Week Three

Question 1

basic skills questions

Answer 1

• Gathering relevant information.
• Clarifying client’s thoughts and feelings.
• Heighten client awareness.
• Used sparingly.
• More on the ‘open’ end of the continuum than on the ‘closed’.
• Assists client to open up, disclose more: to be more specific or behaviourally explicit.
• Help with getting a better understanding of the client’s experience.
• Help to access specific and relevant information.
• Avoid ‘why’ questions; focus on ‘what’, ‘when’, ‘where’, ‘how’.
Not:
• Intrusive; to satisfy counsellor’s curiosity; gather irrelevant information.
• Leading, directing, suggesting.
• Interrogating.

Question 2

types of questions

Answer 2

• Transitional - establishing connections, links; often to an earlier part of the discussion. For example, earlier you mentioned **, I’m wondering how you are feeling about that now?
• Exploring choice. For example, in what other ways could you respond to that?
• Circular - perspective of the other. For example, how do you imagine your brother would feel about **?
• Scaling – tracking change. For example on a scale of 1 – 10, how useful was that strategy?
• Goaling - establishing direction. For example, if you could imagine not feeling stressed at work, what would the first improvement be?
Leading – points the prospective answer in a particular direction.

Question 3

summarising

Answer 3

• Helps client stop and review the ground traversed.
• Reflecting back to the client salient aspects of his/her presenting issues.
• Helps to make connections, build bridges, identify themes.
• Sorts out disconnected material into more manageable units: helps client ‘see a pathway through the forest’.
• Could indicate a turning point, a moment of self evaluation, identification of a goal, a strategic pause.
• Timing and context are vital.
Not
• Always essential.
• A re-run of what has been covered.
• A tabulation of every issue that has been raised.

Question 4

advanced skills

Answer 4

• Primary skills are essential but not necessarily sufficient
• A trusting, empathic therapeutic relationship is a necessary pre-requisite
• Advanced skills are required where there is an ‘impasse’, a feeling of being ‘stuck’ or ‘going around in circles’
• Must be used selectively, with care and sensitivity and at times, after consultation

Question 5

normalising

Answer 5

motional States
• reduces anxiety and brings emotional relief (no, you’re not crazy/odd/dysfunctional)
• allays fears of ‘falling apart’
• a sensitive response can pave the way for referral where necessary
Developmental and Existential Crises
• raises awareness of the inevitability of life crises
• reduces the accompanying high levels of stress
• instills hope and optimism and helps integration
• facilitates ‘meaning making’ and re-visioning
Must not involve the minimising or devaluing of the client’s experience (Oh, everyone feels like that when *** happens) … using tentative language can assist – “I’m thinking it’s not unusual to feel/think that in this situation”.
- No not minimise the situation and make the client feel as though they are over-reacting.

Question 6

normalising example

Answer 6

• A mother comes to see you and she is upset because her 15 year old daughter wants to go out on Saturday night with her friends instead of staying at home with the family.
• Possible “normalising” response: “a lot of teenage girls are wanting to establish peer relationships, which is important, however it makes sense that there is a bit of a sense of loss as they become more independent”.
• So, still acknowledging the mother’s feelings as well as normalising the situation.

Question 7

reframing

Answer 7

• Language that offers an expanded view or a more positive perspective.
• Sometimes a client’s perspective can be clouded by pessimism, negativity, poor self-esteem, depression etc. These factors will impact upon the client’s journey toward improvement/shifting.
• helping client to see a different perspective
• presenting an expanded view of the situation
• reframing behaviour in an adaptive way
• highlighting alternative possibilities
• reframing loaded words and phrases
• expanding perspectives of the self
• drawing attention to the difference between intent and impact
• offering a ‘positive spin’ on perceived failures
  Example: It’s all in the language …
  Client: Client involved in car accident has recently returned to work and notices that she is triggered by car sounds.
  Reframe by counsellor: accident has made you more aware of the need to pay attention when you hear a car.
  Client: I hate it when mum always nags me about tidying my room.
  Reframe: I wonder if mum is simply doing her job as a parent by encouraging skills you will need for your entire life.

Question 8

challenging

Answer 8

• should not be aggressive.
• Challenging/confrontation is often associated with aggression – tends to be under-utilized.
• In counselling it’s about raising awareness (where a primary skill has failed). Used to highlight discrepancies that the client is unaware of.
• must be respectful and non-threatening
• counsellor must be aware of his/her feelings, motives, goals
• skillful confrontation helps clients receive so-called negative message
• context and timing is critical

Question 9

when to challenge

Answer 9

• client is in denial
• failure to recognise self destructive and self defeating behaviours
• not accepting the possibility of serious consequences
• making contradictory statements
• going around in circles
• unable or refusal to focus on the present
• verbal – nonverbal incongruence
• rupture of therapeutic relationship
• not ready to change – pre-contemplative stage

Question 10

how to challenge

Answer 10

• (Perhaps) begin with a brief summary of what has been communicated (client feels heard)
• Communication of the counsellor’s feelings (maybe)
• Clear statement about what the counsellor has noticed that is incongruent.
• Examples
  
  • Couple who agreed to homework then didn’t do it.
  • Client committed to longevity via a healthy lifestyle, who smokes.
  • 19 year old who wants to be rich and won’t make a phone call to get a different job.
  • Client who doesn’t want to be controlling but insists on exact times his wife will visit her sister

Question 11

exploring options

Answer 11

• when clients make a preemptive conclusion that there is ‘no solution’ or only two polar possibilities
• reflecting feelings of being ‘stuck’, ‘trapped’, ‘imprisoned’, ‘frozen’
• using an open question to facilitate exploration of options
• not the offering of options except in a tentative way and as a contribution

Question 12

generating options

Answer 12

• facilitate a wide spectrum of options
  
  • don’t allow the client to only generate one choice.
  • I have no other choice.
• summarise to bring clarity
• explore positive and negative outcomes of all options
  
  • pros and cons of the options
• rank order in terms of preference
• encourage the use of both rationality and emotion in decision making
• emphasize autonomy and the element of ‘choice’ (Glasser, 1998. Choice Theory)
  
  • not making a choice is a choice.
  • Why do we choose to make the choice we do? Is it our own or is it due to what we have been told our whole lives.

Question 13

significance of choice

Answer 13

• there is always a choice
• the difference between what ‘I should do’ and what ‘I want to do’
• the myth of a ‘right choice’ as opposed to a responsible choice
• it is the most desirable, sensible, appropriate, effective choice in a context
• the inevitability of intrapersonal tension in
making choices
• validating the choice ‘not to choose’

Question 14

therapist self disclosure

Answer 14

• Indirect self disclosure is unavoidable
  
  • Age, gender, room décor, wedding ring, certain jewelry, forthcoming holidays
• Direct disclosure relates to intentional verbal disclosures

Question 15

self involving disclosure

Answer 15

• affirmation of client awareness
  
  • “I find the fact that you are able to pay attention to other family members in this time of grief amazing”
• disclosures about the therapeutic process
• ‘cheer leading’ and ‘benevolent curiosity’

Question 16

self disclosing responses

Answer 16

intentional sharing of the therapist’s feelings, thoughts and life experiences

Question 17

perspectives on self disclosure

Answer 17

• 1912, Freud: “the physician should be impenetrable to the patient and like a mirror, reflect nothing but that which is shown to him”.
• Humanist movement in the late 60’s, self-help & feminist movements in 70’s and 80’s resulted in a overt shift around fostering an egalitarian relationship between the client and therapist.
• Humanistic and existential therapists highlight importance of transparency.
• 1990s. Influence of high profile individuals self disclosure. Eg, Oprah.
• Group psychotherapy: Yalom: “group psychotherapists may – just like any other members in the group – openly share their thoughts and feelings in a judicious and responsible manner, respond to others authentically and acknowledge or refute motives and feelings attributed to them”.
• CBT & BT: many believe it is problematic to answer questions with a question: “Can you tell me why you want to know that”.
• Narrative Therapy – refer to self-disclosure as “transparency”.

Question 18

intentional self disclosure

Answer 18

• the research shows mixed results; must be used with care
• can be burdensome to client
• detracts from the client’s story
• can become exhibitionistic
• awareness of counter-transference issues
• not for the novice/trainee counsellor

Question 19

questions to ask yourself

Answer 19

• What is your reason for self-disclosing to this client at this time?
• What is your need to “get closer” to the client about?
• What are you trying to achieve via self-disclosure?
• Will this self-disclosure detract from the client’s issues?
• Will this self-disclosure disempower the client?
• Will this self-disclosure alter the client’s expectations of the counsellor?
• Is there any possibility that this self-disclosure will be used against the client at a later stage?
• Is the client emotionally stable enough to “hear” the self-disclosure in the way it is intended.
• What will happen if you don’t self-disclose?

Question 20

the purpose of goal setting

Answer 20

• Clients can experience psychological blocks, they may lack confidence or necessary skills to move forward - require help to move to action
• We can facilitate clients’ progress by helping them design, choose, craft, shape and develop goals

Question 21

aspects of goal setting

Answer 21

• To help clients (and you) determine what they want to get from their sessions with you
• To help clients identify how they will achieve a task or goal outside of the therapeutic context

Question 22

the cycle of change

Answer 22

pre contemplation
contemplation 
prepratation 
action 
maintenance 
relapse

Question 23

function of counselling goals

Answer 23

• Goals can be motivational
• Goals can be educational
• Goals can serve an evaluative function
• Goals can be made across a range of contexts
  
  • Material Goals
  • Family and Friends Goals
  • Educational/ Intellectual/ Professional Goals
  • Health Goals
  • Leisure Goals
  • Spiritual Goals
  • Creative Goals
  • Emotional/ Psychological Growth

Question 24

what should a goal involve?

Answer 24

• Outcome-oriented
• Specific
• Substantive and challenging
  
  • Hard to complete a goal if it is too easy, not motivating.
• Venturesome and prudent
• Realistic
• Sustainable
• Flexible
• Congruent with values
• Reasonable time frame

Question 25

realistic and congruent goals

Answer 25

• Under the client’s control
• Attainable within the client’s life context (I can come home early 3 times a week… )
• Congruent with the client’s values and beliefs (My family is important, I want them to have shared memories…)
• Client has access to the necessary skills and resources
• Client has explored consequences of change (will work less – or maybe more sustainably…)

Question 26

substantive and challenging goals

Answer 26

• Makes a significant contribution towards the desired outcome (creates quality time, memories…)
• Requires commitment and effort from the client – stretches him/her
• Balance between ‘goal difficulty’ and ‘goal performance’ – relates to client self efficacy about making wise and purposive choices

Question 27

negotiating a time frame

Answer 27

• Not ‘sometime or other’; ‘when ready’ (“when do you think you will be ready to do this?”)
• Identifying immediate outcomes in the context of therapy (“how will our work together here help you?”)
• Facilitating intermediate outcomes – transferring modified behaviours to real life situations (“What kind of changes in your everyday life will you notice in the next two weeks?”)
• Affirming final outcomes – constructive and sustainable change (“ you have achieved … how will this continue to be part of your life..?)

Question 28

flexibility and evaluation

Answer 28

• Goals adapted to changing circumstances (“with the new baby coming, what will you need to change or adapt with your exercise regime?” )
• Open to trade offs between goal specificity and goal flexibility (“will you need a bit more time to achieve your goal?”)
• Maximising achievements – ‘cheer-leading’ (“You have been doing so well with … keep going” … used in life-coaching)
• Building in and identifying potential rewards, reassessing and evaluating outcomes

Question 29

the first step to goaling

Answer 29

• Emphasise here and now action (“what small thing can you start doing today..?” )
• Assessing level of motivation (“ tell me on a scale of 1-10 how motivated you are to do this….?”)
• Identifying potential hurdles (“What could get in the way of you spending more time with your family?”)
  
  • Explore secondary gains
    
    • The good reason for engaging in unhelpful behaviour.
    • Woman who is sexually abused then binge eats to make herself unattractive to men.
• Relapse prevention strategies (“What will help you to get back to being with your kids more ?”)
  
  • Inevitability of relapse.
  • Relapse doesn’t mean starting at point 0.
• Exploring consequences (“Are there things you will sacrifice …? Are there people in your life who will support/not support you? “)
• Recognizing meta-goals/super-ordinate goals (“What will be important to you to keep you going?”)

Question 30

the shadow side of goal setting

Answer 30

oal setting pushes clients out of “safe”/familiar place of talking, exploring, “caring and sharing”. Both counsellor and client may resist the shift.
• Some people are “happier” living in victimhood. “Victimhood and self-responsibility make poor bed-fellows”.
• Goal-setting can involves work, effort, pain, struggle.
• Although achieving a goal can be liberating, it can be subsequently cause an unwanted consequence – eg, achieving a career goal might result in lost family relationship
• Goal achieving involves work and some people are not up for that.

Question 31

skills associated with goal setting

Answer 31

• Verbal skills
• Visualising activities
• Verbal confrontations
• Affirming responses
• Structuring skills (Useful tools when clients need help understanding the goal-setting process)
  
  • Being able to set a goal is improved if you can organise your way to that goal.
• Goal-setting map
• Timelines
• Successive approximation (shaping) – use of rewards

Question 32

SMART

Answer 32

specific, measurable, attainable, relevant, timely

Question 33

goal setting in different contexts

Answer 33

• Goal setting with children
  
  • Consider developmental stage
• Crises and goal setting
  
  • The counsellor will have therapeutic goals. Mutual goal-setting is not possible
• Multicultural contexts
  
  • Monk, Winslade, Sinclair (2008) – refer to Sue and Sue (2007) – Asian Americans, African Americans, Latinos, Native Americans – have short term/immediate goals; whites – long-range goals. “Goal setting is a product of class differences and economic advantage”.