Chapters 7&8 Flashcards
1
Q
Johari Window
A
a conceptual device used to represent the way in which most individuals enter the counselling relationship
4 quadrants (known to self/others)
First two phases of counselling help a client relax enough to tell their story and discover information located in the blind areas of themselves. Once they obtain a better understanding of these areas informed clients can decide how to proceed
2
Q
functional fixity
A
people think their perceptions and interpretations are accurate. Seeing things in only one way or from one perspective or being fixated on the idea that this particular situation or attribute is the issue. This phenomenon is called functional fixity.
3
Q
reframing
A
Perceptions commonly change through the process of reframing. It is a technique that offers the client another probable and positive viewpoint or perspective on a situation.
4
Q
leading
A
Changing client perceptions requires a high degree of persuasive skill and some direction from the counsellor, known as leading. A counsellor anticipates where their clients are and where they are likely to go.
e.g. of leads are silence, acceptance, paraphrasing, as well as persuasion.
5
Q
minimal leads
A
hmm, yes, I hear you. low risk
6
Q
maximum leads
A
confrontation for example, are more challenging and should be used when a solid relationship has been established
7
Q
Continuum of Leads
A
Silence
Acceptance
Restatement(paraphrase)
clarification
approval (affirmation)
General Leads
Interpretation
Rejection (persuasion)
Reassurance
Introducing new information/idea
8
Q
affective responses
A
focus on a client’s feelings
9
Q
behavioural responsess
A
focus on actions
10
Q
cognitive responses
A
focuses on the client’s thoughts
11
Q
3 types of empathy
A
subjective
interpersonal
objective
12
Q
Subjective empathy
A
counsellors momentarily feel what it is like to be the client
13
Q
interpersonal empathy
A
feeling the clients experience from his or her perspective
14
Q
objective empathy
A
results from having knowledge about the client’s problem from reputable sources
15
Q
What makes empathy possible according to Rogers?
A
1)realizing that an infinite number of feelings does not exist
2) you can let yourself into the world of the other person and know that you can return your own world. Everything you are feeling is ‘as if’
16
Q
primary empathy
A
involves communicating a basic understanding of what the client is feeling and the experiences and behaviours underlying these feelings.
17
Q
Advanced empathy
A
reflects not only what clients state overtly but also what they imply or state incompletely.
e.g. client says…I hope everything works out and trails off
counsellor says, For if it doesn’t, I’m not sure what to do next…
18
Q
3 elements of empathy:
A
perceptiveness, know-how and assertiveness.
19
Q
Carkhuff Scale: Empathic Understanding in Interpersonal Process
A
- verbal and behavioural expressions of the counsellor either do not attend to or detract significantly from the verbal and behavioural expressions of the client
- Although the counsellor responds to the expressed feelings of the client, he or she does so in a way that subtracts noticeable affect from the communication of the client
- The expressions of the counsellor in response to the expressions of the client are essentially interchangeable
- The responses of the counsellor add noticeably to the expression of the client in a way that expresses feelings at a deeper level than the client was able to express
- The counsellor’s responses add significantly to the feeling and meaning of the expressions of the client in a way that accurately expresses feeling at levels below what the client is able to express.
20
Q
Self-disclosure
A
a conscious, intentional technique in which clinicians share information about their lives outside the cousnelling relationship. It can help establish trust. Each relationship needs to be evaluated in regard to self disclosure.
21
Q
dyadic effect
A
reciprocal self-disclosure
22
Q
According to Egan what 2 principal functions does self-disclosure serve?
A
1) Modelling
2) Developing a new perspective
Clients learn to be more open by observing counsellors who are open.
Clients see that counsellors are not free of problems or devoid of feelings. and may be able to examine their own lives seeing that problems are universal and manageable
23
Q
According to Egan what are 3 things self-disclosure should be:
A
1) brief and focused
2) not add to clients problems
3) not be used too frequently
24
Q
What are questions counsellors can ask themselves prior to self-disclosure
A
1) Have I thought about why I’m disclosing?
2) Are there more effective less risky ways to reach this goal?
3) Is my timing right
25
Immediacy
one of the most important skills in counselling. It focuses on the "Here and Now" of the therapeutic relationship.
At its core, immediacy involves a counsellors and a clients understanding and communicating what is going on between them - including feelings, impressions and expectations.
26
3 kinds of immediacy
1) Overall (How are you and I doing?)
2) Immediacy that focuses on a particular even in a session - whats going on between us right now
3) Self-involving statements (I like the way you took charge of your life in that situations).
27
Fears about immediacy
1) clients misinterpret counsellor messages: counsellors need to make a tentative guess and fear that a wrong guess loses credibility
2) may produce unexpected outcomes
3) Clients can't manipulate the relationship so may terminate.
28
Best times to use immediacy
* directionless relationship
* where there is tension
* question of trust
* considerable social distance between cr & ce (i.e. cultural backgrounds)
* client dependency
* counter-dependency
* attraction between client and counsellor
29
Humour
incongruent or unexpected response to a question. Requires both sensitivity & timing. Should never be demeaning. Used to build bridges
It can circumvent resistance, build rapport, dispel tension, distance self from psychological pain.
Can be used to challenge a client's beliefs, magnify irrational beliefs to absurdity, or make a paradoxical intervention.
30
confrontation
confrontation is invitational. At its best helps client to examine, modify or control an aspect of behaviour that is currently nonexistent or improperly used.
31
Two Aspects of Contracting
1) focuses on the processes involved in reaching a goal.
2) concentrates on the final outcome
32
Advantages of contracts
1)Provide a written record of goals the counsellor and client have agreed to pursue and the course of action to be taken
2) Formal nature & time limits may act as motivators for a client who tends to procrastinate
3) If contract is broken into definable sections, a client may get a clear feeling that problems can be solved
4) responsibility for change on the client, has the potential to empower the client to be more responsive
5) outlining number of sessions assures the client will return regularly.
33
Approaches to setting up contracts:
* what would you like to work on
* change in the client rather than a person not present
* not include try or maybe
* not goals towards pleasing others (i.e. should/must)
* define concretely what clients wish to achieve. difference between: be happy vs. lose 10 pounds, talk to 3 new people/day
* must focus on change. understanding is good, but insight alone does not produce action.
34
Acronym for contracts
SAFE
Specificity (goals)
Awareness (procedures)
Fairness (relationship is balanced)
Efficacy (empowered decision making)
35
Disadvantages for Contracts
* counsellor cannot hold a client to a contract - no external reward or punishment
* some problems may not lend themselves to contracts
* focuses on outward behaviour - client may miss insights or altered perceptions
* clients may get bored as appeal to change wears off
36
Contracts & Suicide
Bartlett (2006) found contracts were the least effective method . Greatest help included: medication, discussion about stress factors and suicidal thoughts, improvement in lifestyle choices, increase in social activities, more frequent sessions, improvement in problem-solving skills
37
Rehearsal
practicing or rehearsing designated behaviour of a contract.
38
overt rehearsal
client verbalizes or acts out what he or she is going to do
39
covert rehearsal
imagining or reflecting on desired goal
40
homework
"empowering assignments" or "Between session tasks" to help practise the skills learned in counselling and generalize skills to relevant areas of their lives.
41
advantages of homework
* keep clients focused on relevant behaviour between sessions
* helping see what kind of progress they are making
* motivating clients to change behaviour
* helping evaluate and modify their activities
* making clients responsible for control of themselves
* celebrating a breakthrough achieved in counselling.
42
What makes homework effective
tied to some measurable behaviour change , relevant to the clients situation, and clients completing it
43
circular counselling
the same ground covered over and over again
44
transference
Client's projection of past or present feelings, attitudes, desires onto the counsellor. Traditionally emphasized the transference of earlier life emotions onto the therapist
45
How can transference be used?
* help counsellors understand clients better
*employ it as a way of resolving clients problems
46
E.g. of transference
the way the counsellor sits/talks etc may trigger the client. The client may say "You sound just like my mother". If the client begins to act as though the counsellor IS the mother, transference has occurred.
47
Five Patterns of Transference
Client may perceive counsellor as:
1) ideal
2) a seer
3) a nurturer
4) a frustrator
5) nonentity
48
Indirect Transference
harder to recognize. Revealed in client statements or actions that are not obviously related to the counsellor (e.g. talk is cheap and ineffective or Counselling is the experience I always wanted)
49
Transference Pattern: Counsellor is ideal
Client attitude:
profuse complimenting, brags about counselor to others. Imitates counselor behaviour. hungering for counselor presence. General ideation
Counselor experience:
Pride, satisfaction, strength. tension, anxiety, confusion, anger, frustration
Intervention: focus on clients expectations, effects of expectation.
50
Transference Pattern: Counselor as Seer
Client attitude:
ascribes omniscience, power to counsellor, views counsellor as expert, requests answers, solutions, advice
Counselor experience:
feeling all-knowing, God-complex, self-doubt, incompetence
intervention:
focus on client's need for advice (look at self-trust in client)
51
Transference Pattern: Counselor as Nurturer
Client attitude:
profuse emotion, crying. dependence & helplessness, indecision, solicitation of advice. Desire for physical touch, to be held. Fragility
Counselor experience:
urge to sooth, coddle, touch, feelings of sorrow, sympathy. Dperession, depletion
Intervention:
Focus on clients need for dependence (unwilling to take responsibility for self)
52
Transference Pattern:
Counselor as frustrator
Client attitude:
defensive, cautious, guarded, suspicious, enter-exit phenomena, testing of counselor
counselor experience:
uneasiness, on edge, walking on eggshells, withdrawal, dislike for client, feelings of hostility
Intervention:
focus on trust building & relationship enhancement (consequences of trusting others, early experiences
53
Transference Pattern: Counselor as nonentity
client attitude:
lack of focus, volubility, thought pressure, desultory, aimless meanderings
Counselor experience:
overwhelmed, subdued, taken aback, feelings of being used, lack of recognition, sense of being a non person, uselessness
Intervention:
Focus on establishing contract (getting behind client verbal barrier)
54
Negative transference
when the client accuses the counselor of neglecting or acting negatively toward him or her. It must be worked through in order for the relationship to be productive
55
Positive transference
may not be readily acknowledged because it appears to add something to the relationship. mild forms of positive transference are least harmful to the relationship
56
countertransference
counselors projected emotional reaction to or behaviour toward the client This may be irrational, interpersonally stressful, neurotic - emanating from the counselors own unresolved issues
e.g. counselor acting towards the client as she did towards her sister. Or over-identifying with client who has an eating disorder.
This can destroy the counsellors ability to be therapeutic and objective
57
Ways to see countertransference:
1) negatively - viewed as the direct or indirect unconscious reaction of the counselor to the client
2) total approach - sees it as more positive. a diagnostic tool for understanding aspects of client's unconscious motivations
3) both positive and negative.
4) different levels of countertransference occur as the analysis unfolds and the characters (different projections of both analyst and analysand ) transform.
58
Manifestation of countertransference forms:
1) feeling a desire to please the client
2)identifying with the problem so much one loses objectivity
3)developing sexual or romantic feelings for client
4)giving advice compulsively
5)wanting to develop a social relationship with client
59
Why Avoid Termination discussion?
1) associated with loss.
2) not directly related to the microskills that facilitate counseling relationships
60
Functions of Termination:
1) signals something is completed
2) Life is a series of hellos and goodbyes
3) to begin something new a former experience must be completed and resolved
4) in counseling it can also be a motivator.
5) natural point for practice of independence to begin
6) maintaining changes achieved and generalizing problem-solving skills
7) reminder the client has matured
61
What type of counseling theories are associated with shorter times and termination of counseling?
strategic, systematic, solution-focused family therapy
62
Timing of Termination
* Have clients achieved behavioural, cognitive, and affective contract goals?
* Can clients concretely show where they have made progress in what they wanted to accomplish?
* Is the counseling relationship helpful?
* Has the context of the initial arrangement changed?
63
fading
a gradual decrease in the unnatural structures developed to create desired changes - i.e. clients stop receiving reinforcements gradually for behaving in certain ways and appointments are more spread out.
64
How to help termination:
Help clients develop successful problem-solving skills, learning effective ways to deal with problems will help to not need counseling.
65
resistance to termination
when it has lasted a long time and has high level of intimacy.
pain of earlier losses, loneliness, unresolved grief, fear of rejection, fear of self-reliance
66
Client resistance
1) asking for more time at the end of the session
2) asking for more appointments once a goal has been reached
67
Successfully Dealing with Loss
1. Determine ways to make your transition a more gradual process
2. Discover the significance that different activities have had in your life
3. Describe this significance to others
4. Delight in what you have gained and in what lies ahead of you.
5. Define areas of continuity in your life.
68
Unsuccessfully Dealing with Loss
1. Deny your loss
2. Distort your experience by overglorifying it
3. Denigrate your activities and relationships
4. Distract yourself from thinking about departure
5. Detach yourself abruptly from your activities and relationships
69
Goodyear's list of 8 conditions that may make termination difficult for counsellors
1. Signals end of a significant relationships
2. anxiety about clients ability to function independently
3. arounses guilt in counselor for not being more effective
4. When self-concept is threatened by client who leaves abruptly or angrily
5. Signals the end of a learning experience for the counselor (about a particular disorder for example)
6. end of a particularly exciting experience of living vicariously through clients adventures
7. Symbolic of recapitulation of other farewells
8. arounses conflict about counselors individuation
70
premature termination
termination too early based on how well the client has achieved personal goals and general functioning.
71
How common is premature termination
between 30 and 60%
72
Benefits of an exit interview
1. help client resolve negative feelings resulting from the counseling experience
2. a way to invite the client to continue in counseling if he or she wishes
3. another form of treatment or another counselor could be considered in an exit interview
4. may increase the chances that the next time the client needs help they will seek counseling
73
Possible reasons clients prematurely terminate
* to see whether the counselor really cares
* to elicit positive feelings from the counselor
* to punish or hurt the counselor
* eliminate anxiety
* show the counselor the client has found a cure elsewhere
*express to the counselor that they have not felt understood
74
good counselor initiated termination
Opposite of premature termination.
reasons can include illness, working through countertransference, relocation, end of an internship, extended trip, realization that the client needs could be served better by someone else.
75
poor counselor initiated termination reasons
*counselors anger, boredom or anxiety
76
Welfel & Patterson (2005) 4 guildelines to end counseling positively
1) Be aware of the client's needs and desires and allow the client time to express them
2) Review the major events of the counseling experience and bring the review into the present
3) Supportively acknowledge the changes the client has made
4) Request follow-up contact
77
Follow-Up
checking in to see how the client is doing with whatever the problem was sometime after termination
78
Four main ways according to Cormier
1) invite client in for a session to discuss any progress he or she has continued to make
2)a telephone call
3) send a letter
4) mail a questionnaire
5) (not mentioned by cormier) send an email
79
referral
arranging for other assistance for a client when the initial arrangement is not or cannot be helpful
80
Reasons for referral
* client has a problem the counselor doesn't know how to handle
* Counselor is inexperienced in a certain area (substance abuse, mental disorders)
* Counselor knows of a nearby expert who would be more helpful to client
* Counselor and client have incompatible personalities
* relationship is stuck in initial phase of counseling
81
Recycling
alternative when the counseling procesing has not yet worked but can be made to do so. Re-examining all phases of the process.
82
In today's mobile society, it is more common and painful to have:
permanent counsellor initiated termination.
83
minimal leads
include silence, acceptance, paraphrasing
84
85
leads in action phases
persuasion,
86
