526 - Clinical Counseling Basic Flashcards
active listening
WHAT: Psychotherapeutic technique where the therapist shows they are listening to the client (verbal + nonverbal comm.)
Involves…
- asking open/closed ended questions to better understand
- minimal encouragers
- paraphrasing
- summarizing
- reflection of feeling or mood
- body language that conveys attention to client
WHY: Important as it shows the client you understand/are interested in what they’re saying, and fosters trust and a good therapeutic alliance. It allows the therapist to support and validate the client, and to identify any issues/patterns.
EXAMPLE: A client is telling her therapist that she spends a lot of time studying for school, but her grades are still subpar. The client says she feels no matter how hard she tries, her grades don’t improve. The therapist may validate and summarize what the client said by saying, “It sounds like you’re putting a lot of effort in and not seeing any results. That sounds so frustrating.”
biopsychosocial
WHAT: A model that considers the biological, psychological, and social factors when looking at mental disorders.
- can be used to explain cause(s) of a disorder
Biological = genetic vulnerability, disability, physical health
Psychological = behavior, personality, attitudes/beliefs
Social = social support, family history, peer relationships
WHY: Important as it helps to create a comprehensive conceptualization of a client. Aids in psychoeducation to explain how the factors all interact and how/why a disorder may have come about. Also demonstrates the importance of maintaining wellness in all areas of life. May also guide targets of treatment.
EXAMPLE: A therapist is working to assess a client using the biopsychosocial model. The therapist may ask about any history of mental illness in their family (bio), the severity of the client’s presenting concerns (psycho), and if the client has a social support system (social).
boundary crossing vs violation
WHAT: Boundaries that place limits on the therapist-client relationship
- involve physical boundaries or topics that are off limits
Boundary crossing = deviation from standard practice, may or may not be harmful, could be beneficial (ex: therapist hugging client after hard session) — use clinical judgement!!
Boundary violation = serious violation of ethical standards, causes harm to client (ex: having sex with client)
WHY: Important to remember a therapist must adhere to ethical codes regarding boundaries, but can use clinical judgement regarding boundary crossings.
Respecting boundaries are done to protect the therapeutic relationship and the client’s well-being.
EXAMPLE: A therapist is deciding if they should hug a very upset client following a hard session. The therapist considers the client’s culture, their comfort level surrounding physical touch, professional guidelines, and nature of their therapeutic relationship. The therapist uses their clinical judgment to decide this boundary crossing is fine as it will benefit and comfort the client.
clarification
WHAT: A counseling technique in which the therapist restates something a client has said to ask for clarity AND/OR ensure they’re accurately understanding it
“Let me make sure I’m hearing this correctly…”
- can use reflections or summaries
- helps to avoid miscommunication
- can be used to confirm/deny a deeper meaning
WHY: Important as it helps to avoid miscommunication or clarify a deeper meaning. Shows the client that they’re being heard. May also allow clients insight.
EXAMPLE: If a client says they’ve been feeling “off” lately, the therapist may ask for clarification as to what “off” means to them.
client assets
WHAT: Client’s strengths, resources, or positive qualities
- assets can be used to aid in the therapeutic process
Can be internal (positive qualities, goal-oriented mindset) or external (social support, stable job)
WHY: Important be aware of what assets a client has and how they can be used to aid in the therapeutic process. Highlight positive aspects may also empower the client and motivate them for change/growth.
EXAMPLE: If a client says in session they’re feeling anxious and overwhelmed, the therapist may remind them of another time they handled a stressful situation well and highlight their asset of resilience. This may show the client that they are able too handle difficult situations.
client expectancies (outcome and process)
WHAT: A client’s expectations of what therapy will be like + the outcome of therapy
- greatly impact therapy! positive expectancies have been shown to lead to better outcomes
Outcome = clients’ predictive beliefs about the helpfulness of therapy OR likelihood of improvement because of therapy
Process = expectations of what will happen during treatment + how credible they believe a proposed treatment plan is
WHY: Important to remember clients expectancies shape their experience and perception of therapy. Understanding and shaping expectancies can provide a more accurate understand of the therapy process + increases the chance of a positive outcome
EXAMPLE: A client has been court-mandated to be in therapy for their substance abuse. The client has poor expectancies– predicting the therapy process will be stupid and that they’ll have no benefits or change at the end of it.
confrontation
WHAT: Counseling technique where the therapist calls attention to a discrepancy or contradiction in the client’s behaviors, attitudes/beliefs, words, or stories
- challenge thoughts/beliefs/behaviors that may be distressing or hinder progress in therapy
- can be direct & straightforward OR indirect & subtle
WHY: Important tool that can help to motivate a client to make a decision. It promotes open communication, insight, and awareness. May help to align the client’s goals/values and their behaviors. Also important to remember it may be uncomfortable for a client and to use with caution as to not damage therapeutic relationship.
EXAMPLE: A therapist may ask a client, “In our last session you said that you’re happy your last relationship ended, but now you’re saying the breakup is making you sad and your miss your ex partner. Could you clarify that for me?”
engagement
What: Engagement is the client’s level of involvement in therapy and can be fostered using WEG skills as well as influenced by client variables such as doing homework, active participation, being open, and showing up to therapy. Engagement has been correlated with successful therapeutic outcomes.
Why: Engagement is critical in therapy because it fosters a strong therapeutic alliance, enhances motivation, and promotes personal responsibility. Engaged clients communicate openly, adhere to treatment plans, and achieve their goals more effectively. Engagement helps clients develop resilience, trust in the process, and experience faster and longer-lasting positive changes in their mental health and well-being.
Example: A patient comes into therapy and feels hesitant about discussing some of the things that are causing them distress. The clinician then uses active listening skills and simple reflections to demonstrate that they are engaged in therapy. The patient senses this and feels more comfortable to open up, thus increasing their engagement in therapy.
fixed vs growth mindset
Who: Coined by Dr. Dweck to describe underlying beliefs people have about learning and intelligence.
What: A fixed mindset means you believe intelligence, talent, and other qualities are innate and unchangeable. If you’re not good at something, you typically think you will never be good at it. By contrast, a growth mindset means you believe intelligence, talent, and other qualities can be developed with practice and effort. Mindset plays a role in motivation, resilience, and achievement.
Where: Basic Counseling
Why: Fixed and growth mindsets are important in therapy because they shape how clients view themselves, their potential for change, and their approach to challenges. A fixed mindset can limit progress, while a growth mindset fosters resilience, motivation, and personal responsibility. By helping clients shift toward a growth mindset, therapy encourages lasting change, healthier coping strategies, and improved mental health.
Example: You’re working with a client who believes they only have bad qualities and they are unchangeable. You explain to them their perspective of themselves seems to be of a fixed mindset, where they feel they always have to prove themselves rather than learning from mistakes to help them grow.
hierarchy of needs
Who: The Hierarchy of needs was created by Maslow in order to determine how peoples needs are met and what happens if they aren’t.
What: Maslow’s hierarchy of needs is pyramid model that depicts humans needs. These needs include physiological, safety needs, love needs, esteem needs, and self-actualization.
Where: This model can be used in therapy to determine a clients needs and how to meet them so that the client can actively engage and thrive in therapy.
Why: These needs are important when assessing a client to determine what they may need in therapy. The goal of this model is for the client to eventually reach self-actualization.
Example: A therapist is working with a patient that has insomnia. This patient has not been engaged in therapy as they are unfocused and drowsy in most of the sessions due to sleep deprivation. The counselor may then refer them to a psychiatrist to prescribe them sleeping medication so that their physiological needs may be met, resulting in a more engaged and wakeful patient.
holding vs shifting the focus
Who: This skill is used by therapist to help with the pacing and relevance of what is being discussed in a session.
What: Holding/shifting the focus are universal skills used by therapists to maintain or move the topic of discussion while in therapy.
Where: These skills can be used at anytime during therapy in which the therapist feels as though the patient is reluctant to discuss something or rambling on about a topic.
Why: These skills are important because it allows the therapist to maximize their time while also maintaining the structure of a session.
Example: In a session a patient begins to talk about their ex partner who caused them a great deal of distress. This causes the patient to get caught up in their emotions and they begin a rant. The therapist may acknowledge this and move on to another topic that may be more beneficial in therapy. In another example, the patient may be reluctant to open up about their ex partner causing the therapist to hold the focus. This could look like the therapist saying, “lets go back to that one comment about your ex partner causing you distress. Tell me more.”
open ended questioning
Who: This skills is used by the therapist in therapy to help promote dialogue and gain further knowledge on specific aspects in a patients life.
What: This is a universal skill in which a therapist asks a question that cannot be answered with a yes or no, and is intended to get the client to discuss an issue in greater detail.
Where: This skill can be used in therapy at any time to gain further information.
Why: This skill is important because it promotes a detailed discussion pertaining to the clients story. By not allowing the client to respond with a yes or no, they will be more likely to open up.
Example In a session a client expresses that sometimes work is good, but most of the time they hate being there and really don’t like the people they work with. The therapist might ask, “When things are going well at work, what is happening?”
paraphrasing
Who: This skill can be used by the therapist to show the patient that the therapist is engaged.
What: Paraphrasing is a reflection skill in
which the counselor restates the clients words in their own. This demonstrates active listening and understanding while also clarifying and validating the clients experiences.
Where: This can be used to help communicate in an effective and empathetic way that fosters rapport between the therapist and the patient.
Why: Overall, paraphrasing is a crucial skill in therapy that facilitates communication, understanding, validation, and empathy thus helping the therapeutic process.
Example: Client says, “I just feel so overwhelmed with everything going on in my life right now. Between work, family, and my social life, I feel like I’m drowning.” Therapist responds, “It sounds like you’re experiencing a lot of stress from various areas of your life right now. This burnout surrounding work, family, and social commitments has got to be difficult for you.”
rapport
Who: Rapport is built between the clinician and the patient during the therapeutic process and is essential for successful outcomes.
What: Rapport refers to the relationship of trust, understanding, and mutual respect between the counselor and the client. It’s characterized by a sense of comfort, safety, and connection, allowing the client to feel heard, accepted, and understood without judgment. Rapport is built through active listening, empathy, and genuine interest in the client’s well-being.
Why: Rapport is important because it is the bridge that connects the therapist and the patient, allowing them to work together effectively. Without it, patients may struggle to trust the process or to fully engage in the deeper work of therapy.
Example: A patient comes into therapy for depression and anxiety. They are hesitant with sharing what has recently made them upset because they are fearful of being judged. In order to build rapport the therapist actively listens, maintains eye contact, offers verbal and non verbal cues, while giving unconditional positive regard. The patients then feels more comfortable and shares what has been troubling them.
readiness to change
WHAT: A client’s willingness to engage in behavioral and/or cognitive changes.
- verbal + nonverbal comm. can communicate readiness
- resolve ambivalence !!!!
Stages of Change =
1) precontemplation (not thinking about changing)
2) contemplation (thinking about changing)
3) preparation (planning/thinking about the process for change)
4) action (actively doing the steps for change)
5) maintenance (sustaining the change)
Sometimes…
6) recurrence/relapse (undo the change)
What: There are ways to tell how ready someone is to change, these can include statements, behaviors (both verbal and non-verbal) that can communicate readiness. An initial goal is resolving ambivalence regarding the presenting problem.
EXAMPLE: A client has admitted they have a serious problem with alcohol abuse and has come to therapy for help with it. The client is currently in the preparation stage of change, and the therapist will help the client move into the action stage after discussing different options and modalities of treatment.
