CH. 9. Focusing the Counseling Session Contextualizing and Broadening the Story

Question 1

Focusing Essentials

Answer 1

FOCUSING ESSENTIALS:

• Death comes five to seven years earlier to those who face multiple issues and concerns, particularly low income.
• This is called MULTIMORBIDITY.
  
  • Studies on best approaches to help clients whose quality of life has been harmed significantly by long-term conditions show that integrative interventions are better.
  • A proposed chronic care model integrates collaborative goal setting and action planning, self-management of physical symptoms and emotional health, social or spiritual support, informed clinical team, and responsive and flexible organizational process.

We’ll be looking at the example of Nelida, a girl who is upset because her family teases her as the “American Girl” while elsewhere she is cast as the “Cuban Girl” due to her imperfect grasp of both Spanish and English. She is conflicted.

• FOCUSING will help clearly identify the major areas of conflict and discrepancy and then help determine which ones will be approached first.
• COMMUNITY GENOGRAMA systematic way to review old positive memories and help clients see themselves in social context.
• The community genogram provides a visual picture that helps us understand the client’s personal and cultural background.
• ​A central current issue for Nelida is cultural oppression, which she has internalized; she has come to “blame” herself for being different. Rather than focusing just on Nelida as an individual, if you help her see other perspectives, such as being able to name the oppression of the classroom, she is better prepared to reframe and change the negative memory.
  
  • In addition, focusing on family and cultural background will facilitate her pride in her Cuban family and culture and provide positive assets, strengths, and resources to deal more effectively with the cutting comments she has experienced.

“FOCUSING” – Means you look at both the client and their environment.

Question 2

Awareness, Knowledge, and Skills of Focusing

Answer 2

Awareness, Knowledge, and Skills of Focusing:

“FOCUSING” – Means you look at both the client and their environment.

• The first focus dimension is on the unique client before you. Focus on individual issues, so clients can talk about themselves from their personal frame of reference.
• Attending to the theme, or central topic(s), of the session is a second area of focusing.
• Draw out client stories, issues, or concerns.
  
  • If a client has gone through a breakup of a significant relationship, has study difficulties, has cancer or another serious illness, we need to hear the details, and we need to hear a lengthy story.
• Focus on the strengths and capabilities clients bring with them.
• Self-in-Relation, Person-in-Community– Our family and community history and experiences live within each of us.

Types of Focus:

• SIGNIFICANT OTHERS – Might include partner or spouse, friends, and family.
• MUTUAL FOCUS – Use “we” statements involving the client, therapist, or group.
  
  • But we will work through this.
• IMMeDIACY, HERE-AND-NOW FOCUS – Talk about what is going on in that moment in the session.
• COUNSELOR FOCUS – Share your own experiences and reactions.
• CULTURAL/ENVIRONMENTAL/CONTEXTUAL (CEC) FOCUS – Share your own experiences and reactions.
• CEC COUNSELOR STATEMENTS LEADING TO A POSITIVE CONCLUSION – “What are some strengths that you gain from your family, church and community?”
• FOCUS ON PHYSICAL HEALTH AND THERAPEUTIC LIFESTYLE ISUE – Physical and mental health are intimately entwined, focusing reminds us that we need to consider additional issues with each client.
  
  • Here are some additional issues that are part of collaborative work, as well as matters that need to be considered, as appropriate, in the individual counseling session. Many of them focus on self-management and a positive lifestyle.:
    
    • Medication - What are they, and what is their purpose? Is the client compliant in their use and able to afford them?
    • Drugs – As many as 50% of our clients have issues with drugs and potential abuse.
    • Therapeutic Lifestyle Changes (TLC) – Checking out exercise, sleep patterns, and other TLCs is critical.
      
      • Self-management, spirituality, and a meaning for living (see Chapter 11) are particularly important issues in maintaining health and building resilience.
• You are like an orchestra conductor, selecting which instruments (ideas) to focus on, enabling a better understanding of the whole.
• Focusing is a skill that enriches our understanding of our clients and their background,

Question 3

Collaborative care, or integrated care,

Answer 3

COLLABORATIVE OR INTEGRATED CARE – Is a team approach involving counselors, physician, social workers, financial advisers, school/community/governmental officials, and others, as appropriate to client and family needs. Typically, it involves both physical and mental health.

• Many concerns at the same time result in multimorbidity and early death.

Question 4

Community Genogram: Bringing Cultural/Environmental/ Context into the Session

Answer 4

Community Genogram: Bringing Cultural/Environmental/ Context into the Session:

• Stories and issues of many others (e.g., friends, family, unique factors of diversity) deeply affect the client’s narrative.

COMMUNITY GENOGRAM – This can give us a good picture of a client’s cultural background and history, thus enabling us to view the client in a social context.

• Through the community genogram, we can better grasp the developmental history of our clients and identify client strengths for later problem-solving.

Question 5

Developing Your Own Community Genogram

Answer 5

DEVELOPING YOUR OWN COMMUNITY GENOGRAM – The community genogram provides a snapshot of the culture from which you and your clients come.

• Select the community in which you were primarily raised.
• Place yourself at the center.
• Place family on the paper, represented by the symbol that is most relevant for you or the client.
• Place the most influential groups on the community genogram, representing them with distinctive visual symbols.
  
  • School, family, neighborhood, and spiritual groups are most often selected.
  • For teens, the peer group is often particularly significant. For adults, work groups and other special groups tend to become more central.
• Diversity issues can be included in the genogram.
• All of your clients are deeply affected by their race, ethnicity, social class, and other factors, but they are often unaware of how these factors affect who they are. The community genogram makes it possible to understand where the individual came from.
• Watch for interacting physical and mental health issues and whether or not the client has a healthy lifestyle.
  
  • Sometimes clients will include a hospital, thus opening the way for this conversation.

You may consciously or unconsciously avoid talking about certain subjects that make you uncomfortable. You may do the same thing with clients.

• Becoming aware of your possible biases will free you to understand the uniqueness of each individual more fully.

COMMUNITY GENOGRAM (EXAMPLES):

• Each of these images contains valuable stories that give us a better understanding of Nelida as a holistic person in her home community.
• The Map – The client draws a literal or metaphoric map of the community.
• The Star

Question 6

Identifying Personal and Multicultural Strengths

Answer 6

IDENTIFYING PERSONAL AND MULTICULTURAL STRENGTHS:

• Use the community genogram as a strength and a positive asset.
• Focus on positives and identify client strengths and resources. Use the community genogram to search for images and narratives of strengths:
  
  • Post the community genogram on the wall during counseling sessions.
  • Focus on one single dimension of the community or the family.
    
    • Emphasize positive stories.
    • Do not work with the negatives until positive strengths are solidly in mind.
  • Help the client share one or more positive stories relating to the community dimension selected.
  • Develop at least two more positive images and stories from different groups within the community.

Question 7

Family Genogram

Answer 7

FAMILY GENOGRAM (DIFFERENT FROM “COMMUNITY GENOGRAM”):

• Can elaborate the family in even more detail.
• Use both strategies with clients and often hang the family and community genograms on the wall in our office during the session.
• Family stories are real sources of pride and can be central in the positive asset search.
• be sure to search for positive family stories as well as problems.

Question 8

Debriefing a Community Genogram

Answer 8

DEBRIEFING A COMMUNITY GENOGRAM:

• Learn about the developmental history and cultural background of your client.
• Start by asking clients to describe the community and things that they consider most significant in their past development.
• Follow this by asking for a story about each element of the genogram.
• Seek to obtain positive stories of fun and support, strength, courage, and survival.
• That platform of positives makes it possible to explore problematic issues with a greater sense of hope.

Question 9

Observe: Focusing in Action

Answer 9

OBSERVE: FOCUSING IN ACTION:

• How you work with the community genogram is most important. Clients can learn that their issues were developed in a context.
• Armed with these positives, Nelida is better able to face some of the challenges.

AN ACTION PLAN:

• Vital necessity of taking new thoughts, feelings, and behavior home.
• “Homework.” Action plan – encouraged clients to engage in jointly decided homework plans for 30 days. Long-term planning like this will ensure change not only in behavior, but also in neural networks that are more protective for the client.
  
  • The action plan is best reinforced with at least one clear and specific homework assignment, as this kind of activity encourages clients to take home and act on what was learned in the session.

Question 10

Multicultural Issues and Focusing

Answer 10

MULTICULTURAL ISSUES AND FOCUSING:

CULTURAL INTENTIONALITY!:

• Critical role of context. Box 9.3 discusses the issue of where to focus and brings our attention to the multicultural applications of focusing.
• Negative effects on telomeres of context via stress, trauma, and toxicity interfere with cell division and tissue replacement and give way to mortality and age-related diseases (Blackburn, Epel, & Lin, 2015). These are some of the factors that lead to multimorbidity and the need for collaborative, integrated care.

Question 11

Advocacy and Social Justice

Answer 11

ADVOCACY AND SOCIAL JUSTICE:

• The social context of homelessness, poverty, racism, sexism, and other contextual issues may leave clients in an impossible situation.
• The problem may be bullying on the playground, an unfair teacher, or an employer who refuses to follow fair employment practices.
• Helping clients resolve issues is much more challenging when we examine the societal stressors that they may face.
• Advocacy is speaking out for your clients; working in the school, community, or larger setting to help clients; and also working for social change. What are you going to do on a daily basis to help improve the systems within which your clients live?
  
  • As an elementary school counselor, you counsel a child who is being bullied on the playground.
    
    • EX: ​The elementary school counselor can work with school officials to set up policies concerning bullying and harassment, actively changing the environment that allows bullying to occur.
• Counselors who care about their clients also act as advocates for them when necessary. They are willing to move out of the counseling office and seek social change.
• ETHICAL WITNESSING – Moves beyond working with victims of injustice to the deepest level of advocacy.
  
  • Counseling, social work, and human relations are inherently social justice professions. Speaking out for social concerns needs our time and attention.

Question 12

Counseling Clients Who Have Internalized Oppression

Answer 12

COUNSELING CLIENTS WHO HAVE INTERNALIZED OPPRESSION – A step-by-step model for working with internalized oppression.

• Paulo Freire in his Pedagogy of the Oppressed.
• ​Adapting Freire’s psychology of liberation offers specific steps to work with internalized oppression in the form of internalized racism, denying ones’ worth as a woman, believing that one is at fault when bullied, and so on.
  
  • The steps will sound familiar:
    
    1. Develop a relationship.
    2. Build individual, family, and cultural strengths, along with stories and body anchoring.
    3. Body anchoring of positives can be useful in this process.
       
       • In BODY ANCHORING, ask the client to find a positive visual or auditory image within the story.
       • It might be a grandfather speaking supportively at a critical time, it may be personal success, or it can be a hero such as Martin Luther King, Harvey Milk, or Gloria Steinem.
       • Ask clients to notice where they get feelings in their body that they associate with the image.
       • Remind clients that the memory, image, and feeling will always be there for them.
       • Often several images are useful, such as those focused on being cared for and loved, a personal triumph, and the power of a grandmother or the hero.
    4. Hear the story again, making sure that you have the concrete details, thoughts, and feelings.
       
       • Work with the negative feelings gently, but do not use body anchoring.
    5. Encourage NAMING of the negative story—
       
       • Nelida names it as oppression in her second interview in Chapter 11. Others may use racism, sexism, ableism, or another relevant term.
    6. Return to strengths, and anchor them once again.
    7. Plan for generalization and taking the new knowledge home.
       
       • This is the ACTION PHASE liberation.
    8. Follow up to see if changes have occurred in behavior, thought, and emotion.

Question 13

Key Points and Practice

Answer 13

KEY POINTS AND PRACTICE:

• SKILL OF FOCUSING – Focusing is a form of attending that enables multiple views of client stories.
  
  • Emphasizes the importance of both the individual/issue and the social/ cultural context. Focusing enables both the client and the counselor to explore the context of past memories more fully.
• IMPORTANCE OF THE INDIVIDUALISTIC “I” FOCUS – Recall that counseling is for the client.
  
  • Ultimately the unique client before you will be making decisions and acting. The bottom line is to assist that client in writing his or her own new story and plan of action.
• SELECTIVE ATTENTION – The way you listen can and does influence clients’ choice of topics and responses.
  
  • Listening to culture, gender, and context also affects the way they respond.
• DRAW OUT STORIES WITH MULTIPLE FOCUSING – Focusing can help a confused client zero in on important dimensions.
• SEVEN FOCUS DIMENSIONS – Seven types of focuses:
  
  • Focus on client
  • Focus on the main theme or problem.
  • Focus on others.
  • Focus on mutual issues.
  • Focus on counselor.
  • Focus on cultural/environmental/contextual issues.
  • Focus on the here and now (immediacy).
• COMMUNITY AND FAMILY GENOGRAMS – Visual maps to help clients gain new perspectives on themselves and their relationships to their families and their communities
• APPLY FOCUSING TO EXAMINE YOUR OWN BELIEFS – As a counselor, explore your own beliefs and compare these with the views of others.
• FOCUSING AND OTHER SKILLS – Focusing can be consciously added to the basic microskills of attending, questioning, paraphrasing, and so on.
  
  • Careful observation of clients will lead to the most appropriate focus.
  • Counseling could be described as a social justice profession.
• THE ACTION PLAN – Planning for action helps clients organize their behavior, act according to agree-upon plans, and achieve desired goals. Work with the client to jointly decide the best ways to move forward, address and remove potential barriers, and ensure all this is in line with what the client wants to do.
  
  • Long-term action plans promote changes in behavior, as well as in neural networks that will provide change sustainability.
• MULTICULTURAL ISSUES – The goal of much North American counseling and therapy is individual self-actualization, whereas among other cultures it may be the development of harmony with others—self-in-relation.
• SOCIAL JUSTICE AND ADVOCACY – Working for social change may be appropriate to help improve the systems within which your clients live.