CH. 8. How to Conduct a Five-Stage Counseling Session Using Only Listening Skills

Question 1

Basic Listening Sequence:

Answer 1

BASIC LISTENING SEQUENCE:

• To review, ethics, multicultural competence, positive psychology/wellness, therapeutic lifestyle changes, and neuroscience. And none of the BLS skills will be effective or meaningful without skilled attending and observation skills:
  
  • Questioning—open questions followed by closed questions to bring out client stories and concerns.
  • Encouraging—used throughout the session to support clients and help them provide specifics around their thoughts, feelings, and behaviors.
  • Paraphrasing—catches the cognitive essence of stories and facilitates executive functioning.
  • Reflecting feelings—provides a foundation for emotional regulation, enabling examination of the complexity of emotions.
  • Summarizing—brings order and makes sense of client conversation, thus facilitating executive functioning and emotional regulation.
    
    • This integrative skill is particularly critical in mentalizing your ability to understand and join clients in their perspectives and view of the world.
• CHECKOUT – Obtain feedback on the accuracy of your listening.
  
  • Skills of the BLS need not be used in any specific order.
  • Competent counselor uses client observation skills to note client reactions and intentionally flexes to change style.

Question 2

Five-Stage Model for Structuring the Session

Answer 2

FIVE-STAGE MODEL FOR STRUCTURING THE SESSION:

• Characteristics that make an ideal relationship:
  
  • ​Therapist is able to participate completely in the patient’s communication.
  • Therapist’s comments are always right in line with what the patient is trying to convey.
  • Therapist sees the patient as a coworker on a common problem.
  • Therapist treats the patient as an equal.
  • Therapist is well able to understand the patient’s feelings.
  • Therapist always follows the patient’s line of thought.
  • Therapist’s tone of voice conveys a complete ability to share the patient’s feelings.
• Good summary of the first half of this book, as these characteristics are needed for meaningful use of the influencing skills.
• WORKING ALLIANCE – Equally important in any theory of counselor and therapist practice.
• FIVE STAGES OF THE WELL-FORMED SESSION (EMPATHIC RELATIONSHIP – STORY AND STRENGTH – GOALS – RESTORY – ACTION) – provide an organizing framework for using the microskills with multiple theories of counseling and psychotherapy.
• If you are sufficiently skilled in the microskills and the five stages, you are ready to complete a full session using only attending, observation, and the BLS. Many clients can resolve concerns and make decisions without your direct intervention.

Second half of this book focuses on influencing skills.

• Five stages can be used as a checklist to ensure that you have covered all the bases in any session.

Question 3

Five Stages of the Microskills Session

Answer 3

FIVE STAGES OF THE MICROSKILLS SESSION:

EMPATHIC RELATIONSHIP:

STAGE:

• Initiate the session. Develop rapport and structuring. “Hello, what would you like to talk about?” “What might you like to see asa result of our talking today?

FUNCTION and PURPOSE:

• Build a working alliance and enable the client to feel comfortable with the counseling process.

STORY AND STRENGTHS:

STAGE:

• Gather data. Use the BLS to draw out client stories, concerns, problems, or issues. “I’d like to hear your story.” “What are your strengths and resources?”

FUNCTION and PURPOSE:

• Discover and clarify why the client has come to the session and listen to the client’s stories and issues. Identify strengths and resources.

GOALS:

STAGE:

• Set goals mutually. The BLS will help define goals. “What do you want to happen?” “How would you feel emotionally if you achieved this goal?” One possible goal is exploration of possibilities, rather than focusing immediately.

FUNCTION and PURPOSE:

• goal setting is fundamental, and this stage may be part of the first phase of the session.

RESTORY:

STAGE:

• Explore alternatives via the BLS. Confront client incongruities and conflict.“What are we going to do about it?” “Can we generate new ways of thinking, feeling, and behaving?”

FUNCTION and PURPOSE:

• Generate at least three alternatives that might resolve the client’s issues. The system of restorying will vary extensively with different theories and approaches.

ACTION:

STAGE:

• Plan for generalizing session learning to “real life.” “Will you use what you decided to do today, tomorrow, or this coming week?”

FUNCTION and PURPOSE:

• Generalize new learning and facilitate client changes in thoughts, and thoughts, feelings, and behaviors in daily life. Commit the client to homework and an action plan.

Question 4

Decision Counseling and the Five Stages

Answer 4

DECISION COUNSELING AND THE FIVE STAGES:

• The client makes the decisions, not us.
• Benjamin Franklin as the originator of the systematic decision-making model.

(1) identify the problem clearly (draw out the story and strengths, along with goal setting)
(2) generate alternative answers (restory); and
(3) decide what action to take (action).

• However, the ancient Franklin model misses the importance of empathic relationship
  
  • (stage 1), the need for clearer goal setting, and ensuring that the client takes action (stage 5) after the session in the real world.
• These 5 stages are collectively known as PST:
• PROBLEM-SOLVING THERAPY (PST):
  
  • ​Builds on the Franklin framework.
• This foundation enables you to become competent more rapidly in the many other theories of counseling and psychotherapy.

We need to realize that emotions are involved deeply in our decisions. To think that cognition is the sole controlling factor is naïve.

• Emotional regulation and the current physical status of the subject make a difference. But what is interesting here is that the decision is made slightly before we become cognitively aware.

Question 5

Using the Five Stages of Interviewing in Decision Counseling

Answer 5

USING THE FIVE STAGES OF INTERVIEWING IN DECISION COUNSELING:

• It requires a verbal, cooperative client to work through a complete session using only listening skills.
• Completing a session with a client who is less willing to talk can be rather challenging, and there the use of influencing skills will likely be required.

Question 6

Stage 1: Empathic Relationship

Answer 6

STAGE 1: EMPATHIC RELATIONSHIP:

Warm-up by chatting some small talk to get to know each other.

COUNSELOR/CLIENT STATEMENT: 1

• We can turn the recorder off at any time. I’ll show you the transcript if you are interested. I won’t use the material if you decide later you don’t want me to use it. Could you sign this consent form?

PROCESS COMMENTS:

• critical to obtain client permission and offer client control over the material before recording. As a student, you cannot legally control confidentiality, but it is your responsibility to protect your client.

COUNSELOR/CLIENT STATEMENT: 2

• Robert: Sounds fine; I do have something to talk about. Okay, I’ll sign it. [Pause as he signs.

PROCESS COMMENTS:

• Ease and relaxed. Rapport was easily established.

COUNSELOR/CLIENT STATEMENT: 3

• What would you like to share?

PROCESS COMMENTS:

• Open question, almost social in nature, is designed to give maximum personal space to the client.

COUNSELOR/CLIENT STATEMENT: 4

• My boss at A&B Electronics. He’s pretty awful and on me all the time.

PROCESS COMMENTS:

• With some clients, several sessions may be required to reach this level of rapport.

Question 7

Stage 2: Story and Strengths

Answer 7

STAGE 2: STORY AND STRENGTHS:

COUNSELOR/CLIENT STATEMENT: 5

• Could you tell me about it?

PROCESS COMMENT:

• Open question is oriented toward obtaining a general outline of the concern.

COUNSELOR/CLIENT STATEMENT: 6

• Well, he’s impossible . . .

PROCESS COMMENT:

• ​Instead of the expected general outline of the concern, Robert gives a brief answer..

COUNSELOR/CLIENT STATEMENT: 7

• ​Impossible? . . . Go on . . .

PROCESS COMMENT:

• Encourager with warm, supportive vocal tone. Intentional competence requires you to be ready with another follow-up response.

COUNSELOR/CLIENT STATEMENT: 8

• Well, he’s impossible. Yeah, really impossible. It seems that no matter what I do he is on me, always looking over my shoulder. I don’t think he trusts me.

PROCESS COMMENT:

• Clients often elaborate on the specific meaning of a concern if you use the encourager. In this case, the prediction holds true. Here we see the need for a decision as to how Robert can handle this difficult situation.

COUNSELOR/CLIENT STATEMENT: 9

• Could you give me a more specific example?

PROCESS COMMENT:

• Robert is a bit vague in his description. Machiko asks an open question eliciting concreteness in the story. (A search for concreteness is typically additive.)

COUNSELOR/CLIENT STATEMENT: 10

• Well, maybe it isn’t trust. I don’t like customers yelling at me. I started talking back. And of course the boss didn’t like it and chewed me out. It wasn’t fair.

PROCESS COMMENT:

• As events become more concrete through specific examples, we understand more fully what is going on in the client’s life and mind. When Robert said, “No one can do that to me!” he briefly spoke angrily and clenched his teeth and tightened his fist briefly. After the pause, he spoke more softly and seemed puzzled.

COUNSELOR/CLIENT STATEMENT: 11

• Sounds as though this guy gave you a bad time and it made you angry, and then the boss came in. I hear some real anger about the customer, but I’m not so clear about the feelings toward your boss.

PROCESS COMMENT:

• Paraphrase and reflection of feeling represents basic interchangeable empathy. Picking up on the nonverbal mixed message was wise. (Interchangeable at first and then additive in the last sentence as she encourages client to explore emotions.)

COUNSELOR/CLIENT STATEMENT: 12

• Exactly! It really made me angry. I have never liked anyone telling me what to do. But when the boss came after me, I almost lost it. I left my last job because the boss was doing the same thing.

PROCESS COMMENT:

• Accurate listening often results in the client’s saying “exactly” or something similar. Robert loosens up and starts talking about the boss as the real challenge.

COUNSELOR/CLIENT STATEMENT: 13

• Difficult customers are hard to take, but your boss coming in like that is the real issue. He really bugged you. (brief pause) . . . And I hear that your last boss wasn’t fair either?

PROCESS COMMENT:

• Machiko’s vocal tone and body language communicate nonjudgmental warmth and respect.

How does this relate to decision counseling?

• First, one needs to listen and identify client issues and concerns clearly.
• The interview continues to explore Robert’s conflict with customers, his boss, and past supervisors.
• There appears to be a pattern of conflict with authority figures over the past several years.
• This is a common pattern among young males in their early careers.
• After a detailed discussion of the specific conflict situation and several other examples of the pattern, Machiko decides to conduct a positive asset search to discover strengths.

COUNSELOR/CLIENT STATEMENT: 14

• Robert: You got it.

PROCESS COMMENT:

• Robert here is speaking to Machiko’s understanding of his situation.

COUNSELOR/CLIENT STATEMENT: 15

• I’d like to know some things that have gone well for you there. Could you tell me about something you feel good about at work?

PROCESS COMMENT:

• beginning positive asset search. (Additive positive empathy)

COUNSELOR/CLIENT STATEMENT: 16

• I am one of the top salespeople there.

PROCESS COMMENT:

• Robert’s increasingly tense body language starts to relax with the introduction of the positive asset search. He talks more slowly.

COUNSELOR/CLIENT STATEMENT: 17

• Sounds like it makes you feel good about yourself to work hard.

PROCESS COMMENT:

• Reflection of feeling, emphasis on positive regard.

The positive strengths can be used in helping Robert make decisions for what he wants to do.

Question 8

Stage 3: Goals

Answer 8

STAGE 3 GOALS:

COUNSELOR/CLIENT STATEMENT: 19

• How would you like things to be?

PROCESS COMMENTS:

• Open question. The addition of a new possibility for the client represents additive empathy. It enables Robert to think of something new.

COUNSELOR/CLIENT STATEMENT: 21

• Tell me more specifically how things might be better.

PROCESS COMMENTS:

• Paraphrase, open question oriented toward concreteness.

COUNSELOR/CLIENT STATEMENT: 25

• I hear two things in terms of goals. One, that you’d like less hassle, but another, equally important, is that you don’t like to give in. But all this makes you tired, irritable, and discouraged. Have I heard you correctly?

PROCESS COMMENTS:

• Machiko uses a summary of both cognitions and emotions to help Robert clarify his problem, even though no resolution is yet in sight.

Question 9

Stage 4: Restory

Answer 9

STAGE 4: RESTORY:

COUNSELOR/CLIENT STATEMENT: 27

• Given all this, what decisions might you want to make to better things?

PROCESS COMMENTS:

• (Clear summaries typically include both interchangeable and additive empathy, hopefully including positive dimensions.)

COUNSELOR/CLIENT STATEMENT: 28

• I think the next time a customer complains, I’ll keep quiet and fill out the refund certificate. Why should I take on the world?

PROCESS COMMENTS:

• Here we see the beginning of a new decision style. Robert talks more rapidly.

COUNSELOR/CLIENT STATEMENT: 29

• So, one thing you can do is keep quiet. You could maintain control in your own way, and you would not be giving in.

PROCESS COMMENTS:

• Paraphrase, interchangeable empathy. Machiko is using Robert’s key words and feelings from earlier in the session to reinforce his present thinking.

COUNSELOR/CLIENT STATEMENT: 30

• Robert: Yeah, that’s what I’ll do, keep quiet.

PROCESS COMMENTS:

• Whoops! He has identified one way to realize his goals, but clearly is not happy with that one decision.
• There is more work to do. This is definitely not what look for in decision counseling.

COUNSELOR/CLIENT STATEMENT: 31

• Sounds like a good beginning, but I’m sure you can think of other things as well,

PROCESS COMMENTS:

• She is aware that his closed nonverbals suggest more is needed.
• Clients are often too willing to seize the first idea as a way to agree and avoid looking fully at issues.
• Machiko’s neural networks are developing as she practices empathic understanding and learns how to cope with clients who have underlying anger.
• A contract was made: If the situation did not improve within 2 weeks, Robert could participate in an anger management program and seek someone with more experience at the campus counseling center.

Question 10

Stage 5: Action—Generalization and Transfer of Learning

Answer 10

STAGE 5: ACTION- GENERALIZATION AND TRANSFER OF LEARNING:

COUNSELOR/CLIENT STATEMENT: 32

• So you’ve decided that the most useful step is to talk with your boss. But the big question is “Will you do it?” “What specifically could you try next week?”

PROCESS COMMENTS:

• Paraphrase, open question. (Potentially additive)

COUNSELOR/CLIENT STATEMENT: 33

• I’ll do it.

PROCESS COMMENTS:

• He appears more confident with the decision and sits up.

COUNSELOR/CLIENT STATEMENT: 34

• As you’ve described him, Robert, that may be a long wait. Could you set up a specific plan so we can talk about it the next time we meet?

PROCESS COMMENTS:

• Paraphrase, open question. To generalize from the counseling conversation, encourage specific and concrete action in your client so that something actually does happen.

COUNSELOR/CLIENT STATEMENT: 35

• I drink coffee in the late afternoon at Rooster’s. I’ll bring it up with him tomorrow.

PROCESS COMMENTS:

• Decision for a specific plan to take action on the new story is developing.

COUNSELOR/CLIENT STATEMENT: 36

• What, specifically, are you going to say?

PROCESS COMMENTS:

• again eliciting concreteness.

COUNSELOR/CLIENT STATEMENT: 37

• I could tell him that I like working there, but I’m concerned about how to handle difficult customers. I’ll ask his advice.

PROCESS COMMENTS:

• Robert is able to plan something that might work. With other clients, you may role-play, give advice, actually assign homework with an action plan.

In former days, counseling and therapy gave little attention to taking the interview home to the real world. Now this is a central issue and is a key part of decision counseling.

• Listening is clearly the best way to understand a client, but the action skills of influencing and theoretical approaches such as cognitive behavioral therapy are critical additions so that you can reach many types of clients.
• Carl Rogers (Person Centered Therapy) truly brought the ideas of empathic understanding to the counseling and psychotherapy process. Many would say that he humanized counseling and psychotherapy by stressing the importance of relationship, respect, authenticity, and positive regard, also called the working alliance. Working alliance is a useful term as it stresses the way we need to work with, rather than work on, the client.
  
  • A good relationship and working alliance may be in itself sufficient to produce positive change.

Question 11

Integrating Microskills with Stress Management and Social Justice

Answer 11

INTEGRATING MICROSKILLS WITH STRESS MANAGEMENT AND SOCIAL JUSTICE:

• This chapter brings together the listening skills and presents them as basic to virtually all counseling and therapy.
• reminder of the need to remember our foundation of ethics, multicultural competence, and wellness.
• Counseling and therapy are conducted on a consistent ethical base. And a fully aware ethical base suggests the need for awareness of social justice and stress management.
• Stress is an issue in virtually all client issues and problems.
  
  • Stress is demonstrated in vocal hesitations, emotional difficulties, and the conflicts/discrepancies clients face in their lives.
• A moderate amount of stress, is required for development and for physical health.
• If there is no stress, neither physical development nor learning will occur.
  
  • Stress should also be seen as a motivator for focus and as a condition for change.
• CORTISOL is the long-acting stress hormone that helps to mobilize fuel, cue attention and memory, and prepare the body and brain to battle challenges.
  
  • At high or unrelenting concentrations such as post-traumatic stress, cortisol has a toxic effect on neurons, eroding their connections between them and breaking down muscles and nerve cells to provide an immediate fuel source.
• In the uterus, the unborn child responds to stress in the mother.
• Excessive stress results in lesser brain development.
  
  • In adulthood, that child is more likely to have depression, an anxiety disorder, alcoholism, cardiovascular problems, and diabetes.
• Positive experiences in pregnancy seem to facilitate child development.
• Caregivers are critical to the development of the healthy child.
• Children of poverty or who have been neglected tend to have elevated cortisol levels that can slow or destroy cognitive/emotional development over a lifetime.
  
  • Oppression changes the brain in negative ways. Incidents of oppression, such as racism, disrespect, and bullying of all types, place the brain on hypervigilance, thus producing significant stress.
    
    • Think of the varying positive and negative environments that your clients come from.
    • The church that welcomes you helps produce positive development; the bank that refuses your parents a loan or peers that tease and harass you harm development.
  • Our work here is to help clients understand that the problem does not lie in them but in a social system or life experience that treated them unfairly and did not allow an opportunity for growth.
  • One of the clearest findings is that the brain needs environmental stimulation to grow and develop.

Question 12

Taking Notes in the Session

Answer 12

TAKING NOTES IN THE SESSION:

• Intentionality in counseling and psychotherapy requires accurate information.
• We recommend that you listen intentionally and take notes.
• When working with a new client, obtain permission early about taking notes.
• We recommend writing session summaries shortly after the session finishes.

Question 13

Key Points

Answer 13

KEY POINTS:

Basic Listening Sequence (BLS) – Is built on attending and observing the client, but the key skills are using open and closed questions, encouraging, paraphrasing, reflecting feelings, and summarizing. When we listen to clients using the BLS, we want to obtain the overall background of the client’s story and learn about the facts, thoughts, feelings, and behaviors that go with that story.

FIVe STAGES MODEL – Provide an organizing framework for using the microskills with multiple theories of counseling.

Stage 1: Empathic Relationship includes initiating the session, establishing rapport, building trust, structuring the session, and establishing early goals.

Stage 2: Story and Strengths focuses on gathering data. Draw out stories, concerns, and strengths.

Stage 3: Goals establishes goals in a collaborative way.

Stage 4: Restory includes working with the client to explore alternatives, confronting client incongruities and conflict, and rewriting the client’s narrative.

Stage 5: Action involves collaborating with the client to take steps toward achieving desired outcomes and achieving change.

DECISION COUNSELING – Follows the five-stage structure of the interview. Along with the microskills.

• It provides a foundation that you can use to become competent more easily in other theories of helping.
• Regardless of varying counseling and therapy theories, most sessions involve making some sort of decision, including defining the key issues, defining the goal, and selecting from alternatives.

SOCIAL JUSTICE AND STRESS MANAGEMENT – Unjust social systems, poverty, and toxic and long-term stress are damaging to children and adults and can negatively affect the brain.

NOTE TAKING – Accurate records are essential in counseling and therapy.