526 - DEENA'S VERSION 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: Client’s level of active involvement and participation in therapy
- involves open communication, adherence to treatment plans (doing the HW), showing up for sessions
- influenced by clients variables
- can be increased with WEG skills
WHY: Important to know that a client’s engagement is correlated with their therapeutic outcomes. It fosters a strong alliance and signifies motivation to change. It is unlikely that a client with poor engagement will reap any benefits from therapy.
EXAMPLE: A client that is always late to sessions, never does HW assignments, and is very closed-off/resistant to open up would be demonstrating low engagement and very unlikely to have a positive therapeutic outcome.
fixed vs growth mindset
WHAT:
Fixed mindsets believe…
- attributes and abilities are innate and unchangeable
- if they’re not good at something, there is no chance of improvement
Growth mindsets believe…
- talents and abilities can be learned and improved
- practice and effort make a different
- they are able to grow and change
- failure = opportunity for learning
WHY: These mindsets are important in therapy as they shape the attitudes/beliefs and expectancies of clients. A growth mindset fosters motivation, resilience, personal responsibility, and change. A fixed mindset will hinder the therapeutic process. Helping clients shift towards a growth mindset allows for better therapeutic outcomes.
EXAMPLE: A client tells their therapist they want to drop out of school because they’re failing their classes. The therapist explains that the client’s fixed mindset is leading them to believe they cannot change their grades. The therapist encourages a growth mindset, and works with the client to figure out a course of action to improve their grades.
hierarchy of needs
WHO: Maslow
WHAT: A pyramid model that depicts the hierarchy of needs for psychological well-being/self-actualization:
1) Physiological (food, water, shelter)
2) Safety and security (health, employment, feeling of safety)
3) Love and belonging (friendship, family, sense of connection/belonging)
4) Esteem (confidence, achievement, respect of others)
5) Self-Actualization !!!!!! (one’s fullest potential, most complete and authentic version of oneself, creativity, acceptance)
goal of this model = help clients achieve self-actualization
WHY: Important to ensure a client’s basic needs (physiological + safety) are met. If they’re not, it will be impossible to make any meaningful change in session. Being aware of which needs a client does and does not have met aids in treatment planning and goal setting.
EXAMPLE: A therapist is seeing a newer patient that is a single mother. The client tells the therapist that her and her children are going to be evicted at the end of the month because she cannot pay rent. The therapist recognizes the client’s physiological and safety needs are at risk, so she helps the mother find resources/housing.
holding vs shifting the focus
WHAT:
Holding the focus = therapist works to keep client from moving onto another topic + stay concentrated on the topic at hand
Shifting the Focus = skill that moves the topic to something more relevant or therapeutic for client
- used if client is rambling or avoiding a certain topic
- therapist uses verbal + nonverbal communication
WHY: Important as they allow the therapist to maintain session structure and ensure they’re using time efficiently (pacing). Also allows therapist to move the conversation to a ‘deeper’ level and discuss difficult topics.
EXAMPLE: A therapist is talking to a client about the relationship issues they have with their mother. The therapist notices the client suddenly and abruptly moves to another topic. The therapist notices the client’s avoidance of the topic, and may hold the focus on the mother.
open ended questioning
WHAT: Type of questions that cannot be answered with yes/no. Require a more detailed answer
- facilitates conversation and elaboration
- usually start with “how”, “why”, or “what”
WHY: Important aș they encourage clients to speak freely and openly. They are asked from a neutral standpoint, which minimizes leading or influencing the clients’ answers.
EXAMPLE: Instead of a therapist asking “Do you have a good relationship with your mother?”, they may ask “What is the relationship with your mother like?”
paraphrasing
WHAT: A skill that involves paraphrasing what a client has said back to them to convey active listening, ask for clarification, or validate the client.
- maintains the client’s original meaning, tone, feeling, and content
differs from reflection, as reflections stick closer to the client’s original words
WHY: Useful as it shows the client their therapist is listening and understanding what they’re saying. It fosters further conversation and conveys WEG skills from therapist. Also allows for the client to correct any misunderstandings of the therapist, and hear what’s been said again in a different way.
EXAMPLE: A client is saying to their therapist, “I’m so busy all the time. I work full time, have two kids, and I am struggling to keep up. I can barely get up in the morning because I’m so tired and dreading the new day.” The therapist may respond and say, “Wow. Between the kids and work, you have a lot going on right now.”
rapport
WHAT: The connection/relationship between a therapist and client.
Build rapport thru…
* collaboration (using “we” wording)
* good nonverbal communications
* skills such as reflection, open-ended q’s, minimal encouragers
* demonstrating WEG
WHY: Having good rapport is a very important aspect of successful therapy. Having a client’s trust allows for more open and deeper conversation, more engagement, and overall a better therapeutic outcome.
EXAMPLE: Ella has been seeing her therapist for 8 months. She believes they have very good rapport, as she feels comfortable speaking freely with her therapist and discussing difficult topics. Ella has never felt judgement from her therapist, only warm, empathy, and genuineness.
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.
