PSYC 526- Basic Counseling

Question 1

Fixed vs. growth mindset

Answer 1

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.

Question 2

WEG skills

Answer 2

Drawn from Carl Roger’s humanistic approach, WEG skills include warmth, empathy, and genuineness. Roger’s believed that by providing these to clients, therapists could create a healing environment and patients would in a sense, heal themselves. These skills help clients feel understood, heard, and respected.

Example:

Question 3

Open ended questioning

Answer 3

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?”.

Question 4

Miracle question

Answer 4

“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.

Question 5

Hierarchy of needs

Answer 5

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.

Question 6

Biopsychosocial

Answer 6

The biopsychosocial model is a way of conceptualizing a client’s case by considering the biological, psychological, and social factors that may contribute to or influence them. To understand these elements is to develop a full picture and develop a more thoughtful and likely more effective Tx plan.

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.

Question 7

Clarification

Answer 7

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.

Question 8

Client expectancies

Answer 8

Client expectancies are expectations that the client holds regarding what therapy will be like and what clients to expect from the process. Expectancies are considered a common factor and have been demonstrated to shape a client’s experience and influence therapeutic outcomes. 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.

Question 9

Confrontation

Answer 9

Part of basic counseling skills, confrontation is 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?”

Question 10

Capping

Answer 10

Part of basic counseling, capping is a universal skill where a therapist guides a discussion from an emotional realm to a more cognitive realm. To do so, the therapist may ask 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?”

Question 11

Congruence

Answer 11

Part of: person-centered therapy

Who: Rogers

What: AKA authenticity; More specifically, congruence means a person’s experience matches their awareness. According to Rogers, congruence is a condition in a therapeutic relationship that can facilitate client growth.

• 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.

Question 12

Dual relationships

Answer 12

Dual relationships are when multiple roles exist between a therapist and a client. The therapist is either concurrently in another relationship with the 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 the therapist, compromising the therapeutic alliance and quality of treatment.

Question 13

Interpretation

Answer 13

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?”

Question 14

Active listening

Answer 14

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.

Question 15

Encouraging

Answer 15

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.”

Question 16

Engagement

Answer 16

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.

Question 17

Holding vs. shifting the focus

Answer 17

Therapeutic skills in which the therapist attempts to direct the client’s focus 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. The 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 18

Immediacy

Answer 18

Universal skill used to give a response about clinician perspective or experience of what’s occurring in the present moment. Should be anchored in the present moment; critical component of therapeutic 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.”

Question 19

Logical consequences

Answer 19

A universal skill used to help a client explore the pros and cons of making a change. This technique provides 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: 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.

Question 20

Paraphrasing

Answer 20

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?”

Question 21

Positive asset search

Answer 21

A universal therapeutic skill in which the therapist makes a statement or asks a question designed to bring to the surface a client’s 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?”

Question 22

Power dynamics

Answer 22

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.

Question 23

Reflection of deeper meaning

Answer 23

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.”

Question 24

Reflection of feeling

Answer 24

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.”

Question 25

Reframing

Answer 25

A brief therapy tool in which the therapist takes the essence of a statement made by a client and frames it in a more positive way. The purpose of a reframe is to provide the client with new meaning to an old story.

Example: A client complains that there is no space for her to fall apart in the face of a stressful time because everyone depends on her to keep an even keel and keep some semblance of normalcy. A reframe by the therapist might be, “Your family looks to you for stability and reassurance.”

Question 26

Miracle question

Answer 26

Often used in brief therapy, the miracle question is a technique used to gain insight into what the client really wants and to help set goals. A type of question that asks the client to visualize how their life would be different if their problems were fixed, phrased in a way that imagines an overnight recovery.

Example: Liz and her client are discussing his anxiety issues. She asks her client, “I have a weird question. Imagine you went to bed tonight and a miracle happened so that your anxiety and problems were fully gone tomorrow. What would that look and feel like?” The purpose of this question is to get an idea of what her client envisions his life to be like without anxiety.

Question 27

Self-disclosure

Answer 27

Self-disclosure is when a therapist reveals details about himself to his client. Some self-disclosure is unavoidable, such as visual disclosures such as style choices, race, and age. Self-disclosure is a boundary crossing and should be done sparingly and only if it will benefit the client. Therapists should consider their online or social media presence, which is also a form of self-disclosure.

Example: Susan’s client is reeling from the loss of her baby to stillbirth. Her therapist had a stillborn baby herself. The therapist chooses to disclose this detail because her therapeutic judgment tells her that it will help her client feel safe and understood to know she is speaking with someone who experienced the same thing, since one of the client’s biggest struggles is feeling that no one understands what it is like.

Question 28

Stages of change

Answer 28

Transtheoretical model developed by Prochaska & Diclemente; use to conceptualize/assess for a client’s readiness to change.

There are six stages a person goes through en route to change; at the core is an ambivalence to change.

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

Example: A client has admitted that his drinking is problematic and impacting his life and family negatively. He and his therapist have found several support groups and they are discussing treatment options. The client is in the preparation stage of change. The therapist wants to help the client progress to the action stage in which he puts this decision to change into practice.

Question 29

Structuring

Answer 29

This technique is used to provide a clear direction in how the therapy session will go for that day. One way this occurs is by the therapist setting the stage by asking the client a specific question on their thoughts, behaviors, actions, etc. from the past week. The therapist may also discuss specific techniques that are used in therapy for the issue at hand. The therapist may also set the environment up for success by describing their role as the therapist, and the role of the client.

Example: Allison is working through disordered eating behaviors with her therapist. Her therapist has asked her to keep notes on any time these behaviors have occurred between sessions. To structure the session at the outset, the therapist says, “As we begin therapy today, I’d like for you to discuss with me when you felt most debilitated by your relationship with food this past week.”

Question 30

Summarization

Answer 30

A universal skill in which a therapist captures the themes or larger picture of what has been communicated by the client over an extended period of time (an entire session or multiple sessions). This skill demonstrates active listening and brings order to the breadth of information shared.

Example: At the end of a session in which Kathy has described frustration at work, conflict in her marriage, and the feeling that she has to drag herself through each day, the therapist summarizes by saying: “As we come to the end of this session, I want to go over what we’ve discussed. It seems like your goals are to feel more content in your daily life, but your relationships and your job might be impacting how happy you feel.”

Question 31

Suicidality

Answer 31

Assessing for suicidal ideation and plan is part of an initial clinical interview, and ongoing as needed. When assessing for suicide risk, therapist should ask about Ideation: passive or active? frequency?
Plans: Have they thought about how they would do it?
Means: Do they have access to means to complete plan?
Intent: Do you think there’s a chance you may act on these impulses? (over course of next week, etc.)

• if clinician believes a client is likely to commit suicide, confidentiality may need to be broken for the client’s safety.
• SAD PERSONS is an assessment tool that can also be utilized to access suicide risk.
• A safety plan co-created with the client is recommended

Risk factors for suicide include:
-Diagnoses: depression*, schizophrenia, PTSD
-Other psychiatric risk factors: eating disorders, borderline personality disorder, antisocial personality disorder
-Symptoms: hopelessness/desperation, anxiety, aggressiveness/rage or anger, impulsivity/unnecessary risks, recent hospitalization
-Past history: history of childhood trauma or abuse, history of being bullied, family history of death by suicide, past attempts are best predictor
-Behaviors: Making a plan, giving away possessions
Sociodemographic: male, age 45-64, white, separated widowed, divorced, living alone, being unemployed or retired
-Occupation: health-related occupations higher (dentists doctors, nurses, social workers) * especially high in women physicians

Example: In an initial interview, Bob says that he has persistent thoughts of killing himself. He does not have easy access to means, and says he does not intend to act on these thoughts. His therapist proceeds to help him make a safety plan to lower his risk, but does not deem hospitalization necessary.

Question 32

Termination

Answer 32

In clinical practice, termination is the hoped eventual for therapeutic outcome, and should be planned for from the first session. Ideally, discussion of termination begins after client has made progress.

In a planned termination session, therapist should review of progress made, highlight gains, identify areas for future growth, ask about client experience, instill hope for future, and help the client process the experience.

Signs that a client is ready to terminate include missed appointments, disengagement/slowed pace of progression, difficulty finding new areas to work on, lack of compliance.

Example: Deirdre came to therapy for help managing social anxiety. After several months, Deirdre is participating in more social settings, and experiencing less anxiety after implementing strategies her therapist has recommended. Her therapist suggests it is time to discuss termination, highlighting the progress she has made and assuring her that she can return to therapy in the future if need be.

Question 33

Transference/countertransference

Answer 33

Transference is when clients undergoing clinical therapy begin to transfer feelings of a particular person in their lives to their therapist. Countertransference is when a client triggers a particular response (or urge to respond) in the therapist.

Example: Sonya has a very difficult relationship with her mother, and shuts down to avoid conflict often. When her therapist notices her shutting down and acting withdrawn in therapy, she recognizes it as an instance of transference in which Sonya has transferred the feelings she has toward her mother to the therapist.

Question 34

Trustworthiness

Answer 34

In clinical practice, trustworthiness is a crucial characteristic of clinicians and includes their ability to be honest, genuine, and to keep confidentiality. Trustworthiness builds rapport and strengthens the therapeutic alliance, two key elements of successful therapeutic outcomes. When providing therapy to individuals of different cultures - defensiveness often decreases client’s perception of therapist’s trustworthiness.

Example: During the first session, Jenna discusses the process of therapy and confidentiality to her clients. In order to build trustworthiness, she displays genuineness and active listening. Trustworthiness is essential when trying to build rapport.

Question 35

Working alliance

Answer 35

Therapeutic relationship between therapist and client in which both are active collaborators in developing goals for treatment and working towards these goals.

• Can predict successful therapy and outcomes
• Therapist can contribute to its development by showing UPR, empathy, and congruence
• 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: Dale comes to therapy with the broad goal of feeling more secure in his career. His therapist works to with him to build a working alliance by establishing rapport and trust, collaborating on specific goals, and agreeing on a treatment plan.

Question 36

Reflection of content

Answer 36

A universal skill, to reflect content is a technique therapists employ in which they summarize the content of what a client is saying in therapy without changing the meaning. This technique allows clients to experience empathy and feel listened to and is important in the development of the therapeutic relationship. Reflections also allow clients to correct the record when necessary.

Example: A client spends ten minutes discussing a fight she had with her husband. The therapists reflects the content by saying, “You fought over household responsibilities. He refuses to take on more. Then he left the house before the fight was resolved.”