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Counselling > Working in Counselling Relationships > Flashcards

Working in Counselling Relationships Flashcards

1
Q

What is the process of counselling

A
  1. Development/Building Phase
    - establish therapeutic relationship
    - info gathering
    - goal setting
  2. understanding & action phases
  3. termination phase
  • theoretical orientation influences all phases
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2
Q

Microskills

A
  • use of skills are different depending on theoretical orientation of counsellor
  • skills for creating relationships
  • don’t underestimate
  • fundamentals
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3
Q

Building the counselling relationship.

Why is the relationship so important?

A
  • most important/ fundamental element
  • Creates atmosphere: safety, trust
  • Reducing fear, stigma, hesitancy
  • A vehicle & container for intense affect (emotions)
  • full exploration, experience of self in way that allows for growth and change
  • Models a healthy interpersonal relationship
  • Provides motivation to achieve goals
  • Provides support/comfort/reassuranceas they undergo a change process - frightening & unfamiliar
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4
Q

Building a counselling relationship: the working alliance

A
  • primary goal of “beginning”
  • Quality & strength of the reciprocal relationship between both
  • Best predictor of treatment outcome, accounts for an ~30% of outcome variance in therapy: monitor what clients think
    1. Agreement on goals
    2. Agreement on tasks
    3. Bond between client and counsellor
  • Client’s perspective of alliance that matters
  • Rating scales at the end of the session can help assess this SRS, ORS (these instruments measure three key
    components of working alliance)
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5
Q

Factors influencing working alliance

    • has to happen 3-5 session
  • better shape @ beginning of session, improve quicker & more long term success
  • 50% anxiety/depression improve by 8-13
A
  • Seriousness & of Presenting Issues
  • Structure: decrease anxiety: guidelines, flexible/negotiable, verbal or written
  • Readiness for Change
    • Resistant Clients
    • Reluctant Clients: unmotivated to seek help
  • Physical Setting & Proxemics
  • Transference & Countertransference
  • Client Qualities
  • Counsellor Qualities
  • -Empathy primary/advanced
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6
Q

Why are initial sessions important?

A
  • Counselling relationship really begins at the point of first contact – usually phone call schedule first appointment
  • Clients often experience changes as they wait to have their initial session
  • Be mindful about what it may mean for client to enter counselling
  • Be aware of cultural diversity in clients and differences in comfort in disclosing personal information
  • Promoting safety and trust is key
  • Common microskills include: questions, clarifications, paraphrasing, summarizing, reflection of affect/meaning
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7
Q

Types of initials session

A
  1. Information Oriented Interviews: questions, clarification, obtain data, specific questions, factual
  2. Relationship Oriented Interviews: focused on attitudes & emotions
    - Preferences towards either of the above types are influenced by theoretical orientations
    * **- depends on type of initial session you use: setting of work; theoretical orentation
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8
Q

Goals of initial sessions

A
  • Provide client with info about the counselling process & limits to confidentiality to ensure informed consent –i.e. cover “ESENTIALS”
  • Establish rapport, initiate development of the therapeutic relationship, engender hope and positive expectations
  • Orient the client to the counselling process
  • Assess urgency of the client’s issues
  • Explore client expectations & goals for counselling
  • Obtain a basic history of the client, their presenting issues & current life circumstances
  • Assess readiness for change
  • Obtain client commitment to the counselling process
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9
Q

Winding down initial sessions

A
  • Helpful to have it known to both
  • Leave enough time at the end so that the ending does not feel rushed
  • Can be helpful to cultivate hope about the helping process & and solidify a follow up appointment
  • Check in with client about how they felt about the session, & how they are feeling about working with you, inquire about questions they may have
  • maintain boundaries around time/relationship these can get tested at the end of a session
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10
Q

The working stage of counselling

A
  • Occurs after a working alliance is established
  • Characterized by insight generation & experimentation with new ways of thinking, being & relating with varying degrees of success
  • Accurate empathy is critical throughout initial & working phases of counselling
  • Common microskills in this phase involve reframing, leading, multifocused responding, self-disclosure, immediacy, & confrontation
  • Respecting and working with client’s readiness for change is also essential – pacing
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11
Q

Stages of change

  • can enter into any stage
  • can relapse (usually action & maintenance)
A

Stages of Change

  1. Pre-contemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
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12
Q

precontemplation - “what problem?”

A
  • Counsellors can help people acknowledge their problems & become more open to change
  • Consciousness-raising involves increasing the client’s knowledge of the risks & consequences of continuing their current behaviour(s)
  • Involves helping them become aware of the main defenses they are using to cope with their problem
  • Goal setting – very basic, unrelated to change but may relate to exploring some ideas
  • defensive, enter usually due to mandate, reluctant, very expressive, high risk for terminating
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13
Q

Contemplation - “i might have a problem”

A
  • involves a willingness to change,
    paired with some barriers in progressing. - ambivalence about changing.
  • dealing with the problem: waiting for the right time, wishful thinking etc..
  • Counsel Tasks: help client explore their
    ambivalence, helping clients with self re-evaluation pros/cons of changing
  • Goal setting – tentative moving towards specific, thinking about thinking about setting goals
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14
Q

Preparation: “what do i do about this problem”

A
  • feeling ready to move towards change but unsure about goals or not committed to changing
  • Characterized by some confusion/hesitation rather than ambivalence
  • may have made some small changes
  • Goal-setting and motivating clients are important tasks of counsellor
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15
Q

Preparation - Goal setting

A

Counsellor’s Tasks: Goal setting and Motivating

  • Help client set clear goals for counselling and help them commit to those goals by motivating
  • Ineffective goals
  • - Unfocused, unrealistic, uncoordinated
  • Effective goals
  • - Mutually agreed upon
  • - SMART- specific, measurable, attainable, realistic, timely
  • - Encouraging client to share goals with others
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16
Q

Action: “i will try this and see how it works..”

A
  • completely committed, & use maximum effort to achieve this change
  • actively moving towards goals
  • Counsellor tasks: helping clients trouble shoot and problem solve around their actions – helping clients at times to re-evaluate their goals
  • Counsellors LOVE this stage of change – lots of energy – many counselling interventions/techniques are for people
    in this stage
17
Q

Maintenance: I am maintaining the changes I made that work!

A
  • Clients have implemented the changes they were intending on making
  • Clients have come to a place where their goals have been met
  • Clients are now focused on maintaining changes and consolidating these changes
  • Counsellor tasks: primarily to encourage clients to claim responsibility for the changes and celebrate their progress, looking at relapse prevention strategies & preparing client to end therapy
  • Often a stage during which clients terminate
  • Sometimes clients come into therapy in this stage as they feel they may be at risk for “relapse”
18
Q

Common Pitfals of winding down initial sessions

A 
 Talking too much
 Failing to engage the client
 Being judgemental
 Trying to do too much
 Neglecting to offer help
 Failing to collect relevant information
 Not checking in with your client
 Misdiagnosing
 Trying to fix the problem
 Liking/disliking your client too much
Brew & Kottler,
19
Q

Initial sessions

A

Relational style of first session (note that limits to
confidentiality isn’t covered )
 Intention of the counsellor is clearly to connect, understand
and communicate that understanding back to the client
 Counsellor is person centered in orientation – watch for the
use of basic microskills in this session
 Think about what you like about this style of initial session
and what you might do differently…
 I will post an “informational” first session on eclass

20
Q

How to help clients win the battle for initiative and achieve success

A
  1. anticipate anger, frustration
  2. show acceptance, patience, understanding
  3. use persuasion: “foot in the door”/”door in the face”
  4. confrontation: denying behaviour, accepting it as true, developing a middle position
  5. language
  6. mattering: perception that as humans we are important
  7. pragmatic techniques: silence, reflection, questioning, describing, assessing
21
Q

8 common architectural characteristics when it comes to physical settings

A
  1. accessories
  2. colour
  3. furniture
  4. lighting
  5. smell
  6. sound
  7. texture
    8 thermal condition
    - distance between client and counsellor
22
Q

Client qualities - YAVIS; HOUND; DUD

A

Yavis (young, attractive, verbal, intelligent, successful) - preferred client
HOUND (homely, old, unintelligent, non-verbal, disadvantaged)
Dud (dumb, unintelligent, disadvantages) less preferred

23
Q

counsellor qualities - 5 important characteristics that helpers should possess

  • 3 characteristics that make counsellors more influencial
A
  • self awareness, honesty, congruence, ability to communicate, knowledge
  • perceived exerties, attractiveness, and trustworthiness
24
Q

types of initial interviews

A
  • client initiated

- counselor initiated

25
Q

positives to having a client complete a history questionnaire (client initiated interviews)

A
  1. usefullness & reliability
  2. accuracy
  3. expendiency
  4. positive experience
    5 cost saving
    6 accountability
    7 working alliance
    8 reduced number of no shows
    9 increased focus on process, not conent
  5. professional consideration
26
Q

commonalities regarding all interview types

A
  • anxiety and resistance

- frightened and uncertained

27
Q

Information - Oriented First interview
- functions
probed, accents, closed questions (open), request for clarification
- steps

A

functions:

  • intake interview to collect needed info: counsellor focused where responses will be: probed (where, how, who, what), accents n(highlight last few words), closed questions (is do are) (open (what how could)), request for clarification
  • signal beginning of a relationship
  1. identify data
  2. present problem, primary & secondary
  3. client’s current life setting
  4. family history
  5. personal history
    6 description of client during interview
  6. summary and recomendation
28
Q

When building a relationship, what battle does each party have to win

A

battle for structure - administrative control (counselor)

battle for initiative - motivation for change (client)

29
Q

The counselling relationship is comprised of 3 key elements..

A
  1. transference & countertransference
  2. working alliance
  3. relationship
30
Q

best predictor of treatment outcome is..

A

enthusiastic collaboration

31
Q

3 components of a working alliance

A
  • agreement on goals,
    agreement on tasks
    bond between client & counsel
32
Q

What are microskills for rapport building

A
  • basic attending behaviours

- client observation skills

33
Q

What is Primary and Advanced Empathy?

A
  • Primary: counselor has understood clients major themes, non verbal and verbal communications
  • Advanced: help explore themes, issues, emotions, new to awareness
34
Q

goals can be

A
  • unfocused: too broad
  • unrealistic:
  • uncoordinated:
35
Q

7 specific criteria for judging effective goals

A
  1. mutually agreed upon
  2. specific
  3. measurable
  4. attainable
  5. relevant
  6. observable
  7. understood
36
Q

Counsellor skills in the understanding & action phases

A
  • skills that result in client’s viewing their lives differently & thinking, feeling, behaving accordingly
  • Change Perception
  • leading
  • multifocused responding
  • accurate empathy
  • self-disclosure
  • immediacy
  • humor
  • confrontation
  • contracting
  • rehersal
37
Q

strategies to changing perception are?

A
  • redefining the problem
  • altering behaviours in a certain situation
  • perceiving the problem in a more manageable way & acting accordingly
38
Q

Perceptions commonly change through what process?

A

REFRAMING

  • offers probably & positive viewpoints/perspective on a situation
  • change pov gives clients a different way of responding
  • helps become more aware of situational factors associated w. behavioral
39
Q

Lending
- What are some leads
Ex. a good quarter back anticipates where the receiver will be going on the field and throws the ball - pass isn’t on target, relationship suffers

  • minimal leads vs. maximal leads
A
  • silence
  • acceptance
  • paraphrase
  • clarification
  • interpretation
  • Min: minimal encourages- hmm, yes
  • Max: confrontation - employed after 9 solid relationships

Counselling (4 decks)

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