PSYC 526 Basic Counseling

Question 1

Spheres of influence

Answer 1

an assessment framework within the biopsychosocial model; the goal is to assess all spheres of influence
Includes self; partner & children; extended family; friends, neighbors, & acquaintances; employers, schools & professional acquaintances; government and social networks; interactive network/service providers
Used to explore how pts surroundings are influencing them

EXAMPLE: In order to assess a client’s friends, neighbors, & acquaintances as well as their extended family and partner & children spheres of influence, you might ask things like “How is your social support?” “What would your family say is your biggest struggle?” “Tell me about your work life.” All of these questions are working to uncover how each sphere of influence is affecting the client and the presenting problem.

Question 2

Clarification

Answer 2

a therapeutic technique that is used to check whether understanding is accurate; to better understand, therapist restates an unclear or ambiguous message to clarify client’s meaning.
Helps therapist avoid any miscommunication
Can be accomplished using reflections or short, frequent summaries of info and feelings you’ve heard client express
Or you can ask outright “Let me make sure I’m hearing this correctly…..”

EXAMPLE: Your client says, “My husband is a total pig.” You say “Tell me what you mean by ‘pig,’” using clarification to ensure that you accurately understand what the client is saying.

Question 3

Client Expectancies

Answer 3

part of clinical practice; expectations regarding what therapy will be like and what they can expect from the process; expectations shape experience and perception; considered “common factor” in psychotherapy; helps account for similar outcomes among various type of tx
Outcome expectancies: patients’ prognostic beliefs about the helpfulness of therapy or likelihood of improvement because of therapy
Client expectations: expectation that therapy will lead to improvement (before meeting therapist)
Treatment expectancies: expectation about what will transpire during the course of therapy
Treatment credibility: client’s belief in how plausible a treatment seems upon hearing the rationale and overview of the approach (after discussing with therapist)
Therapist has own expectancies as well: for successful therapy, therapist must believe in what they’re doing. This type of positive initial expectancy invites client to believe in it as well, enhancing tx outcome. [Growth mindset]
Therapist and client goals do not always align; this can create trouble for the therapeutic relationship; some clients may expect to be ‘fixed’

EXAMPLE: A client’s expectations are that therapy is a waste of money and that therapists are a bunch of quacks. The therapist knows that counseling is more effective when expectations between the client and counselor, in regards to the goals of therapy, are similar. The therapist explored the client’s expectations and started by demonstrating his own legitimacy and effectiveness as a help giver. He worked on fostering respect and trust, thereby influencing the client’s expectations.

Question 4

Confrontation

Answer 4

a basic counseling technique in which the counselor calls client’s attention to discrepancy or contradiction he/she has observed
An attempt by the counsellor to gently bring about awareness in the client of something that they may have overlooked or avoided
Can help clients increase self-awareness
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
statement may be direct and straightforward or indirect and subtle
Timing is also important

EXAMPLE: “Your words say you would like to spend more time with your sister, but your actions say that it’s not a priority for you” is an example of confrontation because it consists of therapist pointing out a discrepancy between what pt is saying and doing. This would be appropriate if the client explicitly said that she wants to spend more time with her sister and if she had been coming to this therapist for a bit.

Question 5

Congruence

Answer 5

concept in person-centered theory and therapy developed by Carl Rogers; 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
Those that come into therapy are usually in a state of incongruence
Therapist must be congruent, exercise UPR, and engage in empathic understanding
Therapist express positive and negative feelings in therapy
Some self-censoring required in area of self-disclosure but overall, staying true to who they are as a person

EXAMPLE: Beth is in therapy and discloses having several abortions. The therapist states that this is something that should be discussed, while at the same time avoiding eye contact and interrupting the client. The therapist’s behavior lacks congruence in that her nonverbal behavior is not consistent with her verbal behavior. This could negatively influence the working alliance by causing the client feel judged.

Question 6

Core conditions

Answer 6

a part of Carl Rogers’ person-centered therapy; essential traits that the counselor needs in order to affect growth and change in pts, which are: unconditional positive regard, empathy, congruence and genuineness
UPR: showing warmth and support to pt even if they do things clinician doesn’t agree w/
Empathy: therapist demonstrates to clients they understand what they’re saying
Genuineness: therapist being true to themself

EXAMPLE: Samantha has just begun therapy, and she has expressed to her therapist that she is not quite comfortable with the idea of being in therapy. The therapist ensures her that her feelings are completely normal and that it will take time to build a trusting relationship, demonstrating empathy. She also shared that she had similar concerns the first time she went to therapy- demonstrating genuineness. The therapist continues to demonstrate these core conditions along with UPR in order to gain her trust and build a healthy therapeutic relationship.

Question 7

Encouraging

Answer 7

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: You are in an initial clinical interview. The client starts talking about her family and is clearly getting a little caught up. To encourage her to continue on this topic and elaborate, you nod and say, “I see.”

Question 8

Engagement

Answer 8

level of client’s involvement in therapy; can be fostered through use of WEG skills as well as influenced by client variables; includes: doing homework, active participation - being open, showing up to therapy; correlated with successful therapeutic outcomes

EXAMPLE: 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. The therapist continues to express WEG skills to try and engage the client.

Question 9

Focusing

Answer 9

a therapeutic skill that seeks to redirect the client’s attention either away from or towards a topic; structure the session (different techniques fall under this)
Holding the focus: purposefully maintain the discussion on a singular subject.
Shifting the focus: move the topic to something that might be more productive for the client
Here and now: focus on present-tense vs all historical info

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.

Question 10

Immediacy

Answer 10

therapeutic skill in which counselor speaks openly about something that is occurring in the present moment. therapist gives a statement that reflects his/her own response to something happening in the session at that time; should be anchored in the present moment; critical component of therpeutic alliance

EXAMPLE: You’ve hit a lull in the session and decide to utilize immediacy by sharing how you are perceiving the client with the client. “As we sit here, I am aware of your mounting frustration and, in turn, I feel frustrated as well.”
Or “When I hear you say that, I feel I can understand you better.”

Question 11

Interpretation

Answer 11

therapeutic skill in which counselor makes educated guess as to what is happening; hypothesis-testing and clarification of hidden meaning; timing is important; they can be threatening, so resistance is expected and interpreted; can be positive, negative or neutral

EXAMPLE: You notice that every time one of your clients talks about her father, she crosses her arms and purses her lips tightly. You conceptualize this as an expression of stress and emotional distance. You say to the client, “I’ve noticed that when you mention your father, you cross your arms and frown. Could this be an indication that you might be angry with your father?” This is you offering your interpretation. The client should tell you if it is correct and not, and it should facilitate further discussion unless you hit resistance.

Question 12

Listening skills

Answer 12

context of clinical practice; skills used in actively attending to what the client is saying; needed to show that the counselor understands and interprets the information that their client gives them correctly. active listening (different from hearing) is trying to understand the client and their perspective;
Includes:
1) open/closed questions
2) client observation skills (includes assets)
3) encouraging, paraphrasing, summarizing, reflective listening
4) reflection of feeling
Includes open/closed questions, encouraging, paraphrasing, reflection of feeling, summarization

EXAMPLE: 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

Question 13

Logical consequences

Answer 13

universal therapeutic skill; the therapist helps the client assess what the pros and cons of the actions they described might be; skill used to provide the client with a chance to explore what will happen, both good and bad, when the client changes a thought or behavior; unbiased approach

EXAMPLE: Amy discovered her husband is having an affair. The therapists asks her about the possible impacts a divorce could have on both her and the children. He explains that it may be of some value for Amy to imagine what it would be like in the future if she stayed with her husband and what it would be like if she divorced him. They began to explore the logical consequences of both options.

Question 14

Open-ended questioning

Answer 14

therapeutic skill; a question that is intended to generate discussion in greater detail and can’t be answered with “yes” or “no”; usually start with how, why, or what

EXAMPLE: In the initial interview, the therapist was sure to engage in open-ended questioning. Instead of asking, “How many people are in your family?,” the therapist said, “Tell me about your family.” By using this method, the therapist was able to find out basic information, and also the client’s perception of his family instead of just getting basic facts.

Question 15

Paraphrasing

Answer 15

type of content reflection; giving the message that the client has said back in somewhat different words; Universal therapeutic skill used to demonstrate that therapist is listening and to clarify. Meaning, content, tone, feeling are retained in the reflection and the therapist acts as a backboard for client

EXAMPLE: “Yesterday my mom told me that we are going to do things different at home from now on” is what your client says. You might respond with a paraphrase to communicate understanding by saying “You found out yesterday that things are going to change in your family.” Or “Your family is changing.”

Question 16

Positive asset search

Answer 16

universal therapeutic skill; the therapist makes a statement or asks a question designed to bring to the surface unrecognized strengths or assets; purpose is to highlight the strengths and assets the client has to be used as a template for future behavior; also a useful technique during assessment - assets part of detailed view of client; includes hobbies, fun activities, strengths

EXAMPLE: Cynthia works with addicts trying to overcome substance abuse problems. As part of her positive asset search during the initial interview she asks her client, “What do you enjoy doing? What is something you feel you are good at?”

Question 17

Powery dynamics

Answer 17

related to therapeutic relationship; dynamic between therapist and client; natural power differential that exists between therapist and client- BOTH therapist and clients have power in various forms; humanistic vs psychodynamic (who is considered expert?); part of the therapist’s responsibility to preserve client-therapist relationship and avoid harm/exploitation; effects of the power differential can be lessened through the use of unconditional positive regard, genuineness, and empathy.

EXAMPLE: Shaun is aware of the power dynamic between him and his clients. In order to lessen the effects of this uneven relationship, he explains the process and reasoning behind his techniques and is warm, empathetic and genuine.

Question 18

Proxemics

Answer 18

the branch of knowledge that deals with the amount of space that people feel it necessary to set between themselves and others; optimal physical space; can be nonverbal or physical - but still perceived by the client; can affect client’s comfort level; comfort levels differ based on culture, gender, etc.

EXAMPLE: One aspect of proxemics that is important when setting up an office space, is the space between therapist’s chair and client’s chair. Therapist wants to be able to lean forward to show interest without making anyone uncomfortable.

Question 19

Reflection of Feelings

Answer 19

universal therapeutic skill utilized by therapist to show client that he/she is aware of feelings client is experiencing and to demonstrate empathy/connect with client. Highlights client’s emotion words and reflect them back using exact phrase or synonyms. Shows active listening.

EXAMPLE: After listening to your client go on about how she hated having to get a new job and move cross country for her husband you might say something like “You were really pissed off having to move and change jobs.”or “You feel angry about this.” These are reflections of feeling and demonstrate understanding.

Question 20

Reflection of meaning

Answer 20

universal therapeutic skill that demonstrate to the client that you have heard and understand the deeper meaning; therapist listens to client and then gives back in a direct statement what she has heard as the core beliefs, attitudes, or assumptions that the client is expressing indirectly.; core belief that guides the client’s actions or principles. Adds new information to what the client has said. Usually not done until later sessions.

EXAMPLE: Clara tells her therapist, “My husband is always working and going out with the guys. He never wants to spend time with me, we haven’t been intimate in months. He never thanks me for taking care of the house or our children. I don’t know. Sometimes I wonder why he even married me.” Her therapist utilizes reflection of meaning and paraphrases what she has said, “You are feeling neglected by your husband and feel he doesn’t appreciate you.”

Question 21

Miracle question

Answer 21

therapeutic skill aligned with brief therapy; asking the client how his life would be different or what he would notice to be different if the problem were to suddenly go away
Anchored in envisioning a miracle has happened
especially useful with ambiguous clients or creative clients
Allows therapist to get an idea of what the client wants out of therapy
used in solution-focused therapy, Brief therapy, andCBT

EXAMPLE: Frida and her client are discussing his anxiety issues. Utilizing the miracle question, she asks her client, “What would life be like if tomorrow you woke up and a miracle had occurred? What would be different?” The purpose of this question is to get an idea of what her client envisions her life to be like without anxiety.

Question 22

Self-Disclosure

Answer 22

basic therapeutic skill in which therapist provides client information about themselves;
should be used to: establish greater rapport, humanize a client’s experience, or promote greater insight and learning by the client.
Done sparingly and only when relevant
Should not change focus of session
Today’s climate of social media change - plethora of total info available to clients about therapists regardless of how they acquire it - transparency
Various types of self-disclosure:
Deliberate, unavoidable, accidental
Appropriate, benign, and inappropriate

EXAMPLE: A young client is in tx for loss of a parent. He feels that no one understands. The Therapist self-discloses that she also lost a parent at a young age. As a result, the client feels more comfortable sharing events and feelings. The client senses the therapist’s empathy and starts to trust the therapist.

Question 23

Stages of change

Answer 23

transtheoretical model developed by Prochaska & Diclemente; use to conceptualize/assess for a client’s readiness to change; stages 6 stages a person goes through enroute to change; at the core is an ambivalence to change; ambivalence addressed in MI

1) Precontemplation - resistant to change
2) Contemplation - begins weighing pros and cons – ambivalence still
3) Preparation - commitment to change; resolving ambivalence
4) Active Change - putting decision into practice; actively participating in the steps 4 change
5) Maintenance - actively maintaining change
6) Relapse- returns to previous behavior

EXAMPLE: 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.

Question 24

Structuring

Answer 24

universal therapeutic skill; therapist provides information about how therapy works, what is routinely discussed, agenda for day’s activities, and therapeutic process.
Important because it helps the client understand how therapy works and establishes therapy norms
Helps stay on track and maximize productive time
Done at beginning of sessions and beginning of treatment in general– therapeutic rationale, confidentiality, etc.

EXAMPLE: At the beginning of therapy, Susan does some structuring to ensure the client is aware of the structure of the therapy sessions, her fee and appointment policies, and the limits of confidentiality. This establishes norms for therapy so therapist and client both know what to expect.

Question 25

Summarization

Answer 25

universal therapeutic skill and active listening skill; used to review what has been said during the session and to review content over extended period of time.
It is like the cliff notes version of the session to date.
Therapist uses skill either to begin, end, or transition to review materials covered as needed
ABC narrative; making sense of the client’s sometimes jumbled emotions/story; captures the essence of what has been discussed

EXAMPLE: At the end of their session, James summarizes his session with Drew. “So today we discussed your relationship with your mother and how it may be affecting your current relationship with your wife. You have a take home assignment that you are supposed to complete where you will note how many disagreements you have with your wife this week. Is there anything you would like to add before we end for today?”

Question 26

Termination

Answer 26

part of clinical practice; final phase of therapy and ending of the therapeutic relationship
Process of termination begins on first day! Plan for it
When do you terminate? Ideally when it is reasonably clear client is no longer benefitting; goals have been reached or services no longer needed
Signs client is ready: missed appts, disengagemen/slowing of progres, hard to find new areas to work on, lack of compliance
Clients that want to stay on might be repeated old themes, hanging on, or in new crisis
How to terminate?
Review progress made, ask about client experience, share your experience, instill hope for future – remind them they can always ask for more help later

EXAMPLE: After 10 weeks of therapy, James is no longer experiencing anxiety symptoms. He has been working with his therapist on relaxation techniques and emotional regulation. After discussing progress with his therapist, they both agree it would be appropriate to terminate the therapeutic relationship. The therapist assures James that he can come back if he ever feels like he needs some more help.

Question 27

Trustworthiness

Answer 27

part of clinical practice and the therapeutic alliance; crucial characteristic of clinicians; their ability to be honest, genuine, and to keep confidentiality;
very important because it promotes open self-disclosure by client, builds rapport and helps develop therapeutic relationship
when providing therapy to individuals of different cultures - defensiveness often decreases client’s perception of therapist’s trustworthiness

EXAMPLE: During the first session, Fiona discusses the process of therapy and confidentiality to her clients. In order to build trustworthiness, she is transparent and genuine with all of her clients. Trustworthiness is essential when trying to build rapport.

Question 28

Verbal tracking

Answer 28

universal therapeutic/basic listening skill; refers to attending to the client’s words and actively listening; therapist follows client’s lead and show them they are following along (tracking) by reflecting and paraphrasing using key words they have used along the way
Important because it helps client feel heard, important, understood

EXAMPLE: client: I haven’t seen my dad in a long time, school is getting tougher and my relationship with my girlfriend is terrible.
Therapist: “It seems you feel like you are being hit from every direction at once. You said that your dad hasn’t been a presence in a while, you are struggling academically, and your relationship with your girlfriend is suffering. Which would you like to discuss first?”
The therapist uses verbal tracking to make sure the client feels heard, and to allow the client to direct the conversation.

Question 29

Working Alliance

Answer 29

aspect of clinical practice; therapeutic relationship between therapist and client in which both are active collaborators in developing goals for tx and working towards these goals
Can predict successful therapy and outcomes
Therapist can contribute to its development by showing UPR, empathy, and congruence
Collaborative appraoch
Helps build trust between pt and therapist
pre-therapeutic factors influencing its appearance are the client’s preference for tx and expectations about improvement

EXAMPLE: Taylor builds a working alliance with his patient Timothy. They work together to develop goals and a treatment plan to achieve those goals. They decide that Timothy would like to improve his relationship with his wife and children. They decide to utilize Functional Family therapy to increase communication and positive interactions with his family.

Question 30

Capping

Answer 30

universal therapeutic skill; moves client away from emotional information and toward more cognitive based discussions, especially if the counselor feels their client’s emotions need to be calmed or regulated. Therapist asks question that is supposed to lead to cognitive response (e.g., It sounds like you were really sad at that time. What were you thinking when it occurred?”)

EXAMPLE: Your client is getting really emotional about her affair that she had. In order to get her focused on a cognitive aspect rather than an emotion you might do some capping and say, “So you felt really bad about what you did. What were you thinking in that moment?”

Question 31

Hierarchy of needs

Answer 31

part of Maslow’s motivational theory; typically depicted in a five-tier pyramid or hierarchical scheme; typically, 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
1) Physiological - breathing, food, water, sex, warmth, sleep
2) Safety - security & safety of body, employment, resources, morality, family, property
Physiological + Safety = Basic Needs
3) Love and belonging - intimate relationships and friend, family
4) Esteem - prestige; feeelings of accomplishment
Love & Belonging + Esteem = Psychological Needs
5) Self-actualization - achieving one’s full potential including creative activities
Self-Actualization = Self-Fulfilment Needs

EXAMPLE: A counselor was working with Carla, a first time mom. Carla commented on how she was worried about keeping a roof over her new baby’s head as her landlord was trying to evict her. As The counselor realized that Carla needed to work on satisfying her basic needs before they could move onto larger goals based on Maslow’s hierarchy of needs. The counselor worked with Carla and supported her while they tried to find her safe housing.