PSYC 526- Basic Counseling Flashcards
Fixed vs. growth mindset
Someone with a fixed mindset believes that attributes and abilities are inherently fixed and unchanging. Someone with a growth mindset believes that talents and abilities can be improved and developed.
Example: Jerry didn’t get a job he interviewed for. He tells his therapist he is working to sharpen some of the skills the job would have required while he applies to similar postings. Jerry exhibits a growth mindset. Another client, Janet, says she isn’t applying to college because she isn’t smart enough. Janet believes her intelligence is static, which means she has a fixed mindset.
WEG skills
Drawn from the humanistic approach, WEG skills include warmth, empathy, and genuineness. These skills help clients feel understood, heard, and respected.
Example:
Open ended questioning
Open ended questions are a therapeutic technique used to move the conversation forward by minimizing the therapist’s perspective and encouraging the client to lead the way.
Example: Asking “What was that like for you?” after the client describes a situation is open ended as opposed to “Did you feel angry when that happened?”.
Miracle question
“The Miracle Question” is a therapeutic technique associated with Brief Solution Focused Therapy. The therapist asks a version of, “If a miracle happened and you woke up tomorrow and this problem was solved, how would things be different?” The goal is to identify the core issue; gather key indicators about positive change, promotes client’s visualization of resolution/progress/change.
Example: When asked the miracle questions for a client describing difficulties in his marriage, he answers that a miracle would be feeling connected to his partner again and not fighting anymore. The therapist has now oriented his thinking towards solutions, and has identified some goals to hone in on.
Hierarchy of needs
Maslow pioneered the concept of a hierarchy of needs that humans have, as follows:
- Physiological needs: food, water, warmth, rest
- Safety needs
- Belongingness and love needs
- Esteem needs: prestige and feeling of accomplishment
- Self-actualization: achieving one’s full potential
Needs at the bottom of the hierarchy have to be fulfilled before a person can attempt to meet the ones at the top.
Example: In therapy, Angela describes feeling unsafe at home because of her partner’s volatile and sometimes violent behavior. Her therapist should focus on equipping her to find a safe living situation before addressing issues of belongingness or achievement with Angela.
Biopsychosocial
The biopsychosocial model is a way or organizing client problems into categories: biological, psychological, and social in case conceptualization.
Example: In an initial interview, Ethel reports feeling down most of the day most days, and that her mother struggled with depression. She used to be very involved in her church and book club but has attended less often in recent months. The family history of depression is biological, her feelings of sadness are psychological, and her church/book club connections and withdrawal are social.
Clarification
A therapeutic technique that is used to check whether the therapist understands what the client is saying; the therapist restates an unclear or ambiguous message to clarify client’s meaning. Therapist can clarify by using reflections or frequent summaries of info or feelings.
EXAMPLE: Your client says, “I just feel like a failure.” You say, “Tell me what you mean by ‘failure,’” using clarification to ensure that you accurately understand what the client is saying.
Client expectancies
Expectations regarding what therapy will be like and what clients can expect from the process. Expectations shape experience and perception, and are considered a “common factor” in psychotherapy which help account for similar outcomes among various types of treatment. Clients have outcome expectancies (expectation that therapy will lead to improvement before meeting therapist), treatment expectancies expectation about what will transpire during the course of therapy), treatment credibility expectations (how plausible a treatment seems upon hearing the rationale and overview of the approach after discussing with therapist). Therapist expectancies about the effectiveness of treatment also impacts outcome.
Example: A new client thinks therapy is a waste of time and money, but a court has ordered to complete six sessions. Since the therapist knows how limited treatment effectiveness can be with client expectancies like this, he works to establish trust and rapport, and to elicit goals from the client to increase her expectation about what can be accomplished in therapy.
Confrontation
A universal skill in which the therapist brings attention to discrepancies with something a client says or does. A therapist uses confrontation by making a statement (direct or indirect) that provides information to the client about the inconsistencies the therapist has noticed. This technique should only be used during middle and late phase of therapy after solid therapeutic relationship has been established. Confrontation demands a revelation from the client which may be painful or embarrassing, thus this technique should be used carefully- timing is important.
Example: “You said earlier that you aren’t having any problems at work, but you just mentioned that you called-out of work three times last week. Can you tell me more about that?”
Capping
Moving the discussion from an emotional state to a more cognitive state. The therapist asks the client what they were thinking during a specific moment, or how they would feel in the future if a specific emotional event happened.
Example: “I am hearing that you felt extremely anxious and panicked at that moment. Can you tell me what was going through your mind at that time?”
Congruence
Concept in person-centered theory and therapy developed by Carl Rogers which means authenticity or genuineness. Carl Rogers believed that for a person to achieve self-actualization, they must be in a state of congruence
- Conditions of worth can create incongruence between real self and self concept
- Therapist hold attitudes toward clients of congruence, unconditional positive regard, and empathic understanding.
Example: Jill discloses to her therapist that she has had several abortions. The therapist encourages her to talk more about it, but avoids eye contact and crosses her arms. Her behavior lacks congruence because her nonverbal communication conflicts with her verbal communication. This lack of congruence could affect the therapeutic relationship by causing Jill to feel judged.
Dual relationships
Dual relationships are when multiple roles exist between a therapist and a client. The therapist is either concurrently in another relationship with client, concurrently in a relationship with a person closely associated with the client, or promising a relationship in the future. Dual relationships impact the therapeutic alliance and/or disrupt the objectivity of the therapist.
Clinical example: Denise confides in her roommate from college, who is now a therapist, that she is having suicidal thoughts. Denise begs her friend to take her on as a client since she is already comfortable with her. The therapist agrees, and there are thus multiple relationships existing between Denise and therapist, compromising the therapeutic alliance and quality of treatment.
Interpretation
A universal skill used by therapists, normally in the form of a question, to challenge the way a client perceives a situation, clarify hidden meaning, or make an educated guess as to what is happening. Timing is important, since interpretations can be threatening. Resistance is expected.
Example: “Although your mom seems overbearing, could it be that she is just worried for your safety?”
Active listening
Skills therapists use in therapy to demonstrate to the client that she understands and properly interprets what the client is saying and the client’s perspective. Active listening is demonstrated through nonverbal communication (nodding, eye contact), open/closed questions, making client observations (including assets), encouraging, summarizing, reflections.
Example: A client avoids eye contact and speaks softly when describing her husband’s criticisms of her. The therapist leans forward, and says, “I notice that you spoke softly- how were you feeling when describing that?” By using nonverbal communication, an open ended question, the therapist is demonstrating active listening.
Encouraging
Therapeutic skill used to encourage continued discussion by the client; done without interrupting or changing the focus. Can be minimal (okay, I see, etc) or nonverbal (nodding, leaning forward, etc.)
EXAMPLE: In an initial interview, a client is describing her relationship with her mother but seems stuck on what to say next. The therapist senses there is more to say on the topic and encourages her to elaborate by saying, “Say more about that.”
Engagement
Engagement refers to the client’s level of involvement in the therapy process, including doing homework, being open to the process, and showing up to appointments. Therapists can foster engagement by using WEG skills, though it is also influenced by client variables. High levels of engagement are correlated with successful therapeutic outcomes.
Example: A client shows up on time for appointments, has only canceled once when she was sick, and completes homework assignments. She participates fully in sessions, even when discussing painful topics. This client demonstrates a high level of engagement, indicating a likely successful therapeutic outcome.
Holding vs. shifting the focus
Therapeutic skills in which the therapist attempts to redirect the client’s attention towards a topic (holding focus) or away from a topic (shifting the focus).
- Holding the focus: purposefully maintain the discussion on a singular subject.
- Shifting the focus: the therapist redirects the client from an unproductive or irrelevant topic to a more therapeutic topic; the therapist might point out that the client appears to be avoiding or hesitant to discuss a specific topic, or simply shift the focus to it
Example: Client begins to drift from talking about her own feelings of losing her mother to talking about how her children are handling it. Therapist focuses the client back on how she feels about the loss because she is the one seeking therapy. This is an example of holding the focus.
Immediacy
Part of: basic counseling
What: Universal skill used to give a response about clinician perspective or experience of what’s presently occurring in session. Should be anchored in the present moment; critical component of therapeutic alliance
Example: “As you express your frustration about this discriminatory encounter, I am frustrated as well that you experienced that.”
Logical consequences
A universal skill used to help a client explore the pros and cons of making a change.
Example: Linda discovered her husband is having an affair. The therapist asks her about the possible impacts a divorce could have on both her and the children. He helps her explore what the future would hold if she were to stay with him, and if she were to divorce him. Together they discuss the logical consequences of both choices.
Paraphrasing
A universal skill that demonstrates the therapist is actively listening and understanding the content and feeling the client is communicating in which the therapist repeats what the client is saying in slightly different terms. Meaning, content, tone, and feeling are retained in the reflection.
Example: Client says: “There is so much to do at home and at work, all the time, and I feel like I can barely handle it all. Paraphrase: “You are feeling overwhelmed by your responsibilities at home, at work, and in your relationships. Is that right?”
Positive asset search
A universal therapeutic skill in which the therapist makes a statement or asks a question designed to bring to the surface unrecognized strengths or assets. The purpose is to highlight the client’s strengths to be used as a template for future behavior. This is also a useful technique during assessment.
Example: A positive asset search during an initial interview might include questions like, “What do you enjoy doing? What is something you feel you are good at?”
Power dynamics
Power dynamics refer to the dynamic between therapist and client. A natural power differential exists- both therapist and clients have power in various forms. In humanistic theory, the client is considered expert whereas in psychodynamic theory, the therapist (analyst) is considered the expert. Part of the therapist’s responsibility is to preserve client-therapist relationship and avoid harm/exploitation; effects of the power differential can be lessened through the use of WEG skills.
Example: Mark is aware of the power dynamic between he and his clients. He explains the process of therapy and reasoning behind his techniques clearly, and displays warmth, empathy, and genuineness to minimize potential negative effects of the power differential.
Reflection of deeper meaning
A universal skill that demonstrates the therapist is actively listening and understands the deeper meaning of the story the client has told. The therapist does this by directly expressing what they believe the core beliefs, attitudes, and/or assumptions the client’s story reflects.
Example: After a client describes all she does to take care of her family, and how she doesn’t feel there is time for her to take a walk by herself or go out with a friend, her therapist might say, “So you believe that your needs are secondary to your family’s.”
Reflection of feeling
A universal skill that demonstrates empathy and that the therapist is accurately assessing how a client feels about the story she is communicating. The therapist does this by briefly summarizing the feelings communicated by the client without changing the meaning.
Example: “It sounds like you are feeling both sad and exhausted by what’s been happening.”
