toolbox Flashcards
Minimal encourager
A universal skill in which the therapist uses words, phrases, nonverbal signals, or sounds that encourage the client to continue without disrupting or changing the subject.
Examples:
i. words - “continue,” “OK”
ii. phrases - “I understand,” “please keep going”
iii. Sounds - “uh huh,” “mmmhmmm”
iv. Nonverbal signals - nodding
Paraphrase
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.
Example: “So you are feeling overwhelmed by your responsibilities at home, at work, and in your relationships. Is that right?”
Reflection of feeling
a universal skill that demonstrates empathy and that the therapist is accurately assessing how a client feels about the story they are communicating. The therapist does this by briefly summarizing the feelings communicated by the client without changing the meaning.
Reflection of meaning
a universal skill that demonstrates the therapist is actively listening and understands the deeper meaning of the story the client has told. The therapist does this by directly expressing what they believe the core beliefs, attitudes, and/or assumptions the client’s story reflects.
Downward arrow
a technique used in CBT to draw out the core beliefs of a client. Therapists use reflections and questions to move from surface-level content to the core beliefs driving how the client interprets what has happened to them.
Example: “You keep using the words failed and unsuccessful to describe instances in which you felt you could have performed better. Why do you think you see things only in terms of complete success or complete failure? What would happen if you, as you call it, failed?
Definition
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).
Accent
A universal skill in therapy in which the therapist repeats the last several words said by a client to encourage them to keep speaking on the same topic or thought.
Example: Client “I have been really upset about my wife’s actions lately.”
Therapist: “Your wife’s actions lately”
Empathy
A universal skill in therapy in which the therapist assures the client that they understand what they are going though and the emotions they are feeling.
Example: “It must’ve been terrifying to see your brother be taken away in an ambulance”
Prompts
A universal skill in therapy in which the therapist will say something to the client, prompting them to continue talking about the topic they were just speaking about, similar to Accent.
Example: “I would like to hear more about this, can you please continue?”
Reflection of mood
A technique typically used at the beginning of a therapy session in which the therapist makes a comment about the overall mood of the client.
Example: “As we spent the last few minutes discussing your friends, I’ve noticed you have become more quiet and somber.”
Closed question
A type of question intended to incite a short, clarifying answer from the client. It is used minimally (as compared to open questions) to fill in information gaps or highlight a piece of information to the client.
Example: “Who was involved in that conversation?” “When did that conversation take place?” “Is there anyone that does support you in this decision?”
Open question
A type of question intended to incite a longer, detailed response from the client. The question does not grasp for any particular information, but rather leaves space for the client to respond freely about a particular topic.
Example: “How would your husband react if you told him you wanted to go back to school?” “What is it like for you when your friends disregard your input?”
Checkout
A comment that ensures the therapist is accurately understanding what the client has said.
Example: “I just want to make sure I’m hearing you correctly. You said…” “Let’s pause and make sure I’m understanding that part fully.”
Asking the question
A type of question that asks the client to imagine specifically what will be different for them when they are well.
Example: “How will things be different when you’ve achieved your goals with me?” “When you get things to where you want them to be, what will that look like?”
Cognitive disuptation
A way of highlighting a client’s faulty belief and how that belief influences his/her thoughts, feelings and actions.
Example: “Is there evidence to support the fact that your roommate wants to move out?”
Circular questioning
A technique that attempts to get the client (or clients) to focus on their relationship to the problem and how that problem serves a function within the system. Rather than trying to “solve” the problem, this technique simply asks the client(s) to see the problem as a pattern within their system.
Example: “Who else sees how similar you are to your mom?”
Externalizing the problem
A technique aimed at getting the client to see the problem as outside themselves, a separate entity.
Example: “Does the despair always sneak back in at night?” “What color and texture would you describe the despair as?”
Miracle question
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: “I have a weird question. Imagine you went to bed tonight and a miracle happened so that these problems were fully solved tomorrow. What would that look and feel like?”
Probe
A form of closed question used to elicit a specific one or two-word response about a topic.
Example: “What one word would you use to describe how you were feeling when you first heard that information?”
Forced choice question
A question that gives the client two or more options to choose from, can be used to encourage positive reframing or to narrow therapeutic focus.
Example: “When you’ve told me about Timmy’s tantrums, you’ve said that he is being defiant. Is it that he is testing his boundaries or trying to assert some independence?”
The terrible question
Asks the client to consider what would have to happen for the problem to return, makes the client aware of the possibility for setbacks
Example: “The reality is that sometimes we have setbacks and our problems return. How would you know that you were slipping back into old habits?”
Scaling question
Asks the client to rate their emotion on a scale of 1-10. Used to establish a baseline as well as to track progress.
Example: “Could you rate your anxiety at the moment on a scale of 1-10, 1 being totally relaxed and not anxious and 10 being the most anxious you’ve ever been?”
Collaborative empiricism
A question that encourages the client to view their problem logically and to identify facts that their logic. This cognitive-behavioral technique is used to help the client redirect their automatic thoughts from irrational to logical.
Example: “I heard you say earlier that you’re not cut out for college since you got a C on your exam. What evidence do you have to support your idea that you’re not cut out for this?”
Structuring
This technique is used in multiple ways, providing 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: 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.
Here and now
This technique refocuses the session into the present moment, making the client draw connections about past experiences, behaviors, moods, actions, etc. and how that makes them feel in the current moment.
Example: From what I understand, you felt helpless and ashamed after your most recent binge episode. Thank you for sharing your feelings. Is there anybody else in the group who is feeling helpless and ashamed currently?
Defining the problem/issue
The goal of this technique is to find the underlying issues that are causing the client distress. This helps the therapist clarify the issues into understanding just what they are dealing with, as well as figure out what direction the client would like to go throughout the therapeutic process. This technique builds a collaborative relationship between therapist and client/s.
Example: What I hear you saying is that you are finding it really difficult trying to manage working from home and taking care of your kids. It seems like stress is the main issue here. Am I correct?
Defining goals/objectives
As a follow-up to “Defining the Problem/Issue,” this technique is used to define what the client wants out of therapy. It is important to collaboratively define a clear goal that both the client and therapist understand so that they can work together to create a solution.
Example: From what I understand, you seem to be struggling with the stress of work and home life. What would you say your goal is from our time together to help alleviate this stress?
Reframe
A brief therapy tool in which the therapist shifts the focus to a more positive direction, focusing on the deeper meaning behind the client’s words.
Example: “Your family looks to you for stability and reassurance.”
Exploring alternatives
A universal skill in which the therapist encourages the client to see things from another angle.
Example: “Can you think of any other reasons your partner responds that way?”
Identifying/building strengths
A universal skill in which the therapist points out a client’s strengths .
Example: “It sounds like you are skilled at hearing criticism without taking it personally.”
Compliment
A brief therapy technique in which the therapist writes an encouraging note to the family about their progress.
Example: Despite the stress you’re under, it’s clear that you all care deeply about one another and are dedicated to each other’s wellbeing.
Exploration
A universal technique used to help the client identify strengths they can use to move towards therapy goals
Example: “When you’ve been angry in the past and managed to keep your cool, what helped you stay in control?”
Focus on exceptions
A brief therapy tool in which the therapist focuses in exceptions to the client’s rigid perception
Example: “You have said before that you aren’t outgoing, however the story you just shared about planning a dance party for your friends, shows me that your introversion is situational.”
Interpretation
A universal skill used by therapists, normally in the form of a question, to challenge the way a client perceives a situation
Example: “although your mom seems overbearing, could it be that she is just worried for your safety?”
Metaphor
A universal skill employed to illicit the client’s awareness of the impact of his behavior on himself or others.
Example: “You seem to carry the weight of the world on your shoulders. Do you ever get tired from bearing the load?”
Redefining
A universal skill that aims at giving a positive spin to problematic behavior
Example: “Could your tendency to cry easily also mean that you are more in touch with your emotions than the average person?”
Confrontation
In therapy, 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.
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?”
Confirmation
A skill often used in Cognitive-Behavioral Therapy that is employed when a client begins to revert to undesirable patterns of behavior. The therapist points out this regression to the client in a direct, but gentle manner.
Example: “Your tone of voice is beginning to get loud again.”
Cutting off
A universal skill that is used by the therapist when a client has deviated from the central discussion or topic at hand. It is often employed to help get the client back on track. It is important that the therapist uses this technique with discretion and does not offend the client’s right to guide the discussion.
Example: “You just shared a lot of information with me. Can you help me understand how this relates to your feelings of anxiety in the workplace?”
Affirmation
Universal skill used to emphasize client assets and encourage insight into client self-exploration and personal perspective.
Example: “It sounds like you’re aware of changes you need to make to be happier and enjoy life.”
Providing feedback
Universal skill used to express clinician experience in the therapeutic alliance and help the client understand how others interpret and understand them.
Example: “I can see the pain you’re feeling and hear how much this has affected you. I want you to know that I appreciate your openness with me, despite how difficult this can be.”
Immediacy
Universal skill used to give a response about clinician perspective or experience of what’s presently occurring in session.
Example: “As you express your frustration about this discriminatory encounter, I am frustrated as well that you experienced that.”
Providing information
Universal skill used to share factual information with the client.
Example: “It is common for young adults to experience adjustment struggles when they move into college as freshmen.”
Self-disclosure
Universal skill used to state information about the clinician that aligns with the session topic in order to strengthen the therapeutic relationship and normalize the client’s experience.
Example: “I also experienced anxiety for a while when in my first semester of college.”
Holding the focus
the therapist directs conversation such that the client continues to focus on a specific topic; this may involve encouraging the client to continue discussing a difficult topic or redirecting the client if he/she tries to change the topic or has already done so
Example: I can see that it is difficult for you to talk about your relationship with your mother, but I do think it is important for us to keep exploring these emotions right now. Can you tell me more about what she said to you the other day?
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: It sounds like the movie you saw this weekend was great. I would like to shift focus here and discuss your panic attacks.
Camera check
A CBT strategy that has the client focus on thoughts rather emotions from the session by asking the client to explain what is happening in the session as through the lens of a camera.
Example: If someone was filming this recurring fight with your partner, what do you think the film would show?
Creative imagery
A CBT strategy in which the therapist asks the client to picture something neutral or positive.
Example: Now take a moment to close your eyes, and imagine you are at the place where you are most at ease.
Focused imagery
A universal skill in which the therapist helps the client envision a behavior change.
Example: You’ve expressed dismay at the gossip you engage in at work. Close your eyes and imagine that your coworkers are gossiping, but you don’t join in. How would that feel?
Logical consequences
A universal skill to help a client explore the pros & cons of making a change.
Example: “If you decide to move cross-country to San Diego, what would be some of the consequences of making that move?”
Progressive relaxation
A CBT technique to help the client access a relaxed state by walking them through a sequence of tension & relaxation of the muscles.
Example: “I would like for you to find a comfortable seating position and close your eyes. Bring awareness to your breath, breathing-in to the count of 4, exhaling to the count of 6. Now focus on your toes, make them tense….now release, so that they are relaxed, all tension gone…”
Imaginal treatment
A CBT skill that a therapist teaches the client to overpower unhelpful thoughts with their imagination
Example: “Think about your favorite place to relax. When you feel overwhelmed by your school assignment, I want you to take a moment to access this place in your imagination and feel it’s calm before proceeding with your school work.”
Band aiding
AVOID: A skill used to help the client avoid experiencing emotional distress by wrongly reassuring or giving advice that is a disservice.
Example: “The things you’ve experienced have only made you stronger, so let’s focus on the good things instead of how they may have hurt you.”
Overidentification
A skill that is of disservice by countertransference through changing the focus of treatment onto the self and/or by extreme emotional and personal investment in the client.
Example: “Your struggles and pain remind me of trauma in my life that I’m still having a hard time with.”
Double question
A skill to AVOID. When a therapist asks two or more questions successively, the client gets confused about which question to answer.
Example: “How were things at work this week? Has your boss continued to put you on the spot during staff meetings?”
Advice giving
A skill to avoid in therapy in which the therapist tells the client what he/she thinks is best for the client. When a counselor gives advice, they directly or subtly provide the client with their opinion on what the client should do in a situation- this disempowers the client and threatens the therapeutic relationship.
Example: “You should go back to school and finish your degree.”
Condemning questions
A therapy skill to avoid in which the therapist phrases questions in a way that is judgmental and assumes that how the client feels is incorrect. This type of question is likely to cause the client to shut down and feel uncomfortable discussing his/her true feelings.
Example: “Don’t you think maybe your roommate had a right to get upset with what you said to her?”
Minimization
something to avoid; the therapist, directly or indirectly and verbally or nonverbally, implies that what the client is experiencing is not and/or should not be as big as of deal for the client
Example: A lot of kids have mean parents, surely you can’t be that upset about what they did.
Dis-identification
Skill to avoid; this is when the therapist starts to distance themselves emotionally from the issue that the client is dealing with. The therapist starts to lack genuineness and empathy, losing their ability to see what the deeper and underlying issue is that the client is expressing.
