Chapter 4: The Counseling Process Flashcards
What are 3 variables that create a healing environment?
- Saftey
- Personalization
- Softness
Describe the focus of the initial sessions
The counselor focuses on building a therapeutic relationship with the client and helping them explore issues directly affecting them.
In the initial sessions, what 5 things does the counselor do?
- Assess the seriousness of the presenting problem(s)
- Provide structure to the counseling process
- Help client take initiative
- Develop initial case conceptualizations
- Create treatment plans
During the initial counseling session, the counselor should provide a professional disclosure statement… why?
A professional disclosure statement provides the client with info about the counselor and the counseling process, ensuring informed consent.
Define a reluctant client:
- someone who would rather not be there.
Describe the 3 types of resistant clients. What are examples of behaviours each type might show?
- Noncompliant (not showing up)
- Avoidant (outbursts, debates with counselor, tries to derail conversation)
- Ambivalent (has mixed feelings about proposed changes)
describe the concept of motivational interviewing
Motivational interviewing encourages the counselor to roll with client resistance instead of confront it.
What does the trans theoretical model of change describe?
It describes the 5 levels of readiness for change that a client may exhibit.
List the 5 levels of the trans theoretical model of change.
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
What are 4 ways counselors can help clients initiate change?
- Anticipating client resistance from the get-go
- Showing acceptance & empathy
- Using therapeutic confrontation (pointing out inconsistencies in client’s beliefs, actions, etc.)
- Using language (metaphors)
It is important to make clients feel _______, _________, __________, and ______.
It is important to make clients feel, comfortable, respected, supported, and heard.
List the 4 helping skills that can build rapport with the client.
- selecting feelings
- summarizing
- clarifying
- encouraging
Data gathered in initial sessions is used to create a ____ _____________, which is used to develop a ___________ _______.
Data gathered during initial sessions is used to create a case conceptualization, which is used to develop a treatment plan.
What is the core of a case conceptualization?
a clinical hypothesis
How is the case conceptualization related to the treatment plan?
The Case conceptualization links the client’s presenting problems to the treatment plan.
Client records fall into 6 categories. What are they?
- Intake info
- Assessment & diagnostic info
- Treatment plan
- Case notes
- Termination summary
- Other data
If counselor needs to submit client records to a 3rd party, what should they do first?
Must first get WRITTEN CONSENT from client.
What is a subpoena?
- a court order that cannot be ignored?
When given a subpoena, what should you do BEFORE turning over records or appearing in court?
Consult supervisors, a lawyer, and your personal liability insurance company.
Briefly describe what occurs during the working phase of counseling.
- specific objectives are defined
- interventions are implemented
What is included in the treatment plan documentation?
- Problem statement
- Goal statement & date of expected achievement.
- Treatment modality to be used
- Clinical impression/diagnosis
- Names & credentials of everyone involved in the treatment plan
What are the 3 common curative factors of effective counseling?
- Support factors
- Learning factors
- Action factors
What are the 4 Support Factors?
- the therapeutic alliance
- trust
- empathy
- catharsis
What are the 3 Learning Factors?
- cognitive factors
- affective experiencing
- feedback
What are the 3 Action Factors?
- reality testing
- rehearsal
- mastery efforts
What are cognitive distortions?
Negative, inaccurate biases that can lead to unhealthy misconceptions of events.
Name 5 cognitive distortions
- exaggerating the negative
- minimizing the positive
- overgeneralizing
- catastrophizing
- personalizing
Describe how you can help a client reframe a thought
Offer the client another probable and positive viewpoint of what a situation is or why an event might have happened.
Describe affective experiencing, and how it is performed.
Helping clients recognize and acknowledge the emotions they experience
+ the counselor does this by reflecting the clients feelings
Interventions focused on emotions are NOT recommended when clients are highly ______ or _______
highly distressed or psychotic
What is catharsis? Should it be the final goal? If now, what SHOULD be?
Catharsis > releasing emotions verbally.
It should not be the final goal – counselor should help the client examine the beliefs and thoughts that underlie those emotions.
To be effective, homework assigned to clients should be:
Homework should be:
- relevant to the client’s situation
- specifically tied to a measurable behavior
What are the 2 types of rehearsal?
- Overt rehearsal (verbalized or acted out)
- Covert rehearsal (imagined)
Why are case notes important??
Case notes:
- are required for reimbursement
- useful for protection during litigation
Case notes usually include:
- Description of services rendered
- Data and length of session
- An original, legible signature
High risk cases are clients who are potentially:
- violent
- suicidal
- homicidal
- engaged in criminal behavior
- have experienced or committed abuse
If a counselor determines that a client is potentially dangerous, what must they do?
- Document how their conclusion was reached
- Take action
- Document the action
Counselor has the DUTY TO WARN if the client:
threatens to kill or harm someone
If counselor suspects abuse, neglect, or current criminal behavior, what should they do?
- discuss the case with a lawyer
- contact the authorities, if needed
What 4 questions can help determine if it is time to close the counseling relationship?
- Has the client achieved their behavioral, cognitive, or affective goals?
- Has the client developed better coping skills?
- Is the counseling relationship no longer helpful?
- Has the context of the initial counseling arrangement change?
When you have decided to terminate the counseling relationship, how much time should be spend preparing for the end?
1/6 of the time of the total time spend so far counseling
Closing documentation should include what 5 things?
- synopsis of the initial assessment, treatment plan, interventions, and outcomes
- evaluation of client’s current level of functioning
- reasons for closing
- summary of progress toward goals
- follow-up plan
