Clinical Counseling Basics Flashcards
Active Listening
WHAT - A psychotherapeutic technique rooted in Carl Rogers person centered therapy, that involves fully focusing on and thoughtfully responding to a client. Includes verbal and nonverbal cues like paraphrasing, minimal encouragers, nodding, and clarifying questions.
WHY- Active listening is important because it displays empathy and unconditional positive regard to fully understand the content and emotions of what the client is saying. Makes the client feel heard and creates an environment they feel comfortable sharing in
EX- While the client shares memories of her childhood, the therapist is making direct eye contact, nodding at specific points to acknowledge details, and using minimal encouragers such as mhm, okay…yes, and I hear you.
Biopsychosocial Model
WHAT - A model that integrates the biological, psychological, and social factors when looking at mental health. Biological factors can include genetics, neurotransmitters, hormones etc. Psychological factors can include personality traits, thought patterns, coping mechanisms. Social traits can include family, support system, SES.
WHY- This model is important to create a comprehensive conceptualization of a client that takes into account an individuals unique experiences and circumstances. It demonstrates the importance of wellness in every area of your life and is important for guiding treatment
EX- A therapist is working with a client using the biopsychosocial model. The therapist asks about family history of mental illness (bio), the severity of the clients present concerns (psycho), and if the client has a support system (social)
Boundary Crossing vs violation
WHAT- A boundary crossing is a deviation from normal practice which may or may not harm the client. Boundary crossing are for a clinician to use clinical judgement to determine if appropriate such as hugging a client after a tough session. A boundary violation is a departure from the accepted standard of care, typically an ethical violation, which can put the client or therapeutic relationship at risk, such as having sex with a client.
WHY- Important to keep in mind while practicing to adhere to the ethical codes to prevent a boundary violation and consider boundary crossing seriously using clinical judgement to ensure a clients wellbeing
EX- 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- Clarification is a basic counseling technique where the therapist questions or restates information to confirm the intended message from the client was accurately received
WHY- Clarification is an important skill to use throughout therapy to avoid miscommunication and allow the client to correct any misinterpretations and further elaborate and give more insight. Makes the client feel like they are being heard and understood
EX- 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 assets are positive qualities, experiences, or resources that the clients already possess that can be leveraged in therapy to improve outcomes. This can include knowledge, skills, passions, proven resiliency, a support system etc.
WHY - Highlighting a clients assets can be important to enhance motivation and empower them for growth and change
EX - 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 to handle difficult situations
Client expectancies
WHAT - What the client thinks/expects/hopes to get out of therapy and treatment and what the process and therapist will be like. These expectations greatly impact therapy; a client with positive and realistic expectations will be more likely to have better outcomes.
WHY - Important for clinicians to remember that a clients expectations can shape their experiences and understanding and shaping negative perspectives can help improve outcomes.
EX- 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. This can make it difficult for the therapist to get through and help the client.
Engagement
WHAT- Rooted in Carl Rogers client centered therapy, refers to a clients active involvement and participation in the therapy process. Involves open communication, adherence to treatment, showing up to sessions, etc.
WHY- Engagement is essential to treatment success, a clients engagement is directly correlated with their therapeutic outcomes because they are getting the results for the effort they are putting in
EX- A client that is always late to sessions, never does their homework, and is very resistant to opening would be demonstrating low engagement and would be very unlikely to have positive outcomes
Fixed vs growth mindset
WHAT- A fixed mindset refers to a permanent or unchangeable thought pattern. A growth mindset refers to a thought pattern that allows room for learning and change. A fixed mindset is difficult to improve because if they face a challenge they believe they can not overcome there is no changing that thought. On the other hand, a growth mindset person is willing to put in practice and effort when facing challenges that can make a difference
WHY- These mindsets are important to recognize in clients in therapy because they shape a persons belief, attitude, and expectation about the process and their situation. A growth mindset fosters resilience, growth, and motivation, while a fixed mindset can hinder the therapeutic process.
EX- A client tells their therapist they want to drop out of school because they’re failing their classes and there is no point trying anymore they just arn’t good at school. 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
Maslows hierarchy
WHAT- Pyramid model developed by Maslow that depicts the concept that baseline needs must be met in order to progress to fulfilling higher needs. The goal is to reach the highest level of the pyramid which is the need for self-actualization. Order of the pyramid needs: Physiological (food, water, shelter), Safety and security (health, employment, feeling safe), Love and belonging (friends, family, connection), Esteem (confidence, achievement, respect of others), self-actualization (ones fullest potential).
WHY- It is important to ensure a clients basic needs are met (physiological and safety) because if they are not it will be impossible to make meaningful change during session. Being aware as a clinician which needs a client does and does not have can aid in goal setting and treatment planning
EX- 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 before trying to move to higher needs
Holding vs shifting focus
WHAT- Universal skills in counseling. Holding the focus is when the therapist works to keep the client concentrated on the topic at hand. Shifting the focus is a skill the therapist uses to move the topic to something more relevant using verbal and non verbal cues
WHY- These skills are important as they allow the therapist to facilitate the conversation to what is important and ensure they are using time efficiently
EX- The therapist is talking with a client about the relationship issues they are having with their mother. The therapist notices the client abruptly moves to talking about a different topic. The therapist notices the clients avoidance and might say something like “I want to go back to what you just said about you mother making you feel small, tell me more”
Open-ended questions
WHAT- Type of question that can not be answered with a yes or no. These type of questions are intended to elicit detailed responses and facilitate conversation and elaboration.
WHY- Important for clinicians to be aware to use more open-ended questions than closed because open questions allow the client to speak freely and openly and minimize leading or influencing client answers
EX- 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- Basic counseling technique where a therapist restates and reflects back what the client has said in different words while still maintaining the content, meaning, tone, and feeling of what was said
WHY- This is an important skill for therapist to use so the client knows the therapist has heard and understood what was said or has the opportunity to elaborate or correct
EX- A client is saying to their therapist “I am 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 mornings I am so tired”. The therapist may respond by paraphrasing and say “Wow, between the kids and work you have a lot going on right now and its exhausting.”
Readiness to change
WHAT- Refers to an individuals willingness and preparedness to engage in behavioral and psychological changes. The stages of change include 1. Pre-contemplation 2.Contemplation 3. Preparation 4. Action. 5. Motivation 6.Relapse
Individuals move through these stages at their own pace depending on their motivation and awareness. This idea is typically revenant in counseling when talking about substance use and addictions.
WHY- It is important in counseling to understand where individuals are in their change process and tailor interventions accordingly
EX- 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
Reassurance and band-aiding
WHAT - Reassurance is a skill where the therapist provides support, empathy, and encouragement to help the client feel safe and hopeful. Band aiding is a skill to avoid, and it is when the therapist tries to save the client from experiencing pain or trouble their life. The therapist jumps in and saves the client from experiencing strong emotional feelings by communicating to the client that everything will be fine and work out in the end.
WHY - Understanding the difference between reassurance and band aiding is important because band aiding may provide temporarily relief from the issue, but it does not address the underlying issue, it also can give a sense of false hope. Reassurance is important because it can reduce the client’s anxiety and stress while also building trust in the therapeutic relationship, while not immediately trying to cover up the problem
EX- Reassurance - “it is completely understandable to feel this way, and you are not alone. We can work together through this anxiety and help you learn how to manage it.”
Band-aiding - “Don’t cry, everything will be okay and work out in the end!”
Reflection on Content
WHAT- Basic counseling skill that refers to when the therapist repeats back the main points of the information the client said
WHY- Important because it demonstrates active listening and gives the client an opportunity to clarify any misunderstandings from the therapists end
EX- Client says, “I’ve been so busy at work that I haven’t had time for myself”. Counselor: “It sounds like your workload has been overwhelming, leaving little room for self-care.”
Reflection of Emotion
WHAT- Basic counseling skill that refers to when the therapist reflects back a feeling or emotional attitude implicitly in the clients words
WHY- Important because it can allow the client to identify and recognize their emotions that can guide them what to focus on and promote awareness. It demonstrates the therapist is engaging in active listening and makes the client feel heard and understood
EX- While discussing the loss of her father, a patient starts to choke up and cry. The therapist may say, “I can see that it is very painful for you to talk about your father.”
Reflection of Deeper Meaning
WHAT- Basic counseling skill that refers to when the therapist gives a direct statement to the client as to what they are hearing regarding core beliefs, attitudes, and assumptions.
WHY- Useful as it shows the client their therapist is listening and understands the deeper meaning of what was said. May provide insight for therapist and client about client’s undiscovered core beliefs to promote more awareness and better outcomes
EX- A client tells their therapist, “I keep pushing myself to work harder and do better in school, but no matter what I do, it never seems to be enough.” The therapist may respond and say, “I’m hearing a deeper sense that you don’t feel like you’re good enough. Working harder and trying to have perfect grades might be your way of proving your value
Reframing
WHAT- A basic counseling technique the refers to the process of changing ones outlook on a problem by seeing it from a different perspective. Moving perspective from negative to positive outlook.
WHY- Reframing is important to improving clients situations because exploring alternative meanings can build insight for the client and can break maladaptive patterns of thinking
EX- Client: “I feel like my family just sees me as someone to clean us their mess and chauffeur them around.” // Therapist: “You do a lot for your family and you are someone they can count on.”
Rupture and Repair
WHAT - Ruptures occur when the collaborative relationship between client and therapist deteriorates as a result of minor or major tensions that lead to either a confrontation and/or withdrawal ruptures. Confrontation ruptures include overt expressions of dissatisfaction or irritation with the therapist or therapy, whereas withdrawal ruptures consist of the client’s complete or partial disengagement from therapy and/or themselves. Repairing is when the therapist and client are able to restore their connection with one another and mend their relationship.
WHY - The concept of rupture and repair is important and helpful when building a strong therapeutic relationship because it demonstrates the ability to navigate conflict and then come back together
EX- A therapist misunderstands a client’s perspective, leading to the client feeling unheard or invalidated. Repairing this rupture involves the therapist acknowledging and addressing this, showing empathy and validating the client’s experience
Miracle question
WHAT- Question the therapist asks the client to get them to envision what their life would look like if one day they woke up and their problems had disappeared, as if a miracle had happened. Used in therapy to help the client determine what their hopes and goals are.
WHY- Using the miracle question can be useful to clarify what the clients core issue is and reveals key indicators of what positive change would look like
EX- A therapist asks a new client, “If you woke up one day and all your problems were gone, what would be different?
Scaling question
WHAT- Question used by the therapist to get the client to rate the severity of their issue on a scale (usually 1-10). This is used to gauge the intensity of what the client is feeling and can be used as a benchmark for changes.
WHY- Important to use because it can bring clarity and understanding for the clients distress. Can also be used to guide treatment to figure out what to start with or which issue is causing the most harm
EX- Therapist: “Last week, you rated your anxiety at an 8 on a scale of 1 to 10. After exercising the coping skills we practiced, how would you rate your anxiety this week on a scale of 1 to 10?”
Self disclosure
WHAT- Occurs when the therapist shares personal or private information about themselves with the client. The goal is to use self-disclosure to strengthen the therapeutic relationship
WHY- It is important for therapist to carefully consider self-disclosures before doing it as it should be relevant and beneficial to the client. Can be risky as to distract or shift the focus away from the client
EX- Client is a tired, frustrated mother in marriage counseling. She feels alone and overwhelmed. Therapist says, “I understand how you are feeling right now. I also am a mother and I too have felt what you are explaining.”
Structuring
WHAT- When the therapist explains to the client the purpose and procedure of therapy, how it works, and the agenda for sessions. Usually done at the beginning of the session so the client is aware of what to expect.
WHY- Important to provide the client with a framework to establish norms and clarify what the client can expect from the process. Also can be useful to keep the sessions on track and efficient
EX- At the start of the session the therapist says: “With our hour today, I would like to recap what we discussed last week, open the conversation up for you to share any new information and feelings, and with our last 10 minutes we will discuss homework and plan a roadmap for the week. How does that sound to you?”
Suicide risk assessment
WHAT- An assessment tool used to evaluate the likelihood of an individual attempting suicide. Is done during intake and throughout the therapeutic process. Clinicians should ask individuals about thoughts, plans, means, access, and previous attempts
WHY- If a client is showing signs of suicidality, it is important for the therapist to gauge risk and intervene if necessary to ensure safety
EX- A client is telling their therapist they have been really depressed lately and has been missing work because they don’t see the point. The therapist would suicide risk assess maybe use a tool such as SAD PERSONS to assess if they are high risks and if they have thoughts, plans, means, and access
Summaries
WHAT- Basic counseling skill where a therapist encapsulates what a client has said in a brief statement. Can be done at the beginning of a session, recap at the end, or used to transition the focus/hold focus during session.
WHY- Summaries are important because it demonstrates active listening and can be used to remind the client what was discussed, clarify content, or correct misunderstandings
EX- “We have talked quite a bit over the past hour. To summarize, you and your boyfriend made the decision to get a puppy together and it is important to you that its training and rules around the house be followed in a certain way. However, your boyfriend has a different perspective on training and it’s making you feel frustrated as well as disrespected. Is there anything that I missed?”
Termination
WHAT- Refers to the conclusion of treatment and is the final stage of the therapy process. Typically occurs when treatment goals have been achieved and services are no longer needed, or if treatment is not working.
WHY- Termination is important to appropriately time and explain so that the client does not feel abandoned. Want to ensure they leave with hope instilled and on a positive note
EX- A client initially came to therapy due to their phobia of dogs. After 10 weeks, the client no longer is fearful or distressed when a dog walks by them on the sidewalk. The therapist tells the client since they’ve made great progress with exposure therapy and accomplished all their goals, therapy is no longer beneficial to them. The therapist assures to the client that they can always return if needed
Therapeutic Alliance
WHAT- Rooted in Carl Rogers client-centered therapy, he stresses the importance of the the therapeutic alliance which is the collaborative and trusting relationship between the therapist and client. This alliance is necessary but not sufficient alone for successful therapy. This alliance is strengthened through the therapists use of WEG skills, active listening, and unconditional positive regard
WHY- The therapeutic alliance is important as a strong alliance is considered essential to successful treatment as it helps create trust, motivation, collaboration, and open communication.
EX-A client has come to therapy for their anxiety. While the client shares, the therapist actively listens and appropriately responds to demonstrate engagement. The therapist and client collaborate to develop goals and plans to achieve them. This all is building trust and strengthening their alliance
Transference and Countertransference
WHAT- Transference is when the client unconsciously assigns thoughts, feelings, or attitudes associated with something or someone else in their past to the therapist or current situation. Countertransference is when the therapist unconsciously assigns thoughts, feelings, or attitudes toward the client or is triggered by something the client does or says
WHY- Important for the therapist to be aware if they are experiencing countertransference to prevent acting inappropriately toward a client and harming the relationship. Transference can be used as a source of insight into the clients feelings and show an area for focus or growth
EX- Therapist is feeling emotional and upset with a client who reminds them of their own racist parents. The therapist must work to control and harness their personal feelings and tap into the process of understanding so as not to rupture the relationship
WEG Skills
WHAT- Stands for warmth, empathy, and genuineness, which are non-negotiable therapeutic conditions coined by Carl Rogers. Warmth = unconditional positive regard, caring, and accepting, Empathy = understanding the clients experiences and perspective, Genuineness = therapist being honest and authentic
WHY- Important skills for therapist to consistently use to allow the client to feel heard, respected, and understood
EX- During the session, a therapist may convey warmth by creating a safe and nonjudgmental space for the client to share. They may convey empathy by actively listening and using reflections to better understand the client. The therapist shows genuineness by using language understood by the client and acting as an equal collaborator, rather than a superior
Immediacy
WHAT - Immediacy in therapy refers to the therapist’s ability to address what is happening in the present moment within the therapeutic relationship. It involves bringing awareness to feelings, dynamics, or tensions that arise between the therapist and the client in real time.
WHY - Immediacy is important because it can help clients recognize patterns in relationships, builds trust, and encourages open and honest communication.
EX - Client: “I feel like people never really listen to me.”
Therapist: “I wonder if you’re feeling that way with me right now. Do you feel heard in this session?”
Spheres of Influence
WHAT - In therapy, spheres of influence refer to the different domains that affect a person’s thoughts, emotions, and behaviors. These spheres can include personal, relational, societal, and cultural influences that shape a client’s experiences.
WHY – Identifying a client’s spheres of influence can help them identify areas for change and focus their efforts on what they can impact
EX - A client struggling with self-esteem issues may feel pressure from social media to look or act a certain way. A therapist might explore the personal, relational, and societal spheres of the client to identify what they have the control to change
