Final Exam Flashcards
what is paraphrasing?
reflection of content
a miniature version of the client’s story
steps of paraphrasing
- Listening carefully to the client’s story
- Feeding back the client a condensed, nonjudgmental version of the facts and thoughts
o Finding the important information in a large volume of client material and repeating it back in a succinct summary
o Keep the paraphrase short.
characteristics of evocative responses
- Particular (specific)
- Subjective (how the client feels in the situation not how the helper is feeling)
- Connotative (associative, suggestive, and metaphoric language)
define evocative
what moved you, grabbed you, feeling poignant
what is the nonjudgemental listening cycle
- A repeating series of basic helping skills
- A way of conceptualizing a normal or average helping session during which you use the most common building blocks
- the model gives you a pathway of what is could look like to engage in the skills while going through one of these non-judgemental listening cycles
- You are not held hostage to follow these exact steps, it is just an example of what it could look like
- The nonjudgmental listening cycle never goes away; it is the default position of any helper when a new topic is introduced
define positive regard
the ability to suspend judgement and accept a person regardless of his or her actions.
how do novice helpers compare to expeirenced helpers when using the NLC
- Beginning helpers generally have more and smaller listening circles because they cover a greater number of topics in less depth. More experienced helpers have fewer and bigger circles because they explore a small number of topics in more depth
what are the reasons for reflecting
- Communicates to the client that you recognize the emotional background of the story
- Involves listening and then expressing in one’s own words the emotions stated or implied by the client
- Verbally communicates empathy
- Confirms or corrects what client is saying
- Stimulates further exploration of client’s experience
- Captures relevant aspects of client’s message that may have remained camouflaged
- Kind of like a mirror because you are reflecting their experience back to them.
- Provides genuine relief from emotional pressure
- Reflection captures important aspects of the client’s message that otherwise might remain camouflaged
what are the common problems in paraphrasing
- Difficulty hearing story because of “Noise”
o Noise in your head
o Mental noise - Worrying about what to say next
o Remember that your job is to respond to the last thing the client said rather than stimulate a new topic or ask a question
o Shift your attention to the client because it is too difficult to think of two or more things at once - Bring “too much” on the side of the client (siding with the client)
o People tend to side with their client, because you show unconditioned positive regard. You could be reinforcing their own beliefs that might not be really true
o Want to help the client widen their perspective to change their behaviour, not narrow their perspective - Being judgmental of the client
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define emotional intelligence
the ability to monitor one’s own and others’ feelings and emotions to discriminate among them and to use this information to guide one’s thinking and actions
o The ability to recognize and express another person’s feelings can be learned and it has power to deepen the relationship and allow the client to release his or her emotional burdens
when should you state a reflection of feeling
- State the reflection of feeling after 2-3 minutes of talking. But do not wait too long.
steps to reflecting feelings
1. Identify the feelings o Imagine how the client is feeling o nonverbals are major clues o Listening intently to the client 2. Articulate the underlying emotions o Putting the emotion into words o Make a statement that mirrors emotions o Use the appropriate tone of voice to mirror the emotions the individual is experiencing o You feel \_\_\_ 3. Reflect a feeling with a paraphrase o You felt\_\_\_ when\_\_\_\_
common pitfalls with reflection of feeling
- Saying, how did that make you feel?
- Focusing on the wrong person or the wrong topic
- Use the word feel in the place of think
- Undershooting/overshooting
- Parroting
- Letting your reflecting statements go on and on
- Compound response
what is a compound response
o Reflection + question
o It is easier for clients to respond to our next question than sit with the reflection of feeling. But most times, we want them to sit with the feeling
problem with using the word feel in the place of think
o We often use the word feel instead of saying think when it is actually a thought not a feeling
o People often say feel when they are making a statement
o You might believe that you are reflecting feeling but you are really just paraphrasing because the words feel are being confused for the words think
what are the four domains that can be a topic for discussion between a helper and client
- Talking about what is going on inside the client
o Called focusing on the client
o Including their thoughts, feelings, and meanings
o Based on the assumption that the client cannot change others, and it is best to keep bringing the conversation back to the client’s viewpoint and reaction to events even when they complain about others - Talking about the helper
- Talking about the relationship between helper and client
- Talking about external factors such as the environment and other people
what is the Alter ego technique
- An action method for learning to identify feeling is the alter-ego technique from psychodrama
- The alter-ego is asked to imagine the client’s feelings
- The groups will include a client, helper, alter ego
- As the client is taking, the alter- ego will state the emotion the client is expressing. This helps the helper identify the emotion easier and reflect that feeling back.
why do we reflect meaning
- To understand the client at a deeper level
- To lead to deeper self-understanding in the client
- To emphasize that the story is the client’s version
- To push the client to go deeper
- To examine the concept of depth
what is the inner circle strategy
- Sometimes clients have difficulty recognizing that their stories have these deeper layers, and it is useful to challenge them to move form a superficial recounting to the area of personal meanings, secrets, and core beliefs.
- The helper draws a series of concentric circles labeled A, B, C, D, and E
- Most relationships start at E and move toward A
what is the E ring in the inner circle strategy
- At ring e: issues are essentially public and might be discussed with anyone
what is the A ring in the inner circle strategy
contains issues that are very personal
what are the types of summaries
- focusing
- signal
- thematic
- planning
define a focus summary
- Focusing:
o focusing the discussion on the major issues and these, highlights goals.
o Typically, at the start of a session to recap what was talked about during the last session
o Brings the discussion to bear on the major issues and themes, places the spotlight on the client’s responsibility for the problem and reminds the client of the goals
define a signal summary
- Signal:
o middle of session. Ready for the next topic
o tells the client that the helper has digested what has been said and that the session can move on to the next topic.
o If the helper does not summarize occasionally, the client may feel that it is necessary to over an issue several times until full understanding is communicated
o A good time use a signal summary is when the client seems to have come to the end of a story and pauses
define a thematic summary
o notices content patterns and big issues across sessions
o advanced skill because you are making connections across different meaning and different sessions
o is an advanced reflecting skill because It means the helper has to be able to make connections among the content, emotions, and meanings expressed in many client statements or even over many sessions
o often provides new information to the client who may be unaware that the issue is resurfacing so often
o core themes: represent problems that appear in a variety of circumstances
o rather than signaling a transition to a new topic, the thematic summary tends to push clients to an even deeper level of understanding or exploration
o have to know the client for a while
define a planning summary
end of session. Reviews progress in session. Brings closure and plans next steps
o entails a review of the progress, plans, and agreements made during the session
o brings a sense of closure and ends the session on a hopeful note
which summary type is an advanced reflecting skill
thematic summary
define questioning cycle
an unproductive spiral that occurs when the helper does not follow the NLC but automatically reverts to closed questions when there is a pause in the conversation
how to get out of a questioning cycle
o The way to get out of a questioning cycle is to response to the client’s last statement with a paraphrase or an open question
define open self
known to others and ourselves
define blind self
known to others and not to ourselves
define hidden self
known to us but not to other
define unknown self
nobody knows
what is the idea of therapy
- The idea of therapy is to shrink the blind self
- When we get feedback from the helper, the blind self-shrinks because we become aware of what is blind to us
what is the best condition for therapy
medium confrontation and high support
what happens in high confrontation and low support
o Self-examination: low
o Trust: low
o Topics discussed: very superficial
what happens in low confrontation and low support
o Self-examination: low
o Trust: low to moderate
o Topics discussed: superficial
what happens in high confrontation and high support
o Self-examination: high
o Trust: moderate to high
o Topics discussed: deeper if the confrontation is not too high
what happens in low confrontation and high support
o Befriending
o The client is probably encouraged to maintain his or her current behaviour
o Self-examination: low
o Trust: high
o Topics discussed: moderately deeper if confrontation is not too low
what are the worst conditions for helping
high confrontation/low support/trust
what does the ratio between support and challenging effect
the clients willingness to trust the helper, to discuss either deeper or more superficial topics, explore their own thoughts, feelings, motives and actions
what is the primary goal of challenging
to empower clients by encouraging them to explore their thoughts, feelings, and behaviours and to take steps toward their dreams and goals
when to challenge
- Self-misinformation (I know I will do badly on the test)
- Mistaken ideas and belief (I have to be perfect)
- Misinterpreting others’ actions (ie. Mind reading)
o Common mistake among couples.
o When a client acts on assumptions without confirming them
o Ex. I could tell by your actions he did not want to date me anymore - Blaming others vs self (ie. Blaming your boss for your work mistake)
- Inconsistent thoughts, feelings, behaviour, values
- Not operating according to their own values
- Not working on goals
how to give feedback
- Use “I” messages
- Stick to behaviours, not personality traits
- Specific, concrete, nonjudgmental
- Ask permission if appropriate
- Offer feedback tentatively
- Give 1-2 pieces at a time
- Don’t forget to give feedback that emphasizes client’s strengths
- Follow up afterward to process
define discrepancy
an inconsistency, a mixed message, or a conflict among a client’s thoughts, feelings, and behaviours
define cognitive dissonance theory
states that we are motivated to keep cognitions such as values, beliefs, and attitudes consistent
common incongruences
o Verbal and nonverbals
Ex. you are smiling and yet I know this is painful for you
o Beliefs and experience
Ex. I’m confused you say you’re not smart, but you are almost done your degree
o Values and behaviour
Ex. You say your son means a lot to you but somehow, you’ve let other things take up your time
o Verbal expressions and behaviour
Ex. You want to give up drugs, but you keep hanging out with those same friends
o Experience and plans
Ex. You two spend more time together you fight more.. and yet you still want to move in together
o Two verbal messages
Ex. On one hand you say it doesn’t bother your… but then you also say you’re feeling inadequate
the steps to confrontation
- Take time to understand the issue and listen carefully making sure the relationship is well established before confronting. Move through the NLC to fully understand the client’s message and reflect feelings and meanings
- Present the confrontation in a way that the client will most likely accept it. Make your confrontation moderately challenging
- Observe the client’s response to the confrontation. If the client does not fully accept the first confrontation, repeat it in a slightly different way
- Follow up the confrontation by rephrasing or retreating
three common problems with confrontation
- Responding when the client denies the truth of the confrontation or shrugs it off
o Follow up on the confrontation - Responding when the client accepts one part of the confrontation while rejecting another part
o Can clarify this issue and lead to further dialogue
o The helper is encouraged to focus the discussion on the areas of agreement and press for a resolution of the conflict - Client appears to fully accept the confrontation. Now What?
o Encourage the client to engage in some activity that helps resolve the two sides of the problem: something that reinforces the acceptance the client has identified
define relationship immediacy
a technique that helpers use to give clients here-and-now feedback about their effect on another person- the helper.
Relationship immediacy is a comment by the helper about what is happening in the relationship now.
three characteristics of immediacy statements
- “I” statements by the therapist to indicate that this is helper’s perspective
- Describes the clients behaviour or the helping relationship issue in non-judgmental terms
- Helper expresses their feelings in a way that does not overload or burden the client
how to help a client with self-confrontation
- One way to do self-confrontation is for the client to write down everything that they consider to be a conflict in life.
- The helper guides the discussion of these issues in the past, present, and future and helps the client explore the issues collaboratively
- The client and helper try to identify key themes in the client’s life that come from this discussion
- Finally the client and helper identify a plan to solve the dilemmas
define all or nothing thinking
sometimes called back and white thinking
either i do it right or not at all
define mental filter
only paying attention to certain types of evidence
noticing our failures but not seeing our success
what are the two key types of jumping to conclusions
-mind reading and fortune telling
define mind reading
imaging we know what others are thinking
define fortune telling
predicting the future
define emotional reasoning
assuming that because we feel a certain way what we think must be true
ex. i feel embarrassed so i must be an idiot
define labelling
Assigning labels to ourselves or other people ex. i am a loser
define overgeneralizing
seeing a pattern based upon a single event or being overly broad in the conclusions we draw
define disqualifying the positive
discounting the good things that have happened or that you have done for some reason or another
ex. that doesn’t count
define magnification (catatrophizing) and minimization
blowing things out of proportion (catastrophizing) or inappropriately shrinking something to make it seem less important
define shoulds and musts
using critical words like should, must, or ought to make us feel guilty or like we have already failed
if we apply shoulds to other people the result is often frustration
define personalization
blaming yourself or taking responsibility for something that wasn’t completely your fault
conversely, blaming other people for something that was your fault
what does assessment aid in?
o Helps you determine if you are the right helper or if therapy is the right kind of help
o Gives crucial information to plan useful and realistic goals
o Assessment helps clients discover events related to the problem
o Helps us understand the impact of the client’s environment on their mental health
o Helps us recognize the uniqueness of individuals
o Uncovers the potential for violence
o Reveals critical historical data
o Highlights client’s strengths not just weaknesses and pathology
o Helps client become aware of important problems
define formal assessment
include testing and filling out questionnaires and forms
define informal assessment
encompass all the other ways a helper learns about a client, including observing and questioning
when does formal assessment occur
occurs at a specific time in the helping relationship
when does informal assessment occur
an ongoing process
What does Is PATH warm stand for
- Ideation: threatened or communicated
- Substance use: excessive or increased
- Purposelessness: no reasons for living
- Anxiety: agitation/insomnia
- Trapped: feeling there is no way out
- Hopelessness: feeling things will never get better
- Withdrawal: from friends, family, and society
- Anger: rage, seeking revenge
- Recklessness: risking acts, unthinking
- Mood changes: dramatic
what to observe when making informal assessments
o Speech: Does the clients voice annoy or soothe, tone of voice, fast taking vs slow talking
o Client clothing: expensive stylish, appropriate for the weather, cultural background
o Grooming: is the client clean, body odor, personal hygiene
o Posture, Build, and Gait: how the client’s body looks, how the client walks, the clients posture
o Facial expressions
o Other bodily movements
o General appearance: Ex. older than stated age
o Feelings of the helper: we react automatically and unconsciously to the communications of others
define assessment questions
serve an orienting function in that they tell the client what is important focus on gathering client information
define challenging question
questions with the purpose to expand the client’s thinking rather than gather information
Define SMART
specific measurable attainable realistic time-bound
Goals must be:
- Specific: clearer goals= better progress
- Positively stated: turn problems into goals= motivation
- Goals should be important to the client
- They should be realistic
- Simple and concrete: especially important for demoralized clients
define behavioural objectives
- Behavioural objectives are concrete measurable and observable. They specify the client’s current behaviour (baseline) and the target or goal behaviours that indicate success
o Behavioural objectives advantages: they specify exactly what must be achieved in the helping process
objectives vs goals
objectives are more specific
how to use questions for goal setting
- Questions should help make the goal more specific
- Questions should help turn a problem into a goal
- Questions should determine a goal’s importance
- Questions should enhance collaboration on goal setting
- Questions should help confirm the goal is realistic
what is the second goal-setting skill
boiling down the problem
steps to boiling down the problem
- Summarize and enumerating the issues
- Ask the client to identify the most crucial problem
- Selecting the focal problem
- Changing the problem to a goal
- Agreement
what does REPLAN stand for
- R= strong therapeutic relationship
- E= enhance efficacy & self-esteem
- P= practice new behaviours
- L= lower and raise emotional arousal
- A= activate hope & motivation
- N= provide new learning experiences
what two aspects are part of self-esteem and can be used to enhance self-esteem
efficacy and self worth
define efficacy
feeling a sense of competency about a task
define self worth
the idea that you are worthy as a human being that I am an essentially good person.
what is the 10 things i can’t do exercise
- Exercise to build efficacy
- Make a list of 10 things you can’t do and move yourself to action readiness
- Increased competence around new skills
- How do we move toward action readiness
- Then put the following letter next to the items in the list based on what you have done with the item before
o T= talked to someone about it
o V= visualized performance
o M= observed a model
o A= attempt the task - The warm up helps move us towards trying new things and then hopefully reaching that sense of mastery and increasing our sense of efficacy
what does TVMA stand for
o T= talked to someone about it
o V= visualized performance
o M= observed a model
o A= attempt the task
define inner critic
- The idea that we have interjected a negative voice from a critical other outsider who then we take the voice of
what are the steps to counter the inner critic
o Begin to list and notice your negative self-talk
o Come up with counter statements to counter the negative self-talk
o Try to figure out which counter statement seems to be effective in countering your inner critic (negative self-talk)
o Make a list of counter statements to use when negative self-talk begins
define psychodrama
when you reply scenes from our live in therapy and get some opportunity to work through unfinished business and give us a chance to practice what I wanted to say
characteristics of a passive person
o Have poor boundaries
o Don’t like confrontation
o They do not always have their needs met, but they meet others needs
o Tend to give others what they want and sort of sacrifice
characteristics of an aggressive person
o Really put their own need forwards at the expense of others
o Make decisions for others
o Be critical of others
o Have poor boundaries in the sense that they do not accept others boundaries
o May bully people
characteristics of a assertive person
o Communicate themselves or their need freely and accurately
o Know how to say no when appropriate
o Respect the needs of other while also respecting their own
what is assertiveness role play
- Describe
o Describe the behaviour/situation as completely and objectively as possible. Just the facts. - Express
o Express your feelings and thoughts about the situation/behaviour try to phrase your statements using I and not You - Specify
o Specify what behaviour/outcome you would prefer to happen - Consequences
o Specify the consequences (both positive and negative)
what is the downstairs brain
- Downstairs brain is active in anxiety responses
o Basic bodily functions, emotional reactivity, attachment, flight/fight/freeze
o Allows us to act before we think
o Fight/flight response
o Emotional reactions
o Bodily functions
what part of the brain is the downstairs brain
o Brain stem and limbic region
what part of the brain is the upstairs brain
o Cerebral cortex
what is the upstairs brain
o Decision making, planning, self-understanding, control over emotions and body, empathy morality, executive functioning o Allow us to think before we act o Decision-making o Control over emotions and body o Focus/concentration o Empathy o Self-awareness
what is name it to tame it
Help them name the feeling in order to sort of tame and calm the downstair brain down.
used to down regulate emotions
what does RULE in motivational interviewing stand for
o R: resist the righting impulse: behavioural change is triggered by the patient’s motivations, not yours
o U: understanding your patient’s motivations: allow them to set the agenda and help them explore their ambivalence about change
o L: listen to your patient: ask open-ended questions and make sure you understand
o E: empower your patient: help your patients explore what they can do themselves
define demoralization hypothesis
o People show up the therapy demoralized and a sense of personal incompetence because they have not been able to solve their problem
define learned helplessness
o No matter what someone does my problem will not get better
o People with depression get so discouraged (because they had so many failed attempts) that they do not even want to solve their problems anymore
o Ex. rat continues to get shocked regardless of what they do. Regardless if they kit a leaver or not, they are still shocked so eventually the rat gives up
what is the goal of motivational interviewing
to meet the client where they are and not force them to change but gently guide them to the change and giving them a lot of breathing room to work through the ambivalence themselves.
define embedded questions
when the problem is resolved, what will you be doing then that you aren’t doing now
o Hidden messages that suggest a little bit of advice giving.
define scaling questions
on a scale of 1-10 with 10 meaning that you strongly believe that you can improve your relationship, and 1 meaning you think its hopeless, where are you now?
define miracle question
if a miracle occurred and all the problems were solved, what would be different
do you want to encourage or praise clients
- You do not want to praise clients, because it suggests that the therapist is the in the judgement role. You want the client to judge their own behaviour as good or bad
- You want to give them encouragement
In family therapy what are symptoms viewed as
are viewed as an expression of a dysfunction within a family
what are the four horseman
o Criticism: criticizing their behaviour and character
o Contempt: attacking sense of self with an intent to insult or abuse
o Defensiveness: victimizing yourself to ward off a perceived attack and reverse the blame
o Stonewalling: withdrawing to avoid conflict and convey disapproval, distance, and separation
define criticism
criticizing their behaviour and character
define contempt
attacking sense of self with an intent to insult or abuse
define defensiveness
victimizing yourself to ward off a perceived attack and reverse the blame
define stonewalling
withdrawing to avoid conflict and convey disapproval, distance, and separation
define emotional disengagement
the absence of any kind of positive affect during conflict. No humor, no empathy, etc.
define coherent enactments
getting the couples to talk to each other and learn how to express the primary emotions to each other
- Process the enactment how was it for you to hear her share her emotions
