PSYC-526 Clinical-Counseling Basic Flashcards
Active Listening
Active listening is a pattern of listening that keeps you engaged with your conversation partner in a positive way. It is the process of listening attentively while someone else speaks, paraphrasing and reflecting back what is said, and withholding judgment and advice.
-Building trust and establishing rapport
-Demonstrating concern
-Paraphrasing to show understanding
-Using nonverbal cues that show understanding such as nodding, eye contact, and leaning forward
Brief verbal affirmations like “I see,” “I know,” “Sure,” “Thank you,” or “I understand”
-Asking open-ended questions
-Asking specific questions to seek clarification
-Waiting to disclose your opinion
-Disclosing similar experiences to show understanding
Biopsychosocial
a systematic integration of biological, psychological, and social approaches to the study of mental health and specific mental disorders.
an inter-disciplinary model that looks at the interconnection between biology, psychology, and socio-environmental factors. The model specifically examines how these aspects play a role in topics ranging from health and disease, to human development.
suggests that biological, psychological and social factors are all interlinked and important with regard to promoting health or causing disease.
Capping
Universal 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?”) Also used when terminating therapy and to help the client move away from overly emotive responses
Ex: “Give me a couple words that symbolize the emotion you are showing right now.” Or “So you felt really bad about what you did. What were you thinking in that moment?”
Clarification
to check whether understanding is accurate, or to better understand, the therapist restates an unclear or ambiguous message to clarify the sender’s meaning. This will help the counselor avoid any misconceptions or avoid them having to make any assumptions that could hinder their feedback
Ex: “I’m not sure I understand what you mean by ‘sicker than usual’, what is different now?”
Client expectancies
When a person enters therapy, they should voice their opinions about counseling and their beliefs about treatment. In the beginning, they should be able to communicate with their counselor as to what they expect to get out of counseling. This can help the counselor guide and direct their counseling accordingly.
the patient and therapist will need to be in agreement about the goals of therapy as well as the tasks, which are two critical components of the therapeutic alliance
Confrontation
the therapist makes a statement that draws attention to discrepancies in the client’s words, actions, or story; use own thoughts/wording/emotions as feedback; statement may be direct and straightforward or indirect and subtle; timing is important; often used later in therapy
Ex: “You have been telling me that you want help with this issue and that you are willing to try anything to make it go away, yet you did not do the homework assignment from last week.”
Congruence
Carl Rogers believed that for a person to achieve self-actualization they must be in a state of congruence. This means that self-actualization occurs when a person’s “ideal self” (i.e. who they would like to be) is congruent with their actual behavior (self-image). Therapist should come to therapy in state of congruence while client comes in state of incongruence.
Dual relationships
A therapist cannot enter a therapeutic relationship with a client if the therapist has a close previous relationship with the potential client (family member or friend, or has a close personal relationship with a person close to the potential client due to multiple or dual relationships. This should be avoided as the dual relationship could alter the underlying structure of the therapeutic relationship or disrupt the objectivity of the therapist.
An example would be if a close friend of mine has a child who is beginning to act out in school, and she asked me to counsel him to see what’s going on, I would not be able to because of close/frequent contact in a different role and refer her to someone else.
Encouraging
therapeutic technique used to encourage continued discussion by the client without interrupting or changing the focus. Can be minimal (okay, I see, etc) or nonverbal (nodding, leaning forward, etc.)
Ex: nonverbal - nodding head, eye contact, body language; minimal encourager - “okay” “hmmm” “I see”
Engagement
level of client’s involvement in therapy; can be fostered by the therapist (WEG) as well as client variables; includes: doing homework, active participation - being open, show up to therapy; correlated with successful therapeutic outcomes
Fixed vs. growth mindset
Someone with a growth mindset views intelligence, abilities, and talents as learnable and capable of improvement through effort. “the understanding that abilities and understanding can be developed”
On the other hand, someone with a fixed mindset views those same traits as inherently stable and unchangeable over time. a fixed mindset is one that assumes abilities and understanding are relatively fixed. Those with a fixed mindset may not believe that intelligence can be enhanced, or that you either “have it or you don’t” when it comes to abilities and talents.
Hierarchy of Needs
Maslow’s categorization of 5 motivational needs typically depicted in a pyramid; 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; suicidality trumps all; client must be motivated to meet these needs; for clinical purposes sometimes will focus on a higher need due to culture/disorder
1) Physiological - breathing, food, water, sex, sleep, excretion
2) Safety - security of body, employment, resources, morality, family, property
3) Love and belonging - friendship, family, sexual intimacy
4) Esteem - self-esteem, confidence, achievement, respect of /by others
5) Self-actualization - morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts
Holding vs shifting the focus
Holding discussion on topics that are relevant to group members
Shifting the focus when the topics are irrelevant or interesting to only a couple of members
Immediacy
The technique of the counselor speaking 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
Ex: “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.”
“When I just shared my interpretation of what you were saying I noticed your facial expression changed.”
Interpretation
A term used in psychodynamic theory and developed by Freud, this is the clarification of hidden meaning behind what the client says. this is considered the specific intervention of the analyst and the driving force of therapeutic change.
giving new meaning to experiences, actions or beliefs about self, others, or the way the world works; clarification of hidden meaning; timing is important; they can be threatening, so resistance is expected and interpreted; can be positive, negative or neutral
Ex: “Did you ever consider that you have developed this ability to cut people off emotionally in order to save yourself from getting hurt?” or “One explanation could be that he acts like a child in order to get you to play in the role of parent. He feels good when he is being parented and pampered.”
Logical consequences
universal 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
Ex: “If you decide to change in that way, how will people view you differently?” or “What are the pros and cons to making this change in your life right now
A logical consequence is an imposed consequence given by an adult that is related to the behavior. For breaking the toy, a logical consequence might be that the child must earn money to buy a new toy or that the child will not be allowed to play with breakable toys.
Open-ended questioning
a question that is intended to get the client to discuss an issue in greater detail and can’t be answered with “yes” or “no”; usually start with how, why, or what
Ex: “What is it like to be so busy?” or “How might the family react if you stopped doing so much?”
Paraphrasing
selecting a few of the client’s words that stand out and repeating them back in a different way to the client; Universal 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. gets further exploration from client.
Ex: “Yesterday my mom told me that we are going to do things different at home from now on.” “You found out yesterday that things are going to change in your family.” Or “Your family is changing.”
Positive asset search
universal 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
Ex: “You said several years ago you overcome a similar issue. How did you do that?” Or “So one of the things you have going for you is a strong desire to help others.”
Power dynamics
dynamic between therapist and client; power differential that exists between therapist and client; part of the therapist’s responsibility to balance this dynamic and be aware of how the client perceives the power differential
Reflection of content
Listening accurately to another person and reflecting the essence of the content to the other in your own words.
counsellors do not repeat what the client has said, but pick up the most important content information and, using their own words, feed this back to the client.
Reflection of feeling
Listening accurately to another person and reflecting the feeling component of the communication to the other in your own words.
Reflection of feelings involves reflection of the perceived emotional affect of the client.
Universal skill utilized by therapist to show client that he/she is aware of feelings client is experiencing and to demonstrate empathy. Highlights client’s emotion words and may reflect them back using exact phrase or synonyms. “It sounds like you are really tired” “Sounds like you feel manipulated.” Shows active listening.
Ex: “I was really pissed off having to move and change jobs.” “You feel angry about this.”
Reflection of deeper meaning
(combining feelings and content)
Listening accurately to another person and reflecting the essence of both the content and the feelings the other has expressed.
To demonstrate to client that you have heard deeper meaning of story, reflect/repeat back what’s underneath the surface thought to get to the deeper meaning; usually gets to 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: “One of your beliefs is that if you do not get it done perfectly it should not be done at all.” or “It sounds like you believe that your friends frequently take advantage of you.”
Reframing
Reframing is seeing the current situation from a different perspective, which can be tremendously helpful in problem solving, decision making and learning. Reframing is helping you or another person to more constructively move on from a situation in which you or the other person feels stuck or confused.
therapist takes the essence of the statement made by the client and moves it from a negative to a more positive, hopeful one; provides new meaning to an old story
Ex: In response to a mother exhausted by doing everything for everyone in her life - “Sounds like a lot of people depend on you. You are dependable.”
Miracle Question
Solution focused therapy technique. Asking clients to imagine how things would be if they woke up tomorrow and their problem was solved. Used to help clients identify goals and potential solutions. Helps clients look beyond the problem to see what they really want and begin to activate problem solivng. Most effectively introduced when clients complain in vague terms.
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; Especially useful with ambiguous clients; Allows therapist to get an idea of what the client wants out of therapy; solution-focused therapy; Brief therapy; CBT;
Ex: “If a miracle happened tonight and you woke up tomorrow and the problem was solved, what would be the change in your life?”
Self-disclosure
providing the client information about yourself; 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.
Only utilized when it is of client interest and would benefit the therapeutic process. Need to make sure you are aware of any underlying motives you may have as a therapist; cannot just talk about yourself.
Ex: “I have suffered a great loss as well.” Or “I have a granddaughter named Megan.”
Stages of change
Assesses clients readiness or lack of to make changes
stages client goes through enroute to change; at the core is an ambivalence to change; commonly seen in people with substance use issues; ambivalence to change is addressed in MI
1) Precontemplation - no indication of movement or change
2) Contemplation - thinking of change, maybe this is a problem
3) Preparation - thinking more in-depth about change; think about the process they would have to go through (i.e. smoking last cigarette, seeking out therapist or other help)
4) Action - “the process”; actively participating in the steps necessary to change (i.e. chewing Nicorette, exercising, therapy)
5) Maintenance - the process has now become routine and doesn’t take as much effort
6) Reoccurrence/relapse - reoccurrence of problem(s)
Structuring
Universial skill; given to provide direction 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.
Ex: “In terms of therapy, what I try to do is provide an environment for you to learn more about yourself, learn to deal with some of the things that trouble you, and help you continue to grow as an individual.”
Suicidality
The APA defines suicidality as
“the risk of suicide, usually indicated by suicidal ideation or intent, especially as evident in the presence of a well-elaborated suicidal plan.” It can also be defined to include suicidal thoughts, plans, gestures, or attempts.
Risk levels can be noted using the SAD PERSONS Scale.
When certain risk levels are met, measures can be taken towards safety including hospitalization of pt.
Summarization
Universal skill; used to review what has been said during the session and to review content. 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 and to clarify as needed. ABC narrative; making sense of the client’s sometimes jumbled emotions/story; captures the essence of what has been discussed
Ex: “So, in summary, what I heard you talk about this session…”
Termination
goal of the final phase of therapy; ending of therapy and of the therapist-client relationship; goals of treatment have been reached and/or the client has the skills to address their issues on their own; process of termination starts on the first day of therapy and the therapist should plan for termination
Ensure that pt does not grow an unhealthy dependence on therapist.
Transference/Countertransference
Transference is when the client redirects (transfers) an unconscious feeling, desire, or expectation from another person toward their therapist. For example, a therapist may remind a client of her mother. Then, without the client even realizing it, she begins engaging with the therapist as she does her own mother. Transference can actually help the therapist identify patterns of relational interaction occurring in the client’s life.
Countertransference is essentially the reverse of transference. In contrast to transference (which is about the client’s emotional reaction to the therapist), countertransference can be defined as the therapist’s emotional reaction to the client. Similarly to transference, countertransference is a common occurrence in therapy. Because of this, it is essential that we as therapists are aware of how countertransference may be showing up in therapy. We may observe countertransference occurring when we have a strong emotional reaction towards a client.
One common example of countertransference is when a therapist finds herself feeling protective and parental towards a client, as that client may be reminding her of her own child (or someone else she feels protective of in her life).
Trustworthiness
deemed a necessary characteristic of the therapeutic relationship by Wampold; The counselor must create an environment for their client as such that their client feels that they have the capacity to trust their counselor. translates to the therapist’s sincerity, reliability; when providing therapy to individuals of different cultures - defensiveness often harms trustworthiness of therapist
WEG skills
Encouraged the most in Rogerian therapies, but can be applied to most techniques. Refers to the 3 therapist characteristics that are necessary and sufficient conditions for change; warmth, empathy and genuineness.
Warmth refers to showing unconditional positive regard, and non judgmental caring and acceptance of client’s emotions.
Empathy refers to the counsellor seeing the client’s world as they see it. Empathy is to respectfully perceive what the client is bringing from their frame of reference and to communicate that back in a way that makes the client feel they’ve been understood.
Genuineness refers to being transparent, with no superior attitude or professional jargon, and being congruent.
When all three are presented by the therapist and perceived by the client, it turns into trust. It is important to note that its the client’s perception of the therapist’s WEG that is important.
Working alliance
a collaboration between the client and the counselor based on the development of an attachment bond as well as a shared commitment to the goals and tasks of counseling.
construct associated with positive psychotherapeutic outcomes and is essential yet challenging ingredient to effective therapy;
therapists can foster this quality in their clients by developing the therapeutic relationship using universal techniques of acceptance, WEG, and a collaborative approach; setting and working toward meeting goals
