Week 1 - Intake Assessment A Flashcards
Intake Assessment A
Ackerman (2001)
What are the factors the author describes as potentially impeding good treatment outcomes?
Therapist personal factors:
being rigid, uncertain, critical, distant, tense & distracted
Therapist Techniques:
- overstructuring,
- inappropriate self disclosure,
- unyielding use of transference interpretations
- inappropriate use of silence.
These personal factors and techniques also have a similar (negative) influence on therapist ability to recognise and control ruptures.
What is the Therapeutic Alliance?
- key factor in an effective therapeutic relationship
- defined by bordin (79) as a collaboration between the client and the therapist based on the development of an attachment bond as well as a shared commitment to the goals and tasks of counselling.
The working alliance is viewed as a collaborative effort targeting which 3 processes?
1) client and therapist agreement on GOALS of treatment,
2) client and therapist agreement on how to achieve the goals (TASK agreement), and
3) the development of a personal BOND
Why do we assess therapeutic alliance?
So we can have a metric to compare future performance against, i.e. the therapist can see whether the alliance is improving or not and what specific parts of the alliance may need work
The importance of the therapeutic alliance?
Individuals seeking treatment are often feeling unsafe, it is of utmost importance that they feel they are in a safe place and that the therapist genuinely feels concerned for them. A client will not make any progress in terms of interventions they are asked to work on if they do not trust the therapist (or feel safe, like the therapist is on their side, etc)
Judith Beck’s Perspective on Therapeutic Alliance
- be a nice human being in the room with the client.
- treat your client the way that you would like to be treated if you were a client
- accept that clients are supposed to be difficult, that’s why they are clients
- help clients feel safe with you
Judith Beck’s Perspective on Therapeutic Alliance
- be a nice human being in the room with the client.
- treat your client the way that you would like to be treated if you were a client
- accept that clients are supposed to be difficult, that’s why they are clients
- help clients feel safe with you
Judith Beck’s perspective on depressed clients
- frequently see themselves as failures
- may be concerned that they will fail in therapy too
- often see themselves and their lives as out of control
- may think that nothing (including therapy) and no one (including you) can help.
Working Alliance Inventory
Horvath and greenberg (1986)
36 items – therapist, client, observer forms
Each WAI subscale has 12 items and is scored on a 7-point Likert-type scale ranging from 1 (never) to 7 (always)
Subscale scores can range from 12 to 84 and can be summed to obtain a total score. Thus, total scores can range from 36 to 252. Higher scores reflect more positive ratings of WA.
WAI SUBSCALES
Goals – the extent to which there is agreement on the “goals (outcomes) that are the target of the intervention”
Tasks - the extent to which there is agreement on the “in- counseling behaviors and cognitions that form the substance of the counseling process”
Bond - the extent to which a client and therapist possess “mutual trust, acceptance, and confidence”
MICROSKILLS
Attending behaviour Paraphrasing Questions Reflection & exploration Summarising
Attending behaviour
eye-contact,
body language,
interactive and observant,
minimal encouragers,
vocal qualities,
verbal tracking
Paraphrasing
Accurately reflecting ‘Ze Essence’ of what the client has said in your own words – briefly! – Avoid parroting
Two types or combination of both:
Reflections of content – e.g. issues – apparent and undercurrent, meanings, events and consequences, etc.
Reflections and exploration of feelings – observed - picking up verbal and non-verbal messages, explicit & implicit
Summarising
similar to paraphrasing
but brings together more information shared over a longer time
more integrated
Purpose?
- -Can focus the interview
- -Can facilitate deeper exploration
- -Assists in goal identification and prioritising
- -At the end of interview for closing
Use of Questions
Can be open & closed depending on purpose
Examples for open questions
–Can you please describe that feeling?
Examples for appropriate closed questions
–What do you do for work?
