nonverbal) and communicating these back to her.
The most basic way of doing this is to use the following
phrase, “You feel____.”
•The first step in the reflection of feeling process is getting into
tune with the client’s experience- how the client is currently
feeling about the situation.
•The second step is for the therapeutic interview to let the
client know that her emotional position is understood. This is
done by taking the client's communication (both verbal and
nonverbal) and communicating these back to her.
The most basic way of doing this is to use the following
phrase, “You feel____.”
Example:
Client: “I can’t seem to stop drinking. Although I want to stop, I
seem to always wind up with a beer in my hand.”
Therapist: “You feel frustrated.”
Client: “I can’t seem to stop drinking. Although I want to stop, I
seem to always wind up with a beer in my hand.”
Therapist: “You feel frustrated.”
Exercise
1.I’m not really good at anything. Nobody likes me. At times, I
don’t even like me.
2.My house just got foreclosed on. Now I have nothing.
3.Although relationships haven't worked out for me in the
past, I think that this present will be different.
4.When I got up in the front of the room to do my
presentation, I couldn’t remember anything. I flubbed the
whole thing in front of all those people.
5.I was hoping that my friend would help me out this week. I
really needed her help. She told me she would call me back,
but she never did.
1.I’m not really good at anything. Nobody likes me. At times, I
don’t even like me.
2.My house just got foreclosed on. Now I have nothing.
3.Although relationships haven't worked out for me in the
past, I think that this present will be different.
4.When I got up in the front of the room to do my
presentation, I couldn’t remember anything. I flubbed the
whole thing in front of all those people.
5.I was hoping that my friend would help me out this week. I
really needed her help. She told me she would call me back,
but she never did.
•When the therapist reflects the feeling of the client’s
statement, the client experience the reflection to check in
with herself and see if the reflection is accurate and fits. If it
does not fit, the client will let the therapist know.
Client: I don’t know about this new position. I’m not sure
I’m ready.
Therapist: It sound like you’re feeling anxious.
Client: Not exactly. It’s more like I am feeling scared
rather than anxious.
statement, the client experience the reflection to check in
with herself and see if the reflection is accurate and fits. If it
does not fit, the client will let the therapist know.
Client: I don’t know about this new position. I’m not sure
I’m ready.
Therapist: It sound like you’re feeling anxious.
Client: Not exactly. It’s more like I am feeling scared
rather than anxious.
Client: I don’t think I want to be with my wife anymore. I can’t
stand her. I can’t take going home at night knowing that I’m
going to have an argument with her.
Therapist: You’re angry at your wife and frustrated at having
all these arguments with her.
Client: That’s right. Why doe she keep on attacking me?
Therapist: I get the sense that there is something more going
on for you. Maybe it is that you are disappointed in how things
are working out in the marriage.
Here the first therapist’s reflection is a basic reflection of
feeling based on the first clients first statement. The second
therapist reflection attempts to take a step forward and go for
a deeper level of feeling of the client.
stand her. I can’t take going home at night knowing that I’m
going to have an argument with her.
Therapist: You’re angry at your wife and frustrated at having
all these arguments with her.
Client: That’s right. Why doe she keep on attacking me?
Therapist: I get the sense that there is something more going
on for you. Maybe it is that you are disappointed in how things
are working out in the marriage.
Here the first therapist’s reflection is a basic reflection of
feeling based on the first clients first statement. The second
therapist reflection attempts to take a step forward and go for
a deeper level of feeling of the client.
Phrasing reflections
–There are many ways to phrase reflection of feelings.
A key is to vary the reflections so the therapists is not
reflecting in the same way every time. Here are some
ways:
•It seems that…
•I hear that you feel…
•[feeling] seems to be a big issue for you right now
•This makes you [feeling]
•You get anxious when test time comes around
•Fear seems to be the major thing for you right now
–There are many ways to phrase reflection of feelings.
A key is to vary the reflections so the therapists is not
reflecting in the same way every time. Here are some
ways:
•It seems that…
•I hear that you feel…
•[feeling] seems to be a big issue for you right now
•This makes you [feeling]
•You get anxious when test time comes around
•Fear seems to be the major thing for you right now
Paraphrase or Reflection
•Reflections differ from paraphrases in that paraphrases focus
on the content (story, thoughts, ideas, beliefs, situations),
while reflections focus on the feelings the person
experienced.
•Being able to distinguish between the content and feeling of a
response is an extremely important skill. The more therapists
can hear the multiple levels in the clients communication, the
better the chance that they will be able to address the client’s
most pressing concerns.
•Reflections differ from paraphrases in that paraphrases focus
on the content (story, thoughts, ideas, beliefs, situations),
while reflections focus on the feelings the person
experienced.
•Being able to distinguish between the content and feeling of a
response is an extremely important skill. The more therapists
can hear the multiple levels in the clients communication, the
better the chance that they will be able to address the client’s
most pressing concerns.
Reflection of Nonverbal Feelings
–When a client turns away from the therapist, lowers
her voice, pulls her arms in to her body, or does any
of a million other behaviors, these might be clues for
the therapeutic interviewer of how the client might
be feeling at the moment.
–If the discussion in the session is about a past trauma
and the client’s body starts to curl into a ball, the
therapist might get a sense that the client is having a
difficult time thinking or talking about this. The
therapist can reflect, “This is till upsetting you today,
right?”
–When a client turns away from the therapist, lowers
her voice, pulls her arms in to her body, or does any
of a million other behaviors, these might be clues for
the therapeutic interviewer of how the client might
be feeling at the moment.
–If the discussion in the session is about a past trauma
and the client’s body starts to curl into a ball, the
therapist might get a sense that the client is having a
difficult time thinking or talking about this. The
therapist can reflect, “This is till upsetting you today,
right?”
QUESTIONS AND GOAL SETTING
SKILLS
Asking Purpose Questions and
Developing Collaborative Therapeutic
Goals
SKILLS
Asking Purpose Questions and
Developing Collaborative Therapeutic
Goals
The purpose of questions, as with
paraphrasing and reflections, is to
help the therapeutic interviewer
better understand the client’s
worldview while also setting the stage
for the client to move toward change.
paraphrasing and reflections, is to
help the therapeutic interviewer
better understand the client’s
worldview while also setting the stage
for the client to move toward change.
Why questions are important
•Questions help begin the interview (e.g., What bring you in
today How can I help you? How have things been since the
last time we met?)
•Open ended questions help elaborate and enrich the clients
story.
•Questions help bring out concrete specifics of the client’s
world. (e.g., Could you give me a specific example.)
•Questions are critical in assessment ( Questions are a quick
way to determine what the clients primary problem areas are
and the duration, intensity, frequency, form, course, and
consequences of these)
•Questions help begin the interview (e.g., What bring you in
today How can I help you? How have things been since the
last time we met?)
•Open ended questions help elaborate and enrich the clients
story.
•Questions help bring out concrete specifics of the client’s
world. (e.g., Could you give me a specific example.)
•Questions are critical in assessment ( Questions are a quick
way to determine what the clients primary problem areas are
and the duration, intensity, frequency, form, course, and
consequences of these)
•The first word of a certain open questions
particularly determines what the client will
say next.
–WHAT questions tend to lead to facts
–HOW questions to discussion of sequences
–WHY questions to reasons
–COULD questions give the client more freedom to
participate or not and to answer in his own
manner.
particularly determines what the client will
say next.
–WHAT questions tend to lead to facts
–HOW questions to discussion of sequences
–WHY questions to reasons
–COULD questions give the client more freedom to
participate or not and to answer in his own
manner.
Drawback of Questioning
•Questions have potential problems. (e.g., being too
inquisitive, making clients feel defensive)
•In cross cultural situations, question can promote
distrust
•Questions have potential problems. (e.g., being too
inquisitive, making clients feel defensive)
•In cross cultural situations, question can promote
distrust
Open and closed questions
–Open questions allow room for the client to
express himself in ways that make sense to him
–There are two types:
•Highly open questions provide very few restrictions
and leave the field very open (e.g., What would you like
to talk about today?
•Moderately open questions tend to have somewhat
narrower focus (e.g., What about work would you
want to talk about today?)
–Open questions allow room for the client to
express himself in ways that make sense to him
–There are two types:
•Highly open questions provide very few restrictions
and leave the field very open (e.g., What would you like
to talk about today?
•Moderately open questions tend to have somewhat
narrower focus (e.g., What about work would you
want to talk about today?)
•Closed questions are best used
when specific information is
needed. (e.g., are you currently
married?)
•Some problems with closed
questions:
–The client might think that the
therapist will take charge of the
whole session., thus making the
client with passive role at the
start of therapy
–The more closed questions, the
more it comes across as an
interrogation.
–Closed questions do not work
well with a client who is not very
verbal.
when specific information is
needed. (e.g., are you currently
married?)
•Some problems with closed
questions:
–The client might think that the
therapist will take charge of the
whole session., thus making the
client with passive role at the
start of therapy
–The more closed questions, the
more it comes across as an
interrogation.
–Closed questions do not work
well with a client who is not very
verbal.
•Open questions tend to be preferred by
clients, therapists, and therapy instructors.
•One of the biggest skills for a novice therapist
is to be able to take a closed question and
reword it into an open question before it ever
gets asked.
Exercise.
“Do you want to go to the movies this
weekend?” (closed)
“What are your thoughts on going to the
movies this weekend?” (open)
clients, therapists, and therapy instructors.
•One of the biggest skills for a novice therapist
is to be able to take a closed question and
reword it into an open question before it ever
gets asked.
Exercise.
“Do you want to go to the movies this
weekend?” (closed)
“What are your thoughts on going to the
movies this weekend?” (open)
Exercise
Reword the followings statement so that they become open
questions:
1.Is not being around your stepfather the main thing you
want?
2.Are you willing to change?
3.Did you do anything about your depression?
4.Do you realize the connection that you and your mother
have?
5.When did this problem start?
Reword the followings statement so that they become open
questions:
1.Is not being around your stepfather the main thing you
want?
2.Are you willing to change?
3.Did you do anything about your depression?
4.Do you realize the connection that you and your mother
have?
5.When did this problem start?
•Sommers-Flanagan and Sommers-Flanagan (2003) proposed a
third type of question: SWING QUESTIONS
•These are questions that can be answered with a yes or no
answer, but are really intended to get clients to respond with
a lengthier answer.
EXAMPLE
–“Could you tell me about what you were thinking when
you found out your wife was cheating on you?”
–“Would you talk more about what that was like when you
were in that confrontations?”
–“Will you discuss what you did last week to work on your
problem?”
third type of question: SWING QUESTIONS
•These are questions that can be answered with a yes or no
answer, but are really intended to get clients to respond with
a lengthier answer.
EXAMPLE
–“Could you tell me about what you were thinking when
you found out your wife was cheating on you?”
–“Would you talk more about what that was like when you
were in that confrontations?”
–“Will you discuss what you did last week to work on your
problem?”
•Avoid rapid fire questioning, where clients tend to be put
off and feel like they are being interrogated.
•Avoid leading questions
1.You care about your mother, don’t you? (Leading)
What are your feelings toward your mother?
(Nonleading)
2.How can you think that it’s okay to treat someone that
way? (Leading)
What are your views on how people should be with one
another? (Nonleading)
off and feel like they are being interrogated.
•Avoid leading questions
1.You care about your mother, don’t you? (Leading)
What are your feelings toward your mother?
(Nonleading)
2.How can you think that it’s okay to treat someone that
way? (Leading)
What are your views on how people should be with one
another? (Nonleading)
Goal Setting
•Once the therapeutic interviewer and client have discussed the
issues that brought the client to therapy, they can collaboratively
work on goals to make the therapeutic encounter useful.
•Goals can help motivate clients to continue on the path to where
they want to go.
•Therapists can distinguish between general goals and specific
goals.
–Feeling better, being happier, having a better relationship
(general)
–Moving out of the house, starting a job, getting out of bed
before 10 am (specific)
•Once the therapeutic interviewer and client have discussed the
issues that brought the client to therapy, they can collaboratively
work on goals to make the therapeutic encounter useful.
•Goals can help motivate clients to continue on the path to where
they want to go.
•Therapists can distinguish between general goals and specific
goals.
–Feeling better, being happier, having a better relationship
(general)
–Moving out of the house, starting a job, getting out of bed
before 10 am (specific)
•Although each client has his own unique goals that
bring him into therapy, there are some fundamental
therapeutic goals that occur across models of therapy
(Kleinke, 1994):
1.Helping clients overcome demoralization and gain hope
2.Enhancing clients sense of mastery and self efficacy
3.Encouraging clients to face their anxieties rather than
avoiding them
4.Helping clients become aware of their misconceptions
5.Teaching clients to accept life's realities
6.Helping clients achieve insight
bring him into therapy, there are some fundamental
therapeutic goals that occur across models of therapy
(Kleinke, 1994):
1.Helping clients overcome demoralization and gain hope
2.Enhancing clients sense of mastery and self efficacy
3.Encouraging clients to face their anxieties rather than
avoiding them
4.Helping clients become aware of their misconceptions
5.Teaching clients to accept life's realities
6.Helping clients achieve insight
•To get things moving in the direction of goals, therapeutic
interviewers can work on in therapy. Therapists can work on a
goal for each session or for the whole of therapy.
interviewers can work on in therapy. Therapists can work on a
goal for each session or for the whole of therapy.
Components of good goals
–Small rather than large
•My life will be right (bad goal)
•I will begin looking for a job (good goal)
–Salient to clients (goals need to be desired by the
client)
•I will not go out so much because my wife doesn't like it. (bad
goal)
•I will come home at 5:30pm because I want to spend time
with my family (good goal)
–Described in specific, concrete behavioral terms
•I will do better in relationships (bad goal)
•I will ask someone out in the next week (good goal)
–Small rather than large
•My life will be right (bad goal)
•I will begin looking for a job (good goal)
–Salient to clients (goals need to be desired by the
client)
•I will not go out so much because my wife doesn't like it. (bad
goal)
•I will come home at 5:30pm because I want to spend time
with my family (good goal)
–Described in specific, concrete behavioral terms
•I will do better in relationships (bad goal)
•I will ask someone out in the next week (good goal)
–Achievable within the practical contexts of clients lives
•I will win the lottery (bad goal)
•I will open up a bank account and put in 5 % of my
paycheck every week. (good goal)
–Goals should be inclusive of the client’s hard work (in
the clients control)
•My child will start listening to me more. (bad goal)
•I will use a token economy system to try to help my child
stay on target more.” (good goal)
•I will win the lottery (bad goal)
•I will open up a bank account and put in 5 % of my
paycheck every week. (good goal)
–Goals should be inclusive of the client’s hard work (in
the clients control)
•My child will start listening to me more. (bad goal)
•I will use a token economy system to try to help my child
stay on target more.” (good goal)
–Goals should be able to be implemented
immediate (in the here and now)
•Next year, I will start to treat my family better (bad
goal)
•Today, when I go home, I will give each member of my
family a compliment (good goal)
immediate (in the here and now)
•Next year, I will start to treat my family better (bad
goal)
•Today, when I go home, I will give each member of my
family a compliment (good goal)
Endings in Therapy
Summarizing, Ending Session, and
Termination
Summarizing, Ending Session, and
Termination
•Young (2005) delineated four different types of
summaries
–A signal summary occurs when therapeutic
interviewer and client have fully addressed one
specific client issue.
•Therapist: “I would like to take a second and summarize
everything we have been discussing so far today. You talked
about a situation that happened at work where you boss
yelled at you. You were supposed to follow through on a
project and did not do so in a time frame that you boss
wanted . You seemed shocked that you r boss reacted that
way. Further you were disappointed in f\yourself for not
being as on the ball with this obligation because you think of
yourself as very diligent employee. Is that gift of it?”
summaries
–A signal summary occurs when therapeutic
interviewer and client have fully addressed one
specific client issue.
•Therapist: “I would like to take a second and summarize
everything we have been discussing so far today. You talked
about a situation that happened at work where you boss
yelled at you. You were supposed to follow through on a
project and did not do so in a time frame that you boss
wanted . You seemed shocked that you r boss reacted that
way. Further you were disappointed in f\yourself for not
being as on the ball with this obligation because you think of
yourself as very diligent employee. Is that gift of it?”
–A planning summary occurs at the end of the
therapeutic interview. It is a review of what was
discussed in the session so that the client can take the
knowledge and move beyond the interview.
•Therapist: “We are just about finished for todays session. I
was hoping that we could review what we covered. You
were discussing how you were feeling lonely and were
hoping to feel more connected to other people. During the
session, you talked about how one of the things that you
wanted to do was to g out more. This might be a good place
to start next session discussing what you did during the
week to get out of the house more than you have been. “
therapeutic interview. It is a review of what was
discussed in the session so that the client can take the
knowledge and move beyond the interview.
•Therapist: “We are just about finished for todays session. I
was hoping that we could review what we covered. You
were discussing how you were feeling lonely and were
hoping to feel more connected to other people. During the
session, you talked about how one of the things that you
wanted to do was to g out more. This might be a good place
to start next session discussing what you did during the
week to get out of the house more than you have been. “
–A focusing summary occurs in the beginning of
the therapeutic interview and helps to give the
interview focus.
•Therapist: "To begin today session, I’d like to talk about
where we've been. This will help us see where we
want to go. In past sessions, you have discussed the
idea that for several years you’ve been quite anxious.
This feeling has been increasing in intensity for you
lately. You’ve also talked about feeling lost inn terms of
what type of career you want for yourself. Perhaps we
can begin there today.”
the therapeutic interview and helps to give the
interview focus.
•Therapist: "To begin today session, I’d like to talk about
where we've been. This will help us see where we
want to go. In past sessions, you have discussed the
idea that for several years you’ve been quite anxious.
This feeling has been increasing in intensity for you
lately. You’ve also talked about feeling lost inn terms of
what type of career you want for yourself. Perhaps we
can begin there today.”
–A thematic summary occurs after many different
client issues have been addressed. The therapist is
able to connect themes that are running through
several client issues.
•Therapist: “I wanted to take a minute to talk to you about
some of the interesting connections that I've been hearing in
many of the issues we have been talking about. There seems
to be a thread running through our discussions, that of
disappointment. you have been disappointed by your
parents nor respecting you as an adult. You’ve also been
disappointed that your romantic relationships don’t seem to
materialize in the way that you envisioned them. Lastly, it
seems you be been disappointed in yourself that you are not
in the place in your life where you were hoping to be. What
do you think of this?”
client issues have been addressed. The therapist is
able to connect themes that are running through
several client issues.
•Therapist: “I wanted to take a minute to talk to you about
some of the interesting connections that I've been hearing in
many of the issues we have been talking about. There seems
to be a thread running through our discussions, that of
disappointment. you have been disappointed by your
parents nor respecting you as an adult. You’ve also been
disappointed that your romantic relationships don’t seem to
materialize in the way that you envisioned them. Lastly, it
seems you be been disappointed in yourself that you are not
in the place in your life where you were hoping to be. What
do you think of this?”
Ending a session
–It can be difficult because it reminds the therapist and
the client that their meeting is based on a business
relationship.
–It is also difficult because some clients tend to bring
up some of the most important issues right before the
end of the session. Therapist then have to wrap up
the session without trivializing the client’s concerns.
–It can be difficult because it reminds the therapist and
the client that their meeting is based on a business
relationship.
–It is also difficult because some clients tend to bring
up some of the most important issues right before the
end of the session. Therapist then have to wrap up
the session without trivializing the client’s concerns.
Example:
–Therapist: “Jean, we have about five minutes left. Why
don’t we spend the last few minutes we have together
today talking about what you are taking away from this
session and how you might use the time between now
and the next session. “
–Letting the client know how much time is left in
the session is a respectful means of orienting her
to decide what she wants to do with the
remaining time.
–Therapist: “Jean, we have about five minutes left. Why
don’t we spend the last few minutes we have together
today talking about what you are taking away from this
session and how you might use the time between now
and the next session. “
–Letting the client know how much time is left in
the session is a respectful means of orienting her
to decide what she wants to do with the
remaining time.
•Ending a session on time has several important
benefits.
–It keeps the relation grounded in that the client does
not feel extra special because the therapist went
above and beyond normal protocol
–It keeps therapists on track so that they are not late
with their next session
–It keeps the therapist grounded in a business
relationship.
–The client is sent a message of keeping focused during
the whole of the session and utilizing all the available
time.
benefits.
–It keeps the relation grounded in that the client does
not feel extra special because the therapist went
above and beyond normal protocol
–It keeps therapists on track so that they are not late
with their next session
–It keeps the therapist grounded in a business
relationship.
–The client is sent a message of keeping focused during
the whole of the session and utilizing all the available
time.
How to keep time
–Wear a watch and periodically look at it or watch
the clients watch
–Look at the clock in the room, perhaps behind the
client’s chair
–Have timer that makes subtle noise when there is
a certain amount of time left (e.g., 5 minutes
before the time)
–Wear a watch and periodically look at it or watch
the clients watch
–Look at the clock in the room, perhaps behind the
client’s chair
–Have timer that makes subtle noise when there is
a certain amount of time left (e.g., 5 minutes
before the time)
Therapist can let clients know in several ways that the session
has come to an end
–“We are just about out of time. What would you like to do
about the next sessions?”
–“Just to wrap up what we talked about today, you stated
that…”
–(Transition to another topic) “This seem like good place to
end for the day. I saw on the news that the weather is
going to be pretty nasty this weekend, so hopefully you
stay safe.”
has come to an end
–“We are just about out of time. What would you like to do
about the next sessions?”
–“Just to wrap up what we talked about today, you stated
that…”
–(Transition to another topic) “This seem like good place to
end for the day. I saw on the news that the weather is
going to be pretty nasty this weekend, so hopefully you
stay safe.”
TERMINATION
•Termination in therapy can be one of the most difficult parts
of the whole process, yet it can also be extremely gratifying.
–Client initiated endings
•Client: “I’m thinking that I really don't need to come back
anymore.”
•Therapist. “I would have to disagree. Although you have
made some gains, I really fear that you’ll just go right back
into the pattern that brought you here in the first place.”
•Termination in therapy can be one of the most difficult parts
of the whole process, yet it can also be extremely gratifying.
–Client initiated endings
•Client: “I’m thinking that I really don't need to come back
anymore.”
•Therapist. “I would have to disagree. Although you have
made some gains, I really fear that you’ll just go right back
into the pattern that brought you here in the first place.”
–Therapist initiated endings
•If therapist believe that they are not the best suited to work
with a client, they should make referral to someone who is
more qualified
•Client has accomplished the goals.
–Therapist. “I’m not sure how much you have thought about this,
but I would like to talk about the progress you have made over
the course of our meetings. When you first came in, you stated
you were not doing very well. We've met seven times, and by your
statements, things have really changed of you. Personally, I think
you have done a really great job taking control of your life and
other things to get things back in order. I’m really impressed with
what you’ve accomplished. I'm so impressed that I think that this
actually is s very good time for us to talk bout wrapping things up.
I would like you to take this next to think about all of the progress
you have made and when you come back next week, we cant talk
about your thoughts now whether you need to come back
anymore. “
•If therapist believe that they are not the best suited to work
with a client, they should make referral to someone who is
more qualified
•Client has accomplished the goals.
–Therapist. “I’m not sure how much you have thought about this,
but I would like to talk about the progress you have made over
the course of our meetings. When you first came in, you stated
you were not doing very well. We've met seven times, and by your
statements, things have really changed of you. Personally, I think
you have done a really great job taking control of your life and
other things to get things back in order. I’m really impressed with
what you’ve accomplished. I'm so impressed that I think that this
actually is s very good time for us to talk bout wrapping things up.
I would like you to take this next to think about all of the progress
you have made and when you come back next week, we cant talk
about your thoughts now whether you need to come back
anymore. “
–Mutually Initiated endings
–Forced Terminations
•Occur when one of the members of the therapeutic
system is moving away, has been released from a
counseling center, or will no longer be serving in a
therapist capacity.
•Spacing of sessions when one is leaving….
–Forced Terminations
•Occur when one of the members of the therapeutic
system is moving away, has been released from a
counseling center, or will no longer be serving in a
therapist capacity.
•Spacing of sessions when one is leaving….
•Dealing with dependency
–Therapists can help decrease the possibility that clients
will feel dependent on them by helping clients to connect
with people in their social field. From beginning of
therapy, this can be one of the main goals. The more that
clients can go to other people besides the therapist for
sense of companionship, the less likely it is they will feel so
desperate that no one else would understand them.
–Therapists can help decrease the possibility that clients
will feel dependent on them by helping clients to connect
with people in their social field. From beginning of
therapy, this can be one of the main goals. The more that
clients can go to other people besides the therapist for
sense of companionship, the less likely it is they will feel so
desperate that no one else would understand them.
–Another way is not allowing the client to give the therapist
credit for positive change. The client takes most, if not all,
credit for positive movement.
Client: “You changed my life.”
Therapist. “m not the one who made those changes, you
were!”
credit for positive change. The client takes most, if not all,
credit for positive movement.
Client: “You changed my life.”
Therapist. “m not the one who made those changes, you
were!”
•Referrals
–Referring a client to someone else does not mean
the therapist or the therapy was failure. It means
the therapist believes there is someone else who
is more suited to work with that particular client,
dealing with that particular issue, or working in a
specific approach the client deisres.
–Referring a client to someone else does not mean
the therapist or the therapy was failure. It means
the therapist believes there is someone else who
is more suited to work with that particular client,
dealing with that particular issue, or working in a
specific approach the client deisres.
PITFALLS OF THERAPY
How to avoid being
ineffective
How to avoid being
ineffective
Common Mistakes in Microskills
•“WHY” questions
–The question puts clients in a defensive position since if
they knew the answer to why, they might not go to
therapy in the first place
–Most people respond defensively when asked why
questions
•“WHY” questions
–The question puts clients in a defensive position since if
they knew the answer to why, they might not go to
therapy in the first place
–Most people respond defensively when asked why
questions
–Why questions are problematic partly because they may
come from the therapists own curiosity rather than as
thoughtful ways to help the client.
–Instead of asking why questions, therapists can ask how
and what questions.
•Why have you chosen this path for yourself?
•What has been your decision-making process for going on this
path or how have you decided to take this path?
come from the therapists own curiosity rather than as
thoughtful ways to help the client.
–Instead of asking why questions, therapists can ask how
and what questions.
•Why have you chosen this path for yourself?
•What has been your decision-making process for going on this
path or how have you decided to take this path?
“I understand”
–This is good but when the therapist tried to be so overt
about understanding the client, the client then has to
provide to the therapist that the therapist does not fully
understand.
–Instead of “I understand”, therapist can utilize paraphrases
and reflections. The client will know the therapist
understands because of the accuracy of the reflections.
–This is good but when the therapist tried to be so overt
about understanding the client, the client then has to
provide to the therapist that the therapist does not fully
understand.
–Instead of “I understand”, therapist can utilize paraphrases
and reflections. The client will know the therapist
understands because of the accuracy of the reflections.
“Basically”
–If a therapist begins a reflection with “Basically” the
therapist is minimizing the client's situation. It takes
everything that the client has said that is going wrong
(remember, clients come to therapy because life is not
good or not good enough and pouts it into one small
package. This can feel belittling to the client)
–If a therapist begins a reflection with “Basically” the
therapist is minimizing the client's situation. It takes
everything that the client has said that is going wrong
(remember, clients come to therapy because life is not
good or not good enough and pouts it into one small
package. This can feel belittling to the client)
“How does that make you feel”
–It is extremely trite (commonplace)
–Some alternatives:
•What’s going on for you when that happens
•What is that like for you
•How is it for you when that happens
–It is extremely trite (commonplace)
–Some alternatives:
•What’s going on for you when that happens
•What is that like for you
•How is it for you when that happens
Using jargon or technical language
Client. “So as I've stated, my life is really bad right now.”
Therapist. “Well, it seems that you have been dealing with
an Oedipal dilemma and are fixated in an early stage of
development.”
Client. “WHAT?”
Client. “So as I've stated, my life is really bad right now.”
Therapist. “Well, it seems that you have been dealing with
an Oedipal dilemma and are fixated in an early stage of
development.”
Client. “WHAT?”
Common intrapersonal mistakes
–Detachment (different from therapeutic
detachment)
–Going for quick solutions
Therapist: “My recommendation would be that you start
to keep a log of your eating.”
Client. “I've already been doing that for two months
now, and nothing has changed.”
Therapist. “Well then, perhaps you can try to exercise at
least 30 minutes a day.”
Client. “I do.”
–Detachment (different from therapeutic
detachment)
–Going for quick solutions
Therapist: “My recommendation would be that you start
to keep a log of your eating.”
Client. “I've already been doing that for two months
now, and nothing has changed.”
Therapist. “Well then, perhaps you can try to exercise at
least 30 minutes a day.”
Client. “I do.”
Moralizing
•Therapist: “Sean, I just wanted to let you know that I
don’t think how you're acting with your mother is right.
She is your mother. She deserves a certain amount of
respect, and I don’t think you are giving her that.”
•Therapist: “Sean, I just wanted to let you know that I
don’t think how you're acting with your mother is right.
She is your mother. She deserves a certain amount of
respect, and I don’t think you are giving her that.”
–Giving Advice
•Instead of giving advice, therapists are encouraged to
help clients come tot heir own conclusions about the
course of their lives.
–Being Over responsible
•The therapist may have a need to be wanted and so
does most of the work in therapy.
–Unrealistic expectations
•Expecting himself to be perfect and is upset with
himself for having problems. Or expecting the therapist
to solve the clients' life problems
•Instead of giving advice, therapists are encouraged to
help clients come tot heir own conclusions about the
course of their lives.
–Being Over responsible
•The therapist may have a need to be wanted and so
does most of the work in therapy.
–Unrealistic expectations
•Expecting himself to be perfect and is upset with
himself for having problems. Or expecting the therapist
to solve the clients' life problems
–False Understanding
•If the therapist does not quite understand, but falsely
states that she does, she runs risk of losing trust of
client.
–Giving Reassurance
•Therapist. Don’t worry. All things pass, eventually/.
Things will get better for you. You just need to keep
hanging in there, and it will happen
•If the therapist does not quite understand, but falsely
states that she does, she runs risk of losing trust of
client.
–Giving Reassurance
•Therapist. Don’t worry. All things pass, eventually/.
Things will get better for you. You just need to keep
hanging in there, and it will happen
–Confusing the diagnosis with the person
•Kottler and Blau (l989) discussed that when therapists,
before ever meeting the client, find out the client has
been diagnosed with a threatening label (e.g.,
borderline, anorexic), they might come into the
therapeutic encounter with a defensive attitude or
prejudice. This prevents them from connecting with the
client because they are mainly working with the
diagnosis rather than the person.
–Not accepting mistakes
•Kottler and Blau (l989) discussed that when therapists,
before ever meeting the client, find out the client has
been diagnosed with a threatening label (e.g.,
borderline, anorexic), they might come into the
therapeutic encounter with a defensive attitude or
prejudice. This prevents them from connecting with the
client because they are mainly working with the
diagnosis rather than the person.
–Not accepting mistakes
–Negative reactions to the client
•These are clues that there is a connection between
therapist and client.
–Therapist emotional distress
•These are clues that there is a connection between
therapist and client.
–Therapist emotional distress
Common interpersonal mistakes
–Friendship rather than therapy
–Arguing with clients
•E.g., therapist might be pro-life or anti gay.
–Boundary violations
•E.g., having sexual relations with the client, exploiting the
client, and gaining information from the client about non-
therapeutic issues for personal gain
–Other interpersonal mistakes
•Not caring about the client, lack of UPR, trying to impress
others, infantilizing clients.
–Friendship rather than therapy
–Arguing with clients
•E.g., therapist might be pro-life or anti gay.
–Boundary violations
•E.g., having sexual relations with the client, exploiting the
client, and gaining information from the client about non-
therapeutic issues for personal gain
–Other interpersonal mistakes
•Not caring about the client, lack of UPR, trying to impress
others, infantilizing clients.
Quote:
by Charles Ringma
“We cannot simply live for others. A life that is
totally focused on others and shows no regard for
itself will eventually disintegrate. The idea that
such a life is the highest form of spirituality is a
misunderstanding of the rhythm of the inner life.
That rhythm recognizes that we need to be
nurtured, refreshed and empowered if we are to
continue to give…
by Charles Ringma
“We cannot simply live for others. A life that is
totally focused on others and shows no regard for
itself will eventually disintegrate. The idea that
such a life is the highest form of spirituality is a
misunderstanding of the rhythm of the inner life.
That rhythm recognizes that we need to be
nurtured, refreshed and empowered if we are to
continue to give…
…Yet we cannot live for ourselves either. The
quest for solitude and inner strength can
never simply be for that. We are called to
serve the world in which we live. Such
serving is not simply a matter of techniques.
It is also a matter of personal encounter. It is
a matter of drawing close. It a matter of
care…
quest for solitude and inner strength can
never simply be for that. We are called to
serve the world in which we live. Such
serving is not simply a matter of techniques.
It is also a matter of personal encounter. It is
a matter of drawing close. It a matter of
care…
…Henri Nouwen reminds us that care means to be present
to the other person and warns that “cure without care
makes us preoccupied with quick changes, impatient and
unwilling to share each others’ burden”…
to the other person and warns that “cure without care
makes us preoccupied with quick changes, impatient and
unwilling to share each others’ burden”…
…This warning is well placed. We are usually
quick in offering counseling, healing and
helping strategies, and tend to blame the
other for a lack of commitment to our
strategies if results are not forthcoming.
We find it much more difficult to journey with
others, enter their places of pain as they are
opened up to us, offer friendship even when
there is no significant change, and seek to
empower rather than help…
quick in offering counseling, healing and
helping strategies, and tend to blame the
other for a lack of commitment to our
strategies if results are not forthcoming.
We find it much more difficult to journey with
others, enter their places of pain as they are
opened up to us, offer friendship even when
there is no significant change, and seek to
empower rather than help…
…To do this, we will
need to care with a
care that springs
from being nurtured
ourselves.”
need to care with a
care that springs
from being nurtured
ourselves.”
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