PSYC525 – Basic Counseling Techniques

Question 1

Spheres of Influence

Answer 1

A conceptual model of the multiple levels that influence a person. The spheres of influence are the factors in a person’s life that are directly and indirectly related to the problem that the client is experiencing.
(Interaction between the Person, Problem, Environment.)

• The first ring begins at the client/individual level. (coping skills,social skills, self-esteem, temperament, health, sleep and eating patterns, exercise, spiritual beliefs, etc.)
• The second ring involves all interpersonal factors related to the people who sleep under the same roof as the client, including parents, siblings, etc. (Parental expectations, discipline, SES, health, substance/sexual abuse.)
• The third ring consists of organizational factors that are related to the client in terms of : school and/or occupation. (including relationships with peers, the environment, income school/job expectations.)
• The fourth ring deals with the surrounding community. Is it safe/unsafe? Are there any recent events that have happened that impact the community? (shooting, kidnapping)
• The 5th ring deals with world happenings. (9/11, global warming, wars, social change, ect.)
• The spheres of influence should be assessed and understood in the first session.

Ex: By the end of session one, the therapist made sure to assess the client’s problem in relation to the environment by using the spheres of influence model. In the initial interview, the therapist gathered factual data and was able to develop a case conceptualization.

Question 2

Clarification

Answer 2

is a basic counseling technique. It is an active listening skill where the therapist provides a summary of what the client says, focusing on and clarifying its meaning.

-The use of this skill reduces the possibility of miscommunication and shows the client that the therapist hears and understands what the client is saying.

Ex: the client says to the therapist that his teenage daughter is being “impossible”, the therapist repeated, “you say that your daughter is impossible, describe to me what that means.” By using a clarification, the therapist is able to allow the client to elaborate and further communicate what constitutes “impossible” behavior.

Question 3

Client Expectancies

Answer 3

The values that a person places on a given outcome. In the context of clinical practice, these are 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.
• A client’s expectations for tx are important in determining motivation to change and are usually verbalized at the beginning.
• Expectations involve treatment goals and the roles of both client and therapist in achieving treatment goals.
• It is important to understand the clients internal frame of reference; a therapist must ensure client expectations are realistic, adaptive, and appropriate.

Ex: A client’s expectations are that therapy is a waste of money and that therapists are a bunch of quacks. The therapist, mindful of the client’s mistrust, was aware 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 counseling technique in which the counselor highlights incongruities between the client’s verbal and nonverbal communication or within the client’s verbal communication in order to facilitate the client’s awareness of conflicts associated with specific issues or topics.
• This is considered an advanced skill because confrontation involves more of an intervention than a component of effective listening, and it is essential that its use be timed appropriately in order for the client to receive maximal benefit.
• This technique should only be used during the middle and late phases of therapy, after a solid therapeutic relationship has been established. -Confrontation demands a revelation from the client which may be painful or embarrassing.

Ex:Often times clients may have difficulty expressing certain emotions and may describe an emotion without the appropriate affect associated with it.
For example:
Client: (Smiling) It makes me so angry to even think about what he did to me.
Counselor: I can understand how angry that would make you feel. Were you aware of the fact that you were smiling when you stated how angry you were? I wonder if you can say that you’re angry and express some of your anger when you do so?” The therapist uses confrontation so that they can further explore the client’s aversion towards expressing anger.

Question 5

Congruence

Answer 5

–concept developed by Rogers and used in his person-centered therapy.
congruence (also known as genuineness) refers to the counselor’s ability to be real and be consistent in their verbal and nonverbal behavior.

Congruence is one core condition a therapist must possess; it is the willingness to transparently relate to clients without hiding behind a professional or personal facade. In short, the therapist is authentic.

• Rogers postulated that many clients come to therapy because they are lacking congruence in their life, and the counselor may model this to the client.

Ex: Beth talks about having several abortions. The therapists states that she is comfortable with the topic, 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

• in the context of clinical practice, these are three conditions that clients must perceive therapists to have in order for a healthy and beneficial therapeutic relationship to develop. They were developed by Rogers in his client-centered therapy.
• The core conditions are unconditional positive regard, empathy, and congruence (genuineness). WEG

Unconditional positive regard means showing warmth and support to the client, even if they do things the clinician does not agree with.
-Empathy means that the clinician shows the client that they understand their emotions.
Genuineness refers to the clinician being themselves and not putting on airs (autheniticity).

Ex: The therapist knew that he needed to portray the core conditions of empathy, unconditional positive regard, and genuineness to the client in order for the therapeutic relationship to be successful. He used encouragers and summarization in order to communicate empathy while the client talked about her problem.
-He made sure to portray genuineness by allowing his personality to shine through. When the client revealed a shameful secret, he demonstrated unconditional positive regard by telling the client that he fully accepted her regardless of her faults or previous behaviors.

Question 7

Encouraging

Answer 7

This is a basic counseling technique that is an active listening skill.
Encouraging can be any verbal and nonverbal cue that the counselor gives to the client to promote further disclosure by the client.

• This skill can help the therapist portray that he/she is listening, interested and wishes to hear more.
• The skill is useful because the therapist can provide support and encouragement without interrupting the client and the flow of what they are saying.

Ex: teen client describes parents divorce, therapist nods while client is talking. Therapist then provides an open gesture and follows with “go on, tell me more.”

Question 8

Engagement

Answer 8

term originally used in Roger’s person-centered theory/therapy,

• 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.

Engagement can be encouraged through the therapist’s expression of the core conditions, and is influenced by patient factors such as past experiences, expectations, and readiness to change.

Ex: child does not want to talk to the therapist and sits with arms crossed. The therapist engages the child by sitting on floor and coloring with the child. After a few minutes, the child begins to talk with the therapist.

Question 9

Focusing

Answer 9

in the context of clinical practice, this refers to a skill used by the therapist when they need to redirect a client’s attention to a specific goal or issue.

• Focusing is a part of structuring the session. It keeps the client on topic and focused on the specific problem at hand.
• It involves attending to problems/feelings as they arise; the ability to focus encourages the client to work on present problems where there are attainable goals vs focusing on the past.

Using this skill is important because it provides direction in therapy and can result in the creation of goals.

EX: 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. This is important so that she can begin to discover her true feelings and begin to work through them.

Question 10

Immediacy

Answer 10

This is a concept developed by Rogers in which therapists should attend to the client’s problems and feelings as they arise.

• The therapist reflects on an aspect of current feelings, thoughts, or treatment in therapy.
• Immediacy is important because it can help communicate warmth and empathy to the client;
• if the counselor does not give a response to what is happening in the present the client may feel judged, or brushed off.

Ex: Mary came to therapy to deal with issues in her marriage. During the initial interview, she began to cry when she was talking about her family and mentioned her father. The therapist caught this and asked her to talk more about her father as this was the immediate issue. Mary felt relieved that she had been heard. She hadn’t understood the importance the role of her father played in her marriage.

Question 11

Interpretation

Answer 11

-A concept originating from the freudian/psychoanalytic perspective.
In the context of current clinical practice, the client provides the data to the counselor, who then interprets the data by forming a hypothesis.
-Hypthesis may be drawn from a theory or from one’s own personal observations.
An interpretation provides an alternative frame of reference from which the client may view a situation.
- This alternative frame of reference may enable a change of view which in turn may result in changes in thoughts and behaviors.
-Clients may dispute the counselor’s interpretation, as the counselor may be incorrect in their interpretation.

EX: Client comes to therapy saying that he’s having trouble sleeping, losing his appetite, feeling very sad, distracted easily. The therapist interprets the client’s symptoms as evidence of depression. The client’s former view of himself that he was just lazy and useless changed into being hopeful for treatment.

Question 12

Listening Skills

Answer 12

• in the context of clinical practice, these are skills used in actively attending to what the client is communicating (verbally and nonverbally) and then communicating back to client what has been heard.
• Listening skills are crucial in establishing the core conditions. (warmth, empathy, genuineness)
• Active listening by the clinician encourages the client to share information by providing verbal and nonverbal expressions of interest.
• Active listening skills include but are not limited to: clarifying, minimal encouragers, and perception checks, paraphrasing

Ex: 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

• this is a behavioral term which refers to the natural consequences that may follow a particular course of action.
• Logical consequences enable the client to visualize possible outcomes of alternative actions, thus looking at positive possibilities and concentrating on achieving those.

-A therapist may also discuss the logical consequences that may occur when attempting to alter a problem behavior. Sometimes it may be best to simply allow the natural or logical consequences of the behavior to occur, which may serve as a kind of wake-up call to the individual.

Ex– 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 then what it would be like if she decide to divorce him. The began to explore the logical consequences of both options.

Question 14

Open-ended questioning

Answer 14

This is a Basic Counseling technique that is a fundamental skill used promote greater client disclosure.

• Questions are constructed using how and what and can not be answered in one word. (Such as Yes or No)
• It is advised that the therapist refrain from using “why” as it may come across as judgmental or aggressive. OEQ’s are used to progress the client from generalizations to specifics, to obtain more info, and for clarification. OEQ is esp useful in the beginning of therapy bc it allows the client to tell their story in their own way and to focus on what is important to them

Ex: 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 facts, and also the client’’s perception of the family structure.

Question 15

Paraphrasing

Answer 15

Paraphrasing - is a basic counseling skill in which the therapist states, in his/her own words, the main content and thoughts expressed by the client.„
-„A counselor is stating back to the client, in a nonjudgmental way, an accurate
understanding of the client’s communication and the implied meaning of that
communication.
- This 1) lets the client know you are working to understand what they are communicating, 2) brings focus to the client’s communication, 3) allows the client to correct any misperceptions or misunderstandings, and 4) encourages client self-exploration.
-Good paraphrasing indicates attentive listening, and with well chosen words, gives a deep sense of empathy.

Ex: When telling the therapist about her relationship with her mother, the client states: “I don’t know about her. One moment she’s really friendly, and the next time I see her she’s totally cold.”
Counselor: “You haven’t experienced her as being very consistent.” By paraphrasing, the therapist promotes facilitation of client exploration and also the clarification of issues.

Question 16

Positive Asset Search

Answer 16

this is an exploration of a client’s strengths and is an essential part of behavioral analysis; assets that are found may be used to help overcome behavioral problems.
In addition, identifying strengths can help to increase the client’s self-efficacy.
Identifying positive assets may also aid in establishing rapport.

Ex: The patient presents to therapy with extreme social anxiety. As part of behavioral analysis, the therapist conducts a positive asset search. He first began with, “Although you are telling me about your social difficulties, you must be aware of a personal strength– your great sense of humor!” The client felt confident and was able to identify more positive assets on his own.

Question 17

Power Dynamics

Answer 17

in the context of clinical practice, this is the control and authority relationship between the therapist and the client.
There is a natural power differential between the two because the therapist controls certain aspects of the relationship, such as the scheduling and fees; the therapist also has more knowledge about therapy than the client and is seen as the “expert.”
-PD may also be influenced by SES, age, and gender. The effects of the power differential can be lessened through the use of unconditional positive regard, genuineness, and empathy.

Ex: A child comes into office and is afraid to disclose info to therapist. As a result of Power Dynamics, the child sees the therapist as an “authority figure” and refuses to talk or engage in therapy. While maintaining professionalism and proper boundaries, the therapist colored with the child while talking. This communicated to the child that the therapist was genuine and supportive.

Question 18

Proxemics

Answer 18

• the study of how man uses space. It is the study of the ways in which individuals use physical space in their interactions with others and how this use of physical space influences behavior.
• The therapist should be aware that various differences in the use of space can make a client feel more relaxed or anxious.
• When setting up an office/practice, the therapist should make sure the physical setup fosters a safe and comfortable environment and should be consistent with the demographics of the patient population.
• . Office space should not reveal too much about a therapist’s personal life.

-Therapist should be aware of personal space between himself and the client. If a client believes that a therapist is invading their personal space, they may feel threatened and uncomfortable. When setting up an office, there should be enough space between the therapist’s chair and the client’s seat that the therapist may lean forward to show interest without causing discomfort to the client.

Ex: Counselor is aware of the important role of proxemics. -Made sure to have certification on wall for professionalism. Had ample seating options. Proper lighting, office door had window, proper distance from each other. No physical barriers between therapist and exit.

Question 19

Reflection of Feeling

Answer 19

Basic Counseling Technique: The clinician reflects to the client the emotions they have heard or observed through verbal or nonverbal communication, and can be a type of paraphrase.

• allows therapist to demonstrate to the client that he is aware of the emotions the client is feeling.
• RF is a crucial skill bc it conveys empathy, and understanding.
• The client can also be made aware of his own emotions.

Ex: 18 yr old girl reveals that she is having trouble fitting in and often sits alone in her room, the therapist responds by saying, “it sounds like you are feeling lonely and isolated from others”

Question 20

Reflection of Meaning

Answer 20

This a basic counseling technique in which the therapist paraphrases with an emphasis on the meaning behind what the client is saying. -Reflection of meaning highlights a client’s core beliefs that guide their behavior. Reflection of meaning requires the client to explore their meanings and values in more depth from their own unique perspective.
-Using this technique shows that the therapist has not only heard what the client has said but understands the deeper meaning underneath it.

Ex: client explains that it frustrates her when business associates do not follow through with their work and how it bothers her when her friends do not call when they say they will, therapist responds with, “sounds like one of your tenets is to keep your word by doing what you say you will do and when others do not follow this guideline it frustrates you.” She was able to see this pattern in her life.

Question 21

Reframing

Answer 21

• It is a specific counselling skill used by helpers to offer alternative ways of viewing problems/issues. It is basically putting a different (more positive yet realistic) perspective on things that are concerning, worrying or problematic for people.
• It is important that counselor not dismiss the person’s feelings, thoughts or problems. Counselor can validate the person by letting them know that you have heard them. Re-framing is NOT ignoring others’ problems but offering a different point of view about how things may otherwise be.

Ex: The client was complaining that his new step kids are always running a few minutes late and often miss the bus. It’s then his duty to pack them up and drive them to school. The client believes they are doing it on purpose to make him angry.

The therapist may reframe the situation: “I hear what you are saying and it actually sounds to me like you are very important to them. Perhaps they like spending time with you.”

The man thinks and decides: “I think they’re missing the bus on purpose because they have fun when I take them. I think I’ll tell them that instead of running late, just tell me they really want me to drive ‘em.

Question 22

Miracle Question

Answer 22

developed in the context of solution-focused brief therapy, this is a question directed to the client(s) which asks them what their lives would look like if a miracle occurred and the problem that brought them to therapy disappeared.
-This allows the client to essentially describe what they want out of therapy, and paints a picture for both the therapist and the client of what “success” would look like to the client.
The miracle question can help in goal-setting and in finding potential solutions.

EX: A woman presents to therapy with complaints about her children’s behavior. The therapist asks a miracle question, “Suppose our meeting is over, and some time in the evening, you go to sleep. And in the middle of the night, a miracle happens and the problem that brought you here today is solved just like that. When you wake up the next morning, how are you going to start discovering that the miracle happened?” The therapists then uses her positive responses to find solutions and make achievable goals. He then begins to develop a treatment plan to achieve those goals.

Question 23

Self-disclosure

Answer 23

in the context of clinical practice, this occurs when the therapist shares personal information about themselves with a client.

• Self-disclosure should only be used when it could benefit the client, increase rapport, or enhance the therapeutic relationship.
• It should be used carefully because the focus in therapy should always be on promoting the well-being of the client.

Ex; A young client is in tx for loss of a parent. He feels that no one understands. The Therapist 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 24

Stages of Change

Answer 24

The Stages of Change Model describes five stages of readiness and provides a framework for understanding the change process.
-There are five stages an individual progresses through as they consider or commit to a change:
precontemplation (avoidance-client sees no problem behavior or is not considering change), contemplation (Acknowledging that there is a problem but struggling with ambivalence. Weighing pros and cons and the benefits and barriers to change.), preparation (commitment to change, resolving ambivalence), action (making the change), and maintenance (Maintaining the behavior change that is now integrated into the person’s life, and avoiding relapse.)
-By identifying where a person is in the change cycle, interventions can be tailored to the individual’s “readiness” to progress in the recovery process. Interventions that do not match the person’s readiness are less likely to succeed and more likely to damage rapport, create resistance, and impede change. Anything that moves a person through the stages toward a positive outcome should be regarded as a success.This model is important because it helps the counselor choose the best intervention to meet the client where they are.

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 be sure the client progresses to the action stage and begins to modify treatment.

Question 25

Structuring

Answer 25

Structuring is orienting clients to their role and responsibility in the relationship and to the role and responsibility of the therapist.

• the therapist provides a framework for the process of therapy, including things like fees, appointments, confidentiality, and the process of the sessions themselves.
• Structuring is important because it establishes norms for therapy so that the therapist and the client both know what to expect. It also helps to keep the therapy session on track and maximize productive time so that goals can be achieved.

Ex:The client came to therapy a little timid and unsure. She stated that she had never been to a “shrink” before and that she didn’t know what to expect. The therapist made sure to structure the therapy so that the client would know her role and the role of the therapist in therapy. The therapist also informed her that the process of therapy is collaborative. They proceeded to go over how long the initial session would be and what they would explore. The therapist made sure at the end of the first session to explain what to expect in the future sessions.

Question 26

Summarization

Answer 26

• a basic counseling skill used in therapy in which the clinician brings together the major points of a conversation that either brings about correction or confirmation of the information.
• This is an imp skill bc it ensures that the therapist has heard all the correct content and sorts out the main points w/o disregarding the clients emotions or feelings.
• Summaries can be useful at the start of a session to remind both individuals about the last session, in the middle of a session to refocus and structure the session, and at the end of a session to recap what has been discussed and allow the client to make any final comments.

Ex: After a long session, the client said she was feeling a little confused about all of the information she had thrown out about different relationships in her family. In order to help the client understand the session comprehensively, the therapist used summarization. The therapist spoke about the important information that had been gathered during the session and used this information in order to clarify facts and to summarize progress that had been made.

Question 27

Termination

Answer 27

• in the context of clinical practice, this is the final phase of therapy and the ending of the therapeutic relationship between the counselor and the client. –Typically occurs when the goals have been achieved and therapy is no longer necessary. When possible, termination should be mutually decided upon by the counselor and the client and viewed as a positive occurrence. .
• Termination should be appropriately timed and explained well so that the client does not feel that they are being abandoned.

Ex: Client has achieved all therapeutic goals and has started the termination process. During the final session, the client says that, although she is happy about her achievements, she is feeling sad that she won’t be able to see the therapist anymore. The therapist agrees that the client should be proud of all she has accomplished, and states that their relationship was very important. She also says that if, at any time, the client feels that she needs to come back to therapy that the door is always open and she can make an appointment at any time.

Question 28

Trustworthiness

Answer 28

in the context of clinical practice, this is a crucial characteristic of clinicians. In order to promote client disclosure disclosure and have positive outcomes in therapy, the clients must believe that the therapist is genuine and able to safeguard the client’s communications . Trustworthiness is a reflection of the therapist’s honesty and openness and leads the client to believe the therapist is dependable. Trustworthiness is vital in establishing rapport and a working alliance.

EX: The teenage girl believed in the trustworthiness of her therapist. She was able to disclose to him that she was a lesbian and was seeing someone. In her previous sessions she had come to believe that the therapist had her best interest in mind, and that he would not betray her trust by telling her parents everything she said.

Question 29

Verbal Tracking

Answer 29

• in the context of clinical practice, this is an active listening skill; the goal of verbal tracking is to keep the dialogue going where the client leads, rather than where the counselor wants to go.
• This consideration is especially important in the initial sessions because clients are forming their impressions of counselors.
• Verbal tracking involves only restating or summarizing what the client has already said. Verbal tracking does not include therapist’s personal or professional opinion about what the client said.
• It is important because it helps the client feel that they are important and that the therapist is hearing them. It also helps the session stay on track and allows the client to tell their story.

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 by making sure the client feels heard, and to allow the client to direct the conversation.

Question 30

Working Alliance

Answer 30

in the context of clinical practice, this refers to an aspect of the therapeutic relationship between the therapist and the client, in which both are active collaborators in developing goals for treatment and working towards those goals. The working alliance is essential to successful therapy and outcomes. The clinician can contribute to the development of the working alliance by showing the client unconditional positive regard, empathy, and genuineness.

Ex: The therapist knew that research on the working alliance suggests that it is a strong predictor of the outcome of psychotherapy.The therapist asked the client about her goals and what she wanted to achieve in therapy. Next, they worked on figuring out what tasks needed to be completed in order to reach goals. By then end of the session a bond had formed and the client had trust and confidence that the tasks would bring him closer to his goals.

Question 31

Capping

Answer 31

-a technique employed by the therapist in order to move the client from an emotionally intense experience to a cognitive discussion.

Ex: The patient began to cry when she started talking about her father’s death. The therapist knew it was good for the client to express sadness, but the therapist decided to move towards a cognitive discussion by capping before her tears escalated to uncontrollable sobs. The therapist says, “Your fathers death has had a significant impact on you, can you tell me your thoughts when he became sick?

Question 32

Hierarchy of Needs

Answer 32

Maslow first introduced this concept; this hierarchy suggests that people are motivated to fulfill basic needs before moving on to other, more advanced needs.It is a method of classifying human needs and motivations into five categories in ascending order of importance:

• physiological -the basic needs that are vital to survival ( water, air, food, and sleep). Maslow believed that these needs are the most basic and instinctive needs in the hierarchy because all needs become secondary until these physiological needs are met.
• Security:These include needs for safety and security. Examples of security needs include a desire for steady employment, health care, safe neighborhoods, and shelter from the environment.
• Social: belonging, love, and affection. Relationships such as friendships, romantic attachments, and families help fulfill this need for companionship and acceptance, as does involvement in social, community, or religious groups.
• Esteem: After the first three needs have been satisfied. The need for things that reflect on self-esteem, personal worth, social recognition, and accomplishment.
• Self-Actualizing needs:This is the highest level of Maslow’s hierarchy of needs. Self-actualizing people are self-aware, concerned with personal growth, less concerned with the opinions of others, and interested fulfilling their potential.

Ex: In order to assess the patient’s motivation and readiness to change, the therapist first needed to make sure the client’s most basic needs were being met. On the initial interview it was discovered that the client was currently homeless. According to the Hierarchy of Needs, the client’s basic need for security needed to be handled before they could work on the client’s initial complaints concerning her self-esteem.

Question 33

Therapist attractiveness

Answer 33

in the context of clinical practice, these are physical, emotional, and intellectual aspects of the therapist which the client finds likable and desirable. These factors keep the client coming back to the therapist. A lack of therapist attractiveness can result in high drop-out rates, as finding the therapist likable is important in establishing the therapeutic relationship.

EX:Due to factors dealing with therapist attractiveness, the client felt uncomfortable coming back to therapy after the initial session. The client had expected to talk with an older, conservative male, but the therapist was a young female in her 20’s. The client did not feel like it was a good match and sought a male therapist.