ADDC 1508 - Intro to Counselling Test #1

Psychotherapy Definition

• Key elements of the CPRO definition 

  • Psychotherapy uses specific, empirically validated/evidence based techniques and modalities designed for the purpose of treating certain things (v serious disorders) 

  • Primarily targeted at serious disorders of thought/cognition, mood, emotion regulation, perception or memory 

  • Psychotherapy is typically also deeper, involving longer-term depth work, where you might explore things related to someone's past, the influence of that past on someone's presence 

  • Involves deeper intrapersonal work than in counselling (general tendency, not always) 

  • Has to occur within the context of a therapeutic relationship 

Difference between psychotherapy and counselling

• Psychotherapy should be concerned at serious disorders that severely impair functioning  

• “The practice of psychotherapy is distinct from counselling, where the focus is on the provision of information, advice-giving, encouragement, and instruction” 

• Counselling is primarily based on providing basic support and information 

  • Basic advisement 

  • Helping ppl to solve the problems of daily living 

• Often overlap in practice (psychotherapy and counselling) 

  • Psychotherapy became a controlled act because of counselling  

  • Only some forms of counselling relate to psychotherapy  

How and why psychotherapy evolved

• Roughly in the 60s, societal attitudes towards mental illness and addiction changed a lot 

• Contributions to this change: 

  • De-institutionalization 

    • Movement away from institutionalization 

    • Taking folks who don't need intensive ongoing psychiatric care and instead having them access community-based mental health supports 

  • Re-evaluation of treatment effectiveness 

    • Shifting from short to long-term treatment and vice versa depending on which side of things 

    • Move from inpatient/residential and outpatient  

  • Mental health prevalence studies 

  • Social cost studies 

  • Social reforms and changing public attitudes 

  • Advances in neurobiology 

  • Development of new psychotherapy theories and approaches  

• Recent changes

  • Movement away from institutionalized care

  • Expansion of community-based services

  • Recognition of mental health/addictions as disabilities

  • Growth of multidisciplinary teams

  • Increased emphasis on prevention and early intervention

• Every door being a right door  

  • Idea that no matter where you enter, our tx system will be able to help you right there or will be able to connect you directly to someone or something that can  

The use of self in therapy/counselling

• There's a lot that we bring of ourselves to the therapeutic relationship  

  • Should maintain clear professional boundaries and objectivity 

• Important for us to understand that our effectiveness as a therapist, is highly influenced by who we are and how we show up in that therapy space, highly influenced by our relationship with our family of origin 

• Influenced by our personality and interpersonal style 

• Commitment to personal health and well-being 

• Intentional use of self within the therapeutic relationship 

• If you're not putting yourself into the therapeutic relationship, you shouldn’t expect your client to do that  

  • Should be modelling what you expect from the client  

The problem with today’s therapists/counsellors

• Ppl who are first starting out as mental health clinicians: 

  • Are terrified of doing the wrong thing and offending ppl/insulting them inadvertently  

  • Struggle to express themselves authentically because they lack confidence and fear making mistakes  

  • Because we're terrified of offending + making mistakes, we tend to rely heavily on theories 

The nature of transference

• As originally described was a largely unconscious and therefore blameless process 

  • Not aware this is happening in real time  

  • Not something someone is intentionally bringing into a relationship on purpose 

  • Most transference comes from stuff you’ve already been through (specifically relationships, particularly significant ppl in your life)  

    • Will bear some type of resmblance to whatever is happening rn  

• What's happening is that in the here and now, the person you're working with, is enacting in you patterns and tendencies, relational styles, ways of interacting, doing all of this not knowing that those dispositions, tendencies, etc were appropriate to and made sense in some past relationship but they’re doing it with you (as the counsellor) 

  • Can become concerning for a lot of reasons  

• More generally, think of transference and countertransference as smt bigger than this 

  • Not just mapping onto the present of past relationships of ppl that have some kind of significance to yo  

  • Your emotional response to the person you're helped by and if you’re the helper, your emotional response to the person you're helping  

• Has almost nothing to do with what's going on in the present 

• Has to do with stuff that were unresolved in the past, and they're unconsciously trying to resolve it in the present  

• Transference in everyday life and therapy 

  • When we experience distress or uncertainty, we tend to look for what's familiar 

  • The main dynamic at play here, is that ppl are responding to another person that has no place in their past relationships or in their personal life, they're responding in ways that reflect these relationships rather than the one they're actually in  

• Transference can be useful 

  • Was viewed as something always wrong (traditionally) 

    • Not always wrong, can be very useful as a source of insight for why the therapeutic relationship is not functioning properly or hitting a roadblock 

  • The goal isn't to push this aside or redirect it, it's to find a way to help the client respond differently in the here and now to responses they exhibited in the past  

Idealized or positive transference

• Refers to the thoughts/feelings being projected on to you are good ones 

  • Can make things natural/more warm 

  • Can facilitate a warm environment 

• Liabilities to this 

  • Tends to paint you (without earning it) in an automatically better light 

  • In extreme cases, when this occurs, that person will start agreeing with whatever you say or recommend  

• Can help to build a relationship but can get in the way of objectively good work with ppl 

• Can be converted into therapeutically useful moments 

Negative Transference

• When the person you're working with for whatever reason, develops unpleasant feelings towards you 

  • Might lead them to experience hostility, suspicion, fear, etc 

• May be intensified by the therapist's real or perceived behaviour 

• If left unrecognized or unaddressed, it can interfere with or even lead to premature termination of therapy  

• Can be converted into therapeutically useful moments 

Sexualized or erotic transference

• Cannot be converted into therapeutically useful moments 

• Sexualized transference was first described by Freud, who viewed it as a situation in which a client falls in love with the therapist 

• Freud believed these feelings reflected the therapeutic situation and the client's unresolved conflicts – not the therapist personally  

• Today, sexualized transference is typically divided into two forms: 

  • Erotic transference 

  • Eroticized transference 

Erotic transference

• Might* at its upper limit involve some kind of romantic attraction or affection 

• Most of the time there is a genuine growing sense of warmth, closeness, or romantic attraction 

  • If they don’t get any sense of warmth, etc from anyone else, and you're the only person expressing this ever or in a long time (giving them a sense that they're not unlovable) this is easy to fall into  

• But it can become problematic if it starts to interfere with someone's life outside of therapy 

  • Client dependence is a real problem 

  • Creating a sense of long term dependency is not a good thing; it becomes this necessary anchor that the client has to return to multiple times a week 

• Should be called affectionate transference 

  • Not only limited to romantic attraction towards the therapist  

Eroticized transference

• This one is sexual in nature 

• No positive gloss 

• Eroticized transference 

  • Involves an intense, persistent, and irrational erotic preoccupation with the therapist, often accompanied by overt demands for love or sexual fulfillment  

    • Fantasies, thoughts of wanting to be with someone, thoughts of a sexual partnership with someone  

    • Tends to come up when erotic transference is established 

The nature of countertransference

• Transference reaction from the counsellor/therapist 

• The directionality goes from counsellor to client  

• The reaction of the therapist towards a client that can interfere with objectivity bc it's an emotional reaction 

  • Has very little to do with the client and the situation the client and therapist are in together  

• More generally, both transference and countertransference can be defined more broadly as all the feelings collectively that you have towards this person 

  • Too broad a way to think about it  

• Having feelings towards a client does not automatically mean you are experiencing countertransference 

• Happens when our own needs become too important in the therapeutic relationship, and the client triggers  

• Therapists can also respond to clients in ways that reflect their own unresolved issues 

• Something you can never really get rid of  

  • If you were to cease to have attitudes, opinions, etc, then you could get rid of it  

  • You're going to have unconscious emotional reactions in the kind of work we're doing where we're talking abt sensitive and vulnerable things  

  • Can be managed in better or worse ways 

• Your countertransference reaction (as the counsellor) can be triggered by a client's transference  

  • Ex. Someone repeatedly perceives you as hostile and behave towards you in that way, you might eventually begin responding defensively or irritably  

• Transference and countertransference often occur simultaneously creating a complex interpersonal process within therapy  

  • The ppl in the here and now can almost in a way serve as a proxy for ppl in the past or current relationships  

How is countertrasnference managed?

• 1) Just become aware of it and reflect on it  

  • Reflect on how you react to things and wonder why you may have reacted in that way or another  

  • Builds a fundamental/increased awareness you can carry with you beyond the situation itself  

• 2) Seeking supervision and consultation  

  • Talking abt it with someone neutral and objective can sometimes help shed light on something you wouldn’t have been able to see on your own 

• 3) Increase awareness of your own unresolved issues and projections 

  • Don’t do that with your colleagues or professional supervisor 

  • Should not be the focus of professional supervision, something you would take care of in personal therapy  

Examples of countertransference

• Uncharacteristic difficulty understanding aspects of a client's experience 

• Feeling unusually anxious or depressed before or after sessions 

• Difficulty maintaining professional boundaries 

• Drowsiness or inattentiveness not explained by fatigue or other factors 

• Erotic thoughts or fantasies abt the client 

• Excessive fear of losing the client 

• Allowing the client to act out without appropriate intervention 

• Trying to impress the client or seeking their approval 

• Arguing with or becoming defensive toward the client  

Informed consent

• Valid informed consent requires that consent be:  

  • Competent 

    • The client has he capacity to understand and make an informed decision 

  • Informed 

    • The client receives relevant info in a language they understand 

  • Voluntary 

    • Consent is given freely, without coercion 

  • Documented 

    • Consent is appropriately recorded (written or verbal) 

Confidentiality

• An ethical and legal duty to protect someone's privacy 

• Essential that ppl truly believe that you are maintaining confidentiality and handling their private info carefully in order for you to build trust and encourage honest disclosure  

• Limits to confidentiality 

  • Confidentiality may need to be breached when legally or ethically required, including: 

    • Circle of care (as defined under PHIPA) 

    • Suspected child abuse or neglect 

    • Court order or legal subpoena 

    • Imminent risk of harm to self or others 

    • Sexual abuse by a regulated health professional (in general) 

    • Client authorized disclosure (e.g. client says it’s okay for you to speak with their physician) 

• When confidentiality must be broken 

  • If you have to break confidentiality: 

    • Consult with a supervisor (or appropriate authority) as soon as possible  

      • Try to make the client part of the disclosure whenever possible (some exceptions to this) 

    • Document the info leading to the decision 

    • Document all subsequent actions and developments in the client record 

Boundaries

• Professional boundaries are limits that guide safe, effective, and appropriate practice 

  • Some of them are semi-permeable 

• The whole point of a boundary is to protect you as the therapist and the person you are serving 

• What are professional boundaries 

  • Many things fall under boundaries, including" 

  • Practicing within the limits of your competence 

  • Acting in the client's best interest and avoiding harm 

  • Avoiding sexual or exploitative relationships with clients or individuals connected to your work 

  • Maintaining client confidentiality  

• Historically, most approaches to counselling and psychotherapy as harmful to the therapeutic process 

• Today, most clinicians recognize that boundary crossings may be helpful, neutral, or harmful, depending on the context  

• Boundary issues include any therapist behaviour that departs from traditional therapeutic neutrality  

  • These generally fall into two categories 

    • Boundary crossings 

    • Boundary violations 

• Some boundaries should be standard and set from the beginning of any therapeutic relationship/set from the first meeting 

  • How to contact you outside of meeting times 

  • Set hours of work 

  • How long it will generally take to get back to them during work hours 

  • What help they can expect from you 

  • Expectations around confidentiality 

  • Expected duration of the supportive relationship 

Boundary crossing and violation

• Boundary crossing 

  • Often, but not always, intentional  

    • In the sense of being conscious and deliberate 

  • A deliberate departure from traditional therapeutic practice intended to benefit the client or enhance tx  

  • Boundary crossings are often: 

    • Intentional 

    • Clinically justified 

    • Helpful or therapeutically neutral  

  • e.g. swearing 

• Boundary violation 

  • Not debatable  

  • Occurs when a therapist misuses their position of power for personal benefit 

  • Usually involves situations of exploitation or sexual relationships 

  • They are 

    • Always unethical 

    • Often illegal  

    • Often harmful to clients  

Incorporating helpful boundary crossings 

• e.g., self-disclosure, best example of a boundary crossing that can be helpful, but can potentially devolve into a boundary violation  

  • Personal disclosure 

    • Sharing info about yourself within a specific time fame 

    • General rule – self-disclosure should be genuine, timely (pick and choose when you're doing it), and should always be to the benefit of the client 

• 1) Client welfare 

  • Will this benefit the client? 
    Could it cause harm? 

  • Does it help to strengthen the therapeutic alliance 

  • Is the focus still on the client's needs 

• 2) Therapeutic effectiveness 

  • Is there a clear clinical rationale? 

  • Will it improve tx? 

  • Is it part of a well-developed tx plan that considers the client's needs, history, culture, personality, and presenting concerns? 

  • Is it intentional, ethically justifiable, and clinically defensible?  

Function of a code of ethics

• Therapists hold inherent power within the therapeutic relationship 

  • Clients often view us as knowledgeable, skilled, and trustworthy 

  • Our professional role, title, and workplace confer authority 

  • We may control access to services or resources 

  • Many of the ppl we serve are experiencing vulnerability  

• The therapeutic relationship is not one of equals

• Professional ethical frameworks 

  • Professional practice is guided by: 

    • Codes of ethics 

    • Ethical guidelines 

    • Standards of practice  

   

Nature of a helping relationship

• Working relationship/therapeutic alliance, building enough rapport,  

  • Has little to do with specific techniques  

  • Has more to do with the type of relationship you've cultivated with someone 

• Therapeutic relationship characterized by warmth, genuineness, and respect 

• It's about listening as much as possible without judgement  

  • Doesn't mean not having judgements  

  • We're constantly judging things, but we mean what we're doing with those judgements 

    • Can't stop yourself from having thoughts and feelings abt ppl, but what we mean is what you end up doing with them  

• The environment that you craft/cultivate with the person you're working with 

  • Should be based on trust and mutual respect 

    • If you severely damaged trust, you might have a future relationship with that person that has 60% trust when it used to be 80% - 90% 

    • If something happens that corrodes or destroys the sense of trust the person has with you, its extremely difficult to win it back 

    • #1 reason that clients have to be referred out to another counsellor is because of an erosion of trust 

      • Hard to keep talking to someone if you don’t feel safe with them  

Client/Person-Centered

• One in which one of the parties has the intent of promoting the growth development, maturity, improved functioning and or improve coping with the life of the other party 

  • One sided relationship! 

  • The nature of that power differential is such that the client has zero responsibility for any of these things for you (the counselor) 

  • The intentional direct goal fo this work is the promotion of the growth, development, etc for the client! 

Person-centered therapy 

• Shift away from an expert therapist who knows everything and solves all your problems 

  • Direct opposite 

• Emphasizes the client's own understanding of their experiences 

  • Uses the client as the expert in their own life and what they want for themselves 

  • Autonomy-based approach to counselling  

• Collaborative and non-directive  

  • The point isnt to tell anyone what to do  

  • Gives you a space to make you the engine of change  

• Represents the most non-directive approach  

  • The goal is to create an open, accepting atmosphere that facilitates the client's self-disclosure and exploration, rather than one driven by therapist techniques or agendas 

Person-centered therapy emphasizes

• All about acceptance eand draewing out/bringing out (sometimes called elicitation or evoking, drawing out/pullign out what's already in them, not trying to sneak things in there) 

• Believes in every individual's capacity for growth and overcoming adversity  

  • Everyone has within them (if you look long enough and are patient) you will find the resources within them to make changes 

• The client is the central figure in therapy, the therapist is just there to guide (facilitation, not directing), guiding your growth by focusing on what's happening in the here and now  

  • The here and now is the therapeutic space  

  • Give them a space where it becomes obvious to them what needs to be done  

Core conditions of person-centered therapy

• A person-centred approach has 3 core conditions 

  • Rogers identified these as individually necessary and jointly sufficient  conditions for positive tx conditions 

• Most ppl accept that many of these are individually necessary, but they disagree almost entirely that they're sufficient 

  • More is needed esp for positive tx outcomes 

• If you create a space with these 3 conditions is all we need (maximize them) 

  • 1) unconditional positive regard 

    • Doesn’t mean you view them as the best, you accept them as much as possible without judgment  

    • How that judgment gets challenged/expressed/conveyed to your client  

    • Modern-day concept of this is meeting ppl where they're at (like in harm reduction) 

  • 2) empathy 

    • Doing everything you can to convey to someone that you're trying to understand where they're coming from  

  • 3) congruence 

    • Matches up nicely with self-disclosure 

    • Genuineness, authenticity, being transparent and authentic in how you relate to your client  

    • Rogers wanted there to be a match or alignment between what you're expecting from your client (want them to be genuine, authentic, transparent, etc), if you expect that from your client, you should also reflect that back 

    • Am I really conveying to my client who I really am in my session? Am I lying? 

Why empathy is important

• Helps the counsellor understand the client's frame of reference 

• Communicates understanding and acceptance 

  • Someone sees you and understands you in this moment  

• Builds rapport and strengthens the therapeutic relationship 

  • Change will naturally emerge if you build a good relationship with your client  

• Facilitates client insight, self-acceptance, and new perspectives 

  • Really good empathy helps someone to see themselves, when you take intelligent risks with advanced empathetic reflection, it can help someone see themselves in a new way 

    • Involves taking risks  

  • Trying to move someone's insight a bit further 

  • No such thing as a bad reflection unless you're being insincere  

3 core conditions of a therapeutic relationship

• 1) Relationship building 

  • We need to be doing this from the get-go, before we can think of anything else 

  • Basic attending, listening, validating 

• 2) Challenging the supported individual to find ways to change 

  • Confrontation 

  • Challenging them with new ways of thinking, feeling, or behaving  

• 3) Facilitating positive change 

  • By helping them facilitate change outside of sessions  

  • Most helping relationships don’t follow this in any kind of step by step kind of way  

Validation

• Validation is abt helping someone to feel understood 

  • To really feel that their situation makes sense given what they're going through/have been through  

  • Saying that there is nothing wrong with you, your thoughts and feelings make total sense 

• You're not telling someone I agree with what you're thinking/perspective or I approve/endorse it  

  • You can validate someone and still think that what they've conveyed to you is batshit 

  • Can validate someone with whom you profoundly disagree 

6 Levels of Validation

• 1) being present 

• 2) accurate reflection 

• 3) reading unspoken feelings 

• 4) validate based on history 

• 5) validate based on current circumstances 

• 6) radical genuineness 

Level 1 - being present 

• Just being there, showing up for someone, non-verbally 

  • Using some verbal attending skills 

  • Encourages (mhm, nods, being present with someone without laser beaming into their soul) 

• Communicating to your client that you're there for them in the here and now 

• Don’t have to say anything to them abt what they said 

• Sometimes making someone feel heard, seen, understood is giving them your full attention  

Level 2 – Accurate reflection 

• How you show someone that you're listening by telling them 

• Don’t have to paraphrase/summarize everything, highlight the big thing you heard 

Level 3 – reading unspoken feelings 

• Trying to decode what someone has not really said to you 

• We're inferring what the client may be thinking or feeling, even if they have not said so directly  

• Often referred to as advanced empathy bc it captures unspoken thoughts, emotions, or urges 

• Although you may be "wrong", accurate reflections can be very powerful  

  • If it invites the client to clarify, it's not a bad moment 

• At this level, still focusing on the client's internal world  

• Not making wild and ridiculous guesses  

• Focuses on the client’s internal experience (thoughts and emotions)

• Draws on observations, body language, knowledge of the client’s history, and clinical experience

Level 4 – validate based on history 

• Specific to the person but reaches back to their own life experiences/past/history 

• Connect the client's current experience to relevant past experiences 

• Requires a good understanding of how those two things might connect  

  • Client's history and present circumstances  

• You're conveying to someone that what they think or feel makes sense given what they're through  

  • e.g. makes sense that you're irritated; growing up with an abusive father who frequently controlled you helps explain why being told what to do is so difficult  

Level 5 – validate based on current circumstances 

• Extending outwardly  

• Validating based on current experiences, but how those current experiences might measure up for the vast majority of ppl in your situation  

  • Asking someone to zoom in on smt that just happened (brought them into therapy) wanna validate what they're going through/how you just reacted makes sense bc that's what many ppl would do  

• Distinction between level 4 and level 5 

  • Level 4 

    • Makes sense bc of this client's unique history (what YOU have PERSONALLY been through in your life) 

  • Level 5 

    • Makes snese bc most ppl would likely react similarly (given the fact that MOST ppl in a situation like this would feel this way TOO) 

Level 6 – radical genuineness 

• Abt self-disclosure 

• The riskiest but potentially the most powerful form of validation if used sparingly and properly  

• Where you attempt to relate to your client appropriately as one human to another 

• Treating the client as an equal while still acknowledging that their strengths and struggles are not yours 

  • Expressing genuine hope that positive change is possible  

• Implicit way of showing someone that there's hope for this "look at me. I haven't imploded" 

• Has to be genuine 

• This level must come from the therapist's authentic self and may be easier when you have had similar life experiences 

History of psychological tx 

• Historically, clinical psych (application of psych to clinical issues) has: 

  • 1) mainly been pathology/problem based 

    • Focusing on what's wrong on deficits, weaknesses, focuses on what's disordered, adverse or negative symptoms 

      • Idea is that if we turn our attention to what's not going well, this is how we'll help ppl to thrive  

      • Biomedical approach  

      • One of your arms is broken, now we have to find a way to use the rest of your body to function 

        • Positive psych, strength-based approach to mental health flipped on its head 

        • Said rather than focus on what's wrong, how abt we focus as much of our attention on what is going well, what ppl can use for strength  

  • 2) emphasized repairing trauma, deficits, disorders, and symptoms 

  • 3) viewed talking abt problems as the primary path to healing 

  • 4) given relatively little attention to strengths and positive experiences 

  • 5) often defined mental health as the absence of symptoms, which may be unrealistic for many  

• A more manageable goal may be helping ppl manage symptoms while improving well-being 

Positive psychology

• If someone is repeatedly put in situations where they don’t achieve smt, they don’t get the positive result or outcome that they're looking for, after a while, why bother syndrome kicks in 

  • What's the point if my efforts don’t amount to anything  

• Martin Seligman was focused on how we can counteract this psychological problem (learned helplessness) 

  • That this problem was a product of a wrong way of approaching how ppl were struggling in life 

• Though ppl should focus far more on what's going well than what's going wrong 

  • This shift gave rise to positive psych  

The PERMA Model

• A model of human flourishing 

  • Encapsulates more than happiness and good feelings 

  • Abt everything that makes a life worth living, good, meaningful 

  • Research suggests that strengthening PERMA and investing time into enhancing each of these elements increases flourishing and indirectly reduces psychological distress 

• Seligman proposed 5 key contributors to wellbeing (PERMA) 

  • 1) P – positive emotion 

    • Not the idea of just maximally amplifying good emotions  

    • Good emotions are things like rapture, joy, sympathy 

    • Positive emotion is any state experienced by you as being on balanced pleasant  

    • What matters is that you notice and appreciate, taking note and grateful for the times in your life where you do experience positive emotions 

    • Really appreciate the cause they don’t always show up  

  • 2) E - engagement 

    • About absorption 

    • Try to get into activities that are enjoyable and meaningfully challenging  

    • Have to be a nice balance of meaningful challenge and enjoyment 

    • Similar to the concept of flow  

    • Whatever it is you pick, becoming absorbed in it and using your strengths for it 

      • Using your strengths means you’re approaching something that requires your strengths (if too easy, not using your strengths) 

  • 3) R – relationships  

    • Need to build supportive, meaningful relationships with ppl that matter to yu 

  • 4) M – meaning  

    • Need something beyond yourself (e.g. religion, faith, family, community, advocacy, spiritual) 

    • What am I contributing to that's beyond my moment to moment  

  • 5) A – accomplishment  

    • Working toward meaningful goals and experiencing achievement  

    • Learned helplessness is the opposite of working towards meaningful goals and achievement  

    • Work incrementally (the point is achievement) and realistically towards more and more challenging and meaningful achievement  

Positive Psych Exercises

• 1) Three blessings  

  • Each night, write down 3 things that went well for you and why 

• 2) gratitude visit 

  • Write a letter to someone you never properly thanked, then read it to them in person, over the phone, or not at all  

• 3) savouring 

  • Slow down and fully experience an activity  

• 4) stoicism 

  • The last time meditation 

  • Deeply engaging in your feelings and facing them head-on and using them maturely in the service of what matters most to you, your loved ones, and your community 

  • Imagine it’s the last time you’re ever going to be doing something  

Attending Behaviours

• Behaviours (verbal and non-verbal) involve what we say and communicate verbally and non-verbally to show that we're really there for someone 

  • Paying attention, conveying genuine interest and curiosity in what they're saying  

• All of these behaviours are meant to communicate to someone directly or indirectly (most are indirect), not just empathy but respect and a fundamental understanding of what someone is communicating to you 

  • Trying to create a safe space/environment for the speaker to share beyond surface-level concerns 

• Main benefits: 

  • Helps to create a great therapeutic relationship 

  • Builds comfort, trust and therapeutic rapport 

  • Encourages clients to express and explore freely 

  • Helps clients take ownership of the session  

  • Provides counsellors with deeper insight  

Aspects of attending behaviour 

• 1) Eye contact 

  • Maintain comfy natural eye contact 

  • Use intermittent, yet frequent eye contact rather than staring 

  • What is considered appropriate varies across cultures, subcultures, ages, etc 

  •  Kimited eye contact may refelct any factors, including truama; anxiety or shame; mental ehalht symptoms; neuordiversity; susbtance intoxication or withdrawl  

• 2) Attentive body language 

  • SOLER 

    • S – Sit (or face the client squarely  

      • Want to sit and face someone as squarely as you can without making them unnecessarily uncomfy  

        • Can sit more at an angle  

    • O – Maintain an open posture 

    • L – Lean slightly forward to communicate interest 

    • E – Maintain appropriate eye contact 

    • R – Relax (avoid unnecessary fidgeting or tension) 

      • As much as you can try to avoid mannerisms that convey to someone that you're tense or viewing someone with suspicion 

• 3) Comfortable distance 

  • Approximately an arm's length apart (common NA norm) 

    • Personal space varies across cultures and individuals 

    • Adjust based on client comfort and the counselling setting 

    • Consider safety: be aware of exits  

  • Avoid blocking the client’s path to the door 

  • Position yourself so both client and counsellor can exit comfortably if needed 

• 4) Vocal tone 

  • Use a voice that communicates: 

    • Warmth  

    • Calmness 

    • Respect  

    • Compassion 

    • Genuine interest 

  • Speak at a comfortable pace and volume  

  • Every situation is gonna call for some adjustment in how you're communicating with someone  

• 5) Verbal tracking 

  • Ability to stay with the client's story rather than jumping to another topic  

  • What we're trying to do by using the skills that show 

    • Following the client's agenda 

    • Listening for important facts, thoughts, emotions, and meanings  

    • Demonstrating that you're following through 

      • Paraphrasing 

      • Summarizing 

      • Reflecting feelings 

      • Using silence effectively  

Basic Listening Sequence (BLS)

• Basic bc it's so fundamental that its gonna require the least amount of calculated, if you're communicating with another person and you care what they're saying and wanna convey that you care what they say and are trying to keep track of it, this is fundamental (even outside of counselling) 

• Helps counsellors 

  • Listen more effectively 

  • Draw out clients' stories 

  • Explore thoughts and emotions 

  • Identify strengths and resources 

• Why do we use them? Trying to do 3 things 

  • 1) Identify relevant parts of someone's story (can call this the situation) 

    • Looking for key facts and thoughts of the client's understanding of their situation 

    • Skills utilized: what questions, encouragers; paraphrases 

  • 2) Identify central emotions about the situation 

    • Central emotions about their situation  

    • Some skills utilized: questions; reflection of reflection of feeling (advanced form of paraphrasing), emotion-focused encouragers 

  • 3) Provide an overall summary of what you heard 

    • Primary skill utilized: summary of facts and feelings, checking for accuracy 

    • 2) Slow things down – if you notice you're having a hard time keeping track of what the client is saying, slow it down and just check with the client where they're at 

    • 3) For silence 

      • When you feel stuck  

      • Sometimes you need a summary to capture where you've been and to springboard onto something new 

  • 5 core skills of the basic listening sequence 

    • Use of both open and closed questions 

    • Encouragers  

    • Paraphrasing 

    • Reflection of feelings 

      • More targeted at our emotions 

    • Summarization  

      • A collection of paraphrases and reflection of feelings 

BLS - 1) Open vs Closed Questions

• 1) Open vs closed questions 

  • Open questions 

    • Usually begin with what, how, could, would  

    • Encourage discussion 

    • Promote exploration 

    • Invite deeper reflection 

    • Generate richer responses 

  • Closed questions 

    • Question that usually can be answered yes, no or a specific determinant quantity 

    • Usually begins with  

      • Is 

      • Are 

      • Do 

      • Did 

      • Have 

    • Gather specific info 

    • Clarify details 

    • Narrow the focus 

    • Can feel like an interrogation is overused  

• Why do we use questions? We ask a question when we wanna orient the client's attention to something  

• Helps client 

  • Focus attention on feelings or key content 

  • Build awareness and understanding 

• Encourages client to 

  • Clarify or elaborate 

  • Focus on areas needing attention  

  • Identify areas needing focus 

• Enables the counsellor to 

  • Better understand client's statements 

  • Understand the client's needs and goals 

• Generally, we wanna use more open questions unless your purpose is to focus your clients attention and to control the convo in a therapeutically useful way 

  • Open questions tend to open the conversation and closed questions are meant to close it 

BLS - 2 + 3) Encouragers and paraphrases 

• Encourages 

  • Very simple 

  • Easy to use to demonstrate to someone that you are present, and you're encouraging them to continue speaking and sharing and elaborating  

    • Opposite of conveying to someone that you want them to shut up  

  • Also includes non-verbals 

  • Focusing on verbal cues  

    • I.e. Mhm, uh huh, okay 

• Paraphrases 

  • When you say back to someone what your mind and heart have just heard that person say 

  • Involves a bit of empathizing 

  • Not repeating back verbatim  

• Purpose of encouragers and paraphrases 

  • Helps client 

    • Feel understood 

    • Gain direction for next steps 

  • Encourages client to 

    • Expand discussion of the same subject 

    • Clarify their remarks 

  • Enables the counsellor to 

    • Verify understanding of the client's message 

    • Highlight important issues for further exploration 

BLS - 4) Reflection of feelings 

• A deeper and more focused paraphrase 

• Its focused on emotions 

• Has more general application 

• Saying back to someone in your own words what they've just said to you 

• Requires that you say back to someone what you think or feel they are feeling esp when the feeling is not communicated 

• Helps client 

  • Realize not only that you're trying to understand but helps them realize the counsellor actually understands 

  • Helps them to understand their own feelings 

  • By revealing feelings that might have been expressed only vaguely 

  • Helps ppl realize that feelings/behaviours or life situations are connected  

• Encourages client to  

  • To express their feelings  

  • Recognize and accept feelings as part of who they are 

  • Express and own their feelings 

• Enables the counsellor to 

  • Verify whether you're accurately understanding what the client is experiencing 

  • Helps to bring out problem areas in a gentle way that's not overwhelming  

BLS - 5) Summaries

• Very similar to paraphrasing, but the purpose of one is to capture a long thread of convo 

• General rule 

  • When to paraphrase? 

    • Relatively shorter bits of convo 

  • When to summarize? 

    • Relatively longer bits of convo 

    • Less likely to leave out key moments of convos 

• Helps client  

  • Clarify meaning 

  • Realize that the counsellor understands 

  • Gain a sense of movement and progress in the conversation 

• Encourages client to 

  • Explore an issue further or acknowledge the problem 

• Enables the counsellor to 

  • Provide focus and continuity 

  • Verifies understanding of content and feelings 

  • Bring closure to a topic and facilitates transition 

  • Ends the session logically  

3 Stages of the Skilled Helper Model

• A model we use to help ppl to understand and manage their problems in the most effective way possible 

• Strengths-based model, fairly straightforward and can be used in conjunction with transtheoretical models (e.g., stages of change) 

• Stage one 

  • The current picture - What's going on? 

    • What is your story? What's going on for you right now? What is your lived reality 

• Stage two - The preferred picture 

  • What do I need or want? 

  • What would you like to address or change in a positive way? 

• Stage three - The way forward 

  • How do I get what I need or want? 

  • One of the most popular and oldest models of a skilled helper model that maximizes this Rogers' current self-concept and ideal self-diagram