526- Clinical Counseling: Basic

Question 1

Active listening

Answer 1

Skills therapists use in therapy to demonstrate to the client that she understands and properly interprets what the client is saying and the client’s perspective. Active listening is demonstrated through nonverbal communication (nodding, eye contact), open/closed questions, making client observations (including assets), encouraging, summarizing, reflections. Example: A client avoids eye contact and speaks softly when describing her husband’s criticisms of her. The therapist leans forward, and says, “I notice that you spoke softly- how were you feeling when describing that?” By using nonverbal communication, an open ended question, the therapist is demonstrating active listening.

Question 2

Biopsychosocial

Answer 2

The biopsychosocial model is a way or organizing client problems into categories: biological, psychological, and social in case conceptualization. Example: In an initial interview, Ethel reports feeling down most of the day most days, and that her mother struggled with depression. She used to be very involved in her church and book club but has attended less often in recent months. The family history of depression is biological, her feelings of sadness are psychological, and her church/book club connections and withdrawal are social.

Question 3

Boundary crossing vs. violation

Question 4

Clarification

Answer 4

A therapeutic technique that is used to check whether the therapist understands what the client is saying; the therapist restates an unclear or ambiguous message to clarify client’s meaning. Therapist can clarify by using reflections or frequent summaries of info or feelings. EXAMPLE: Your client says, “I just feel like a failure.” You say, “Tell me what you mean by ‘failure,’” using clarification to ensure that you accurately understand what the client is saying.

Question 5

Client assets

Question 6

Client expectancies (outcome and process)

Question 7

Confrontation

Answer 7

A universal skill in which the therapist brings attention to discrepancies with something a client says or does. A therapist uses confrontation by making a statement (direct or indirect) that provides information to the client about the inconsistencies the therapist has noticed. This technique should only be used during middle and late phase of therapy after solid therapeutic relationship has been established. Confrontation demands a revelation from the client which may be painful or embarrassing, thus this technique should be used carefully- timing is important. Example: “You said earlier that you aren’t having any problems at work, but you just mentioned that you called-out of work three times last week. Can you tell me more about that?”

Question 8

Engagement

Answer 8

Engagement refers to the client’s level of involvement in the therapy process, including doing homework, being open to the process, and showing up to appointments. Therapists can foster engagement by using WEG skills, though it is also influenced by client variables. High levels of engagement are correlated with successful therapeutic outcomes. Example: A client shows up on time for appointments, has only canceled once when she was sick, and completes homework assignments. She participates fully in sessions, even when discussing painful topics. This client demonstrates a high level of engagement, indicating a likely successful therapeutic outcome.

Question 9

Fixed vs. growth mindset

Answer 9

Someone with a fixed mindset believes that attributes and abilities are inherently fixed and unchanging. Someone with a growth mindset believes that talents and abilities can be improved and developed. Example: Jerry didn’t get a job he interviewed for. He tells his therapist he is working to sharpen some of the skills the job would have required while he applies to similar postings. Jerry exhibits a growth mindset. Another client, Janet, says she isn’t applying to college because she isn’t smart enough. Janet believes her intelligence is static, which means she has a fixed mindset.

Question 10

Hierarchy of needs

Answer 10

Maslow pioneered the concept of a hierarchy of needs that humans have, as follows:- Physiological needs: food, water, warmth, rest- Safety needs- Belongingness and love needs- Esteem needs: prestige and feeling of accomplishment- Self-actualization: achieving one’s full potential Needs at the bottom of the hierarchy have to be fulfilled before a person can attempt to meet the ones at the top. Example: In therapy, Angela describes feeling unsafe at home because of her partner’s volatile and sometimes violent behavior. Her therapist should focus on equipping her to find a safe living situation before addressing issues of belongingness or achievement with Angela.

Question 11

Holding vs. shifting the focus

Answer 11

Therapeutic skills in which the therapist attempts to redirect the client’s attention towards a topic (holding focus) or away from a topic (shifting the focus). - Holding the focus: purposefully maintain the discussion on a singular subject.- Shifting the focus: the therapist redirects the client from an unproductive or irrelevant topic to a more therapeutic topic; the therapist might point out that the client appears to be avoiding or hesitant to discuss a specific topic, or simply shift the focus to it Example: Client begins to drift from talking about her own feelings of losing her mother to talking about how her children are handling it. Therapist focuses the client back on how she feels about the loss because she is the one seeking therapy. This is an example of holding the focus.

Question 12

Open-ended questioning

Answer 12

Open ended questions are a therapeutic technique used to move the conversation forward by minimizing the therapist’s perspective and encouraging the client to lead the way. Example: Asking “What was that like for you?” after the client describes a situation is open ended as opposed to “Did you feel angry when that happened?”.

Question 13

Paraphrasing

Answer 13

A universal skill that demonstrates the therapist is actively listening and understanding the content and feeling the client is communicating in which the therapist repeats what the client is saying in slightly different terms. Meaning, content, tone, and feeling are retained in the reflection. Example: Client says: “There is so much to do at home and at work, all the time, and I feel like I can barely handle it all. Paraphrase: “You are feeling overwhelmed by your responsibilities at home, at work, and in your relationships. Is that right?”

Question 14

Rapport

Question 15

Readiness to change

Question 16

Reassurance and bandaiding

Question 17

Reflection of content

Answer 17

A universal skill, to reflect content is a technique therapists employ in which they summarize the content of what a client is saying in therapy without changing the meaning. This technique allows clients to experience empathy and feel listened to and is important in the development of the therapeutic relationship. Reflections also allow clients to correct the record when necessary. Example: A client spends ten minutes discussing a fight she had with her husband. The therapists reflects the content by saying, “You fought over household responsibilities. He refuses to take on more. Then he left the house before the fight was resolved.”

Question 18

Reflection of feeling

Answer 18

A universal skill that demonstrates empathy and that the therapist is accurately assessing how a client feels about the story she is communicating. The therapist does this by briefly summarizing the feelings communicated by the client without changing the meaning. Example: “It sounds like you are feeling both sad and exhausted by what’s been happening.”

Question 19

Reflection of deeper meaning

Answer 19

A universal skill that demonstrates the therapist is actively listening and understands the deeper meaning of the story the client has told. The therapist does this by directly expressing what they believe the core beliefs, attitudes, and/or assumptions the client’s story reflects. Example: After a client describes all she does to take care of her family, and how she doesn’t feel there is time for her to take a walk by herself or go out with a friend, her therapist might say, “So you believe that your needs are secondary to your family’s.”

Question 20

Reframing

Answer 20

A brief therapy tool in which the therapist shifts the focus to a more positive direction, focusing on the deeper meaning behind the client’s words. Example: A client complains that there is no space for her to fall apart in the face of a stressful time, because everyone depends on her to keep an even keel and keep some semblance of normalcy. A reframe by the therapist might be, “Your family looks to you for stability and reassurance.”

Question 21

Minimal encouragers

Question 22

Miracle question

Answer 22

“The Miracle Question” is a therapeutic technique associated with Brief Solution Focused Therapy. The therapist asks a version of, “If a miracle happened and you woke up tomorrow and this problem was solved, how would things be different?” The goal is to identify the core issue; gather key indicators about positive change, promotes client’s visualization of resolution/progress/change. Example: When asked the miracle questions for a client describing difficulties in his marriage, he answers that a miracle would be feeling connected to his partner again and not fighting anymore. The therapist has now oriented his thinking towards solutions, and has identified some goals to hone in on.

Question 23

Scaling question

Question 24

Self-disclosure

Answer 24

Self-disclosure is when a therapist reveals details about himself to his client. Some self-disclosure is unavoidable, such as visual disclosures such as style choices, race, and age. Self-disclosure is a boundary crossing and should be done sparingly and only if it will benefit the client. Therapists should consider their online or social media presence, which is also a form of self-disclosure. Example: Susan’s client is reeling from the loss of her baby to stillbirth. Her therapist had a stillborn baby herself. The therapist chooses to disclose this detail because her therapeutic judgment tells her that it will help her client feel safe and understood to know she is speaking with someone who experienced the same thing, since one of the client’s biggest struggles is feeling that no one understands what it is like.

Question 25

Structuring

Answer 25

This technique is used to provide a clear direction in how the therapy session will go for that day. One way this occurs is by the therapist setting the stage by asking the client a specific question on their thoughts, behaviors, actions, etc. from the past week. The therapist may also discuss specific techniques that are used in therapy for the issue at hand. The therapist may also set the environment up for success by describing their role as the therapist, and the role of the client. Example: Allison is working through disordered eating behaviors with her therapist. Her therapist has asked her to keep notes on any time these behaviors have occurred between sessions. To structure the session at the outset, the therapist says, “As we begin therapy today, I’d like for you to discuss with me when you felt most debilitated by your relationship with food this past week.”

Question 26

Suicide risk assessment

Question 27

Summaries

Question 28

Termination

Answer 28

In clinical practice, termination is the hoped eventual for therapeutic outcome, and should be planned for from the first session. Ideally, discussion of termination begins after client has made progress. In a planned termination session, therapist should review of progress made, highlight gains, identify areas for future growth, ask about client experience, instill hope for future, and help the client process the experience. Signs that a client is ready to terminate include missed appointments, disengagement/slowed pace of progression, difficulty finding new areas to work on, lack of compliance. Example: Deirdre came to therapy for help managing social anxiety. After several months, Deirdre is participating in more social settings, and experiencing less anxiety after implementing strategies her therapist has recommended. Her therapist suggests it is time to discuss termination, highlighting the progress she has made and assuring her that she can return to therapy in the future if need be.

Question 29

Therapeutic alliance

Question 30

Transference/countertransference

Answer 30

Transference is when clients undergoing clinical therapy begin to transfer feelings of a particular person in their lives to their therapist. Countertransference is when a client triggers a particular response (or urge to respond) in the therapist. Example: Sonya has a very difficult relationship with her mother, and shuts down to avoid conflict often. When her therapist notices her shutting down and acting withdrawn in therapy, she recognizes it as an instance of transference in which Sonya has transferred the feelings she has toward her mother to the therapist.

Question 31

WEG skills

Answer 31

Drawn from the humanistic approach, WEG skills include warmth, empathy, and genuineness. These skills help clients feel understood, heard, and respected. Example: