PSYC 526 Flashcards
Active Listening
What: A psychotherapeutic technique in which the therapist listens to a client closely, asking questions as needed, in order to fully understand the content of the message and the depth of the client’s emotion. Involves attending to what the client is saying as well as what they are not saying, both verbally and nonverbally. Includes: open/closed questions, minimal encouragers, paraphrasing, summarizing, reflections of feeling/mood
Why: The ultimate goal of active listening is to foster positive change in the clients. It shows the client that you understand what they’re saying and is done using various WEG skills and techniques.
EX: A client shakes his head while talking about wife’s career. Picking up on the client’s nonverbal communication, the therapist demonstrates active listening skills and says, “I notice you are shaking your head, what does that mean for you?” The therapist demonstrates that he is actively attending to the client, and he is encouraging the client to share more information by asking a relevant, open-ended question
Biopsychosocial
What: denoting a systematic integration of biological, psychological, and social approaches to the study of mental health and specific mental disorders. Biological factors can include genetic vulnerability, disability, and physical health. Psychological factors can include behavior, personality, and attitudes/beliefs. Social factors can include social support, family background, and peer relationships. It’s a model used to account for a variety of factors affecting a client’s life that can help in assessment.
Why: It demonstrates the importance of maintaining wellness in all areas of life. Allows comprehensive conceptualization and the reciprocal relationship of these.
EX: During an intake session, a therapist asks a client about her medical history, and it turns out that she is almost deaf which is adding to her depression as she feels left out of conversation with friends and is having trouble connecting
Boundary Crossing vs Violation
What: boundaries define a set of roles for the participants in the therapeutic process used to protect the relationship and client’s well-being. A boundary crossing describes departures from commonly accepted clinical practice that may or may not benefit the client. A boundary violation is a departure from commonly accepted practice that places the client or therapeutic process at serious risk.
Where: ethical boundaries in clinical practice
Why: Maintaining boundaries is an extremely important part of keeping the therapeutic alliance positive, safe, and healthy as it is a critical part of successful therapeutic outcome. The key difference here is the reason for crossing a boundary, if it is for the clients well-being it can be accepted and even truly improve the client’s therapeutic process but if done for the wrong reasons, it can cause serious harm. It is important to differentiate between these and as a therapist know when it is acceptable to cross a boundary.
EX: Self-disclosure is considered something that should not be done by a therapist, but in certain cases it can be helpful for a client to hear a piece of personal information from their therapist but only if it aids in their improvement; this would be considered a boundary crossing.
Clarification
What: A basic counseling technique in which the therapist provides a summary of what the client says, focusing on and clarifying its meaning. Clarification goes further than restatement and reflection of feeling but stops short of interpretation. It is more than just restating and reflecting the client’s words but will restate in different words what the client has said to allow them to hear what they have just said
Why: It is important because it reduces the possibility of a miscommunication and shows the client that they are being heard. It can also be useful for clients that are extremely emotional and clients with poor insight.
EX: Client says “I am just so upset, my mom doesn’t love me anymore because I’m failing out of school and she is so disappointed in me. My life is over.” The therapist might clarify and say “So it seems that your mothers approval is a defining factor in your life”
Client Assets
What: Things the client does well. This can include strengths, skills, resources, and access to them. Assets can be internal (such as commitment to learning, positive values, and social competencies) and internal (such as support, empowerment, boundaries, and expectations). What the client brings to the table and how they can be used to aid in the therapeutic process.
Where: used in behavioral analysis
Why: This is important because it helps bring positive aspects of the client into the therapy room to promote client success in reaching their goals.
EX: During an intake session, Tara discloses that she has a lot of close family members and through discussion the therapist finds out she is very resilient through all that she’s been through.
Client Expectancies (outcome and process)
What: The expectations that the client brings into therapy about what therapy will be like and what they can expect from the process. Expectations are the catalyst for coming to therapy and help determine the direction and objective of therapy. Outcome expectancies - patients’ prognostic beliefs about the helpfulness of therapy or likelihood of improvement because of therapy. Processes are related to what will transpire during therapy including treatment planning, type of therapy, and the duration of the therapy course
Why: Understanding and shaping client expectancies can improve the likelihood of a beneficial outcome and can provide more accurate insight into the process of therapy.
EX: A client is in mandated therapy for his substance use, his outcome expectancies are extremely poor as he thinks this isn’t going to work
Confrontation
What: A basic counseling technique in which the counselor calls the client’s attention to a discrepancy or contradiction that the therapist has observed. The therapist will make a statement that draws attention to the discrepancies in the client’s words, actions, or stories. This can be direct and straightforward or indirect and subtle. Confrontation demands a revelation from the client which may be painful or embarrassing; as a result this technique should be used carefully.
Why: Confrontation can help motivate a client to make a decision or face the reality of a situation. It also helps to promote open communication, insight awareness, reducing resistance, and increasing the congruence between client goals and behavior.
EX: For example a therapist might say, “you just said that this doesn’t bother you, but I can see you shifting a lot in your seat”
Engagement
What: Engagement refers to the active involvement and participation of a client in therapy. If the client is not engaged with the therapy process, it is unlikely to succeed. it can be fostered through the use of WEG skills as well as influenced by client variables. It includes doing homework and active participation, being open, showing up to therapy. The client’s level of engagement is correlated with successful therapeutic outcomes.
EX: A client that repeatedly shows up late, never completes the homework assignments, and is very closed-off is said to be demonstrating low treatment engagement. This is correlated with negative therapeutic outcomes - therapy is unlikely to work
Fixed vs Growth Mindset
What: A fixed mindset is that attributes and abilities are inherently fixed and unchanging, on the other hand, a growth mindset is that talents and abilities can be improved and developed. People with a fixed mindset generally believe that achievement affirms inherent positives, one cannot change what you’re born with and that everyone can be compared the same way. People with a growth mindset think that people have the capacity to grow and change, that failure/challenges provide opportunity for growth and strengthening of abilities and things can be learned. A growth mindset is important for facilitating change in a therapeutic environment.
EX: An issue arises that a student finds out they are failing out of school, one with a fixed mindset would just drop out because they believe they can’t change that. Someone with a growth mindset would ask themselves what they can do to improve their grades and what can I do better next time?
Hierarchy of Needs
What: This is discussed as part of Maslow’s theory leading to self-actualization. A model typically depicted as a pyramid to show motivations for client’s needs. The bottom are basic needs. One must satisfy lower level basic needs before progressing on to meet higher level growth needs; important to consider these needs while assessing what client needs in therapy - meet them where they are at! for clinical purposes sometimes will focus on a higher need due to culture or disorder; self- actualization ultimate goal of therapy in this framework
EX: Carla comes to therapy and is homeless, before the therapist can work on psychological needs, she must connect Carla to resources to get her basic needs met
Holding vs Shifting the Focus
What: Holding the focus is when the therapist works to keep the client from moving off of the subject and onto another topic. The client is asked to remain concentrated on the topic at hand. Shifting the focus is when the therapist makes a statement about something from her past that aligns with what has been discussed.
Why: These are extremely important skills to use in therapy because people generally will get uncomfortable and try to discuss something else when discussing a difficult or “root of the problem” topic.
EX: A therapist might say “I want to go right back to what we were just talking about, can you tell me more about that situation?” to shift the focus of the conversation.
Open-Ended Questioning
What: A type of questioning used in counseling in which questions are asked which cannot be answered by yes/no or one to two word responses, but require more detailed responses from the client. It allows the client to share how they are feeling without any leading questions. Generally start with what, who, how, and why.
Why: These questions minimize the influence of our own perspective as the therapist, and do not send any implicit messages.
EX: Instead of a therapist asking, “Do you have any family?” they will ask, “What is your family like?”
Paraphrasing
What: The therapist selects a few words of the client’s that stand out then repeats them back in a different way to the client. It stays true to the content, meaning, feeling, and tone of what the client said. It is very similar to reflection but reflections stick closer to original content. The therapist acts as a backboard to the client to hear their thoughts.
Why: Paraphrasing is useful because it allows the client to know that the therapist is hearing and understanding them, lets the client correct any misconceptions or misinformation, and allows the client to hear what they are saying fed back to them in a different way.
EX: A client says “I am so busy all the time, I can’t keep up with everything. I work 10 hours a day, I have two kids, and I can’t seem to find the motivation to get up in the morning. The therapist might respond with “You have a lot on your plate.”
Rapport
What: The emotional connection between counselor and client. This is one of the most important aspects of successful therapy. You want to focus on collaboration by using “we” words and let it be client directed with therapist redirection. Nonverbals and timing are very important as well. Using skills like open-ended questions, reflections, paraphrases, and minimal encouragement to demonstrate empathy, warmth and genuineness are vital to the rapport building.
Why: The establishment of rapport with a client in psychotherapy is frequently a significant mediated goal for the therapist in order to facilitate and deepen the therapeutic experience and promote optimal progress and improvement. This leads to great adherence, satisfaction, and better therapeutic outcomes.
EX: John has been seeing his therapist for 2 years now. He believes they have a strong rapport and is comfortable talking about anything. He thinks this rapport was built on trustworthiness, warmth, and non-judgment from his therapist
Readiness to Change
What: There are ways to tell how ready someone is to change, these can include statements, behaviors (both verbal and non-verbal) that can communicate readiness. An initial goal is resolving ambivalence regarding the presenting problem. Precontemplation – no indication of movement or change, Contemplation – thinking of change, maybe this is a problem, Preparation – thinking more in-depth about change; think about the process they would have to go through, Action – “the process”; actively participating in the steps necessary to change, Maintenance – the process has now become routine and doesn’t take as much effort, Recurrence/relapse – recurrence of problem(s)
EX: A client has admitted that he has a serious problem with alcohol abuse. He and the therapist have found several support groups and they are discussing options. The client is in the preparation stage of change. The therapist wants to help the client progresses to the action stage in which he puts this decision to change into practice.
