Intro to Counseling Quiz 3

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Empathy

the ability to see the world as another sees it

nonjudgmental

understanding another person’s feelings and feeling the associated distress

Subtractive empathy

counselor responses detract from or distord client communication

“oh that sounds really hard”…can sound dismissing depending on how you say it

Basic empathy

counselor responses are roughly interchangeable with client statements

“thats so hard to have to feel sad all the time”…using clients words and giving it back to them

Additive empathy

counselor responses add something to client statemnets

deeper understanding of feeling/meaning…new way of looking at something

hypothesize what the client is actually feeling and going through

very intense

Attending

listen to clients story

recognize the course of suffering and difficult feelings the client might be experiencing

feel the clients pain

communicate that you feel and value their pain…”im sorry youre going through that” “that sounds upsetting, but also terrifying”

Nonverbal behaviors

patterns of eye contact…breaks in eye contact, holidng eye contact, dialation/contraction of pupils

facial expressions…flat affect, extreme facial response, use of smiles, frowns, and furrows

affect

biological demonstrations of emotional reactions

feeling

bodily felt experience of affect

emotion

feelings along with associated thoughts and behaviors…links to self/identity

distress

sense of pain that accompanies some emotions

recognition of feeling

recognize the emotions that the client is likely feeling…listen for specific words the client uses…use empathy

feel some of the distress that comes with that feeling…use your own experiences when youve felt this way…take the feeling to its most extreme place

restatement

simple structure of reflection of feeling

'“i wonder if youre feeling angry…”

classic structure (reflections of feeling)

bring emotion into the moment

sentence stem: “it sounds like…”, “i hear that…”

name the feeling: “…youre feeling really__”

the underlying facts of reasons behind the feeling “…because your husband lost his job, and that’s unfair”

check out: “does that seem right?” or “am i hearing you correctly?”

Meaning

what brings value to our lives…use thoughts, feelings, and behaviors to help clients see what matters

helps clients understand their wants vs needs

meaning is especially useful…

regarding instances when clients are stuck and can’t understand the blockage

may relate to the conflict between multiple different values

Reflection of meaning

explore issues of meaning/value in the client’s life

follow the same process/structure as a reflection of feeling

identify issues of importance for the client and reflect how they are or are not pursuing them

General questions to elicit meaning

• “What do you make of that?” 

• “What does that mean to you?” 

• “What’s missing in your life?” 

• “What gives you the most satisfaction? 

• “What is the purpose of ______ for you?” 

• “What does ________ represent to you?”

Specific questions to elicit meaning

• “Cara, I’m hearing that, for you, earning a good salary represents the freedom to do the things you want in life and feel a sense of independence from your family. Does that sound right?”

• “Marcus, it sounds like your mother’s heart attack has made you really question some basic things about your life. Is that close?...Can you tell me more?”

reframing

an effort to help a client recognize how theyre blocking their ability to change their perception

challenged clients currently held beliefs from a particular perspective

Possible angles of reframing

Functionality: “how is that working for you?”

Fake-it-til-you-make-it: “what would it be like if you just pretend you were good at public speaking”

Focusing on positives: “i hear your fears, but also note how excited you are about this date”

Reframing examples

• “As we’re talking, I’m noticing that you’ve been focusing a lot on the negative aspects of yourself and your life right now.They must feel pretty consuming.”

• “Uh, yea, that’s because I actually don’t really see any positive aspects. At least not major ones.”

• “I hear you. You’ve felt like this for a long time; it must be hard to see those positive aspects. What is that like for you, to only see negative in yourself?

cautions around reframing

can allow counselors to focus on positives to avoid distress

pertinent to develop trust and demonstrate validation of clients pain before reframing

prioritize active listening, attending skills…

interpretation

links behavior, thought, emotion, or memory to something outside the clinets awareness (new persepctive)

helps client make connections between apparently isolated events

points out themes or patterns in a clients behavior, though, or feleings

examples of interpretation

• “Could your anger at your husband be connected to the grief over your mother’s death?”

• I wonder if you’re expecting me to respond like your father does?”

why might interpretation be distressing

shakes a clients view and knowledge of their identities and lives

(interpretation requires established trust)

Building an Interpretation

When you have determined that the client is ready for the interpretation, pose as a gentle question or hypothesis

keep phrasing tentative

use a stem

Link the topic of interest (content) or emotion/behavior/thought that occurred in session (process) to topic outside of client's awareness 

Use check-outs when appropriate or you’re unsure 

If possible, use the client's own words

Examples of interpretation

“I’m wondering if your father leaving you when you were little might have led you to avoid connecting with me now, as a way to protect yourself from being abandoned again?”

“Do you think that your mother’s expectations that you be a ‘perfect lady’ might have led to you not being willing to show your true self to others you love? Does that sound right?”

The following statement is an example of:

• reflection of meaning

• reframing

• interpretation

“Marcus, I’m definitely hearing that your mom’s heart attack has had a profound impact on you and how you view your own life. Can you share a little bit on what the new view of life means to you?”

refelction of meaning

The following statement is an example of:

• relfection of meaning

• reframing

• interpretation

“Marcus, it really sounds like you’ve been questioning just about everything in your life since your mother’s heart attack. And yet, she survived. Let’s focus on that piece for a moment.What would that feel like?”

Reframing

The following statement is an example of:

• reflection of meaning

• reframing

• interpretation

• “Marcus, I’m wondering if the scare that came with your mom’s heart attack might have been so painful because it reminded you of how your father left your family when you were so little.”

Interpretation

Immediacy

a here-and-now approach that refers to the direct events of the therapeutic hour

What’s happening in the office, in the relationship, right now

Benefits of immediacy

Helps clients experience emotions more deeply

Helps clients process reenactments

Creates interpersonal safety in the therapeutic relationship

Provides a corrective emotional experience

Allows us to navigate client resistance

Creates proximity

Times to use immediacy

If you notice nonverbal or other content clues that the client is having about an emotion or to what youre currently doing in therapy…example: crossing their arms when they don’t usually do that

If the session is lacking direction, overtly focused on details outside of the room, bring it back to the hereand-now

You feel a tension within the room

Acknowledging the risk/trust involved when discussing certain painful topics

the process of immediacy

• Ask about ”what’s currently going on” in a gentle and kind way

  • “I’m wondering what that was like for me to say that part of you hates yourself?”

  • “What is it like to feel the intensity of that pain with me.”

• Go slowly, and be thoughtful with your comments

• Feel free to move back and forth into the past and future, and between thoughts/feelings/behaviors, but keep returning to the present

Once you think the associated feelings are too intense, you can allow the client to move away from the moment

challenges/difficulty of immediacy

Immediacy feels intense and initially awkward…can feel out of control as a counselor

Working in the here-and-now means its very difficult to hide from the feelings of anxiety, anger, hurt, or sadness that might arise

Puts a lot of responsibility on the therapist; it is unlikely that the client will lead, so we must take the lead in addressing what’s happening in the room

Problematic immediacy

Most common issue is if counselor “bails out,” and ends up opening a discussion of process but being unwilling to continue it

If we bail out, we end up sending the message to the client that their feelings are too intense for us and that they can’t be processed

Self-Disclosure

When the counselor briefly shares some aspect of their own perspective, including their own story, thoughts, or immediate experience

Appropriateness is highly contingent on theory and personal style

Self-Involving statements

therapist expresses their feelings about the client

“I notice that I’m feeling quite frustrated with you, as well.”

“I don’t perceive you in that way.”

“When you say that, it makes me feel quite defensive. Do you think other people in your lives have this reaction?”

Research has shown that the effective use of selfinvolving statements is highly validating for clients

Self Disclosures – Personal Revelations

A reference to a personal circumstance that might help highlight new options for a client

Is an acknowledgment of the counselor as a person who has had successes and failures

• But be careful! Often the goals can be fulfilled with other techniques…

Responses to direct questioning from client

“I’d be happy to answer that question but I’m wondering what made you think of it now?” … “I’m wondering if you have some concerns about the work we are doing?”

“I am a counselor-in-training so I have not had a great deal of experience. That’s why all of my sessions are reviewed by a supervisor with more experience and training. Is there anything in particular that has happened thus far that’s concerned you about my training?”

Try to respond in a non-defensive, curious, open stance to feedback

self-disclosure issues

• May demonstrate a boundary issue for the counselor

• May bring up fears of judgment

• You do not want to monopolize the dialogue

• A form of intimacy that some clients might find difficult

resistance

Behaviors that block a client from acting in their best interests and responding positively to counseling interventions…any form of behavior a client may engage in that slows down therapy

reasons for resistance

fear of intensity, of losing control, and of change

shame, guilt, and lack of trust

types of resistance

indirect: talking excessively or very little, arriving late or early, being unprepared for session, too much or too little emotional control during session

interventions to address resistance

open intervention to explore it from a perspective of curiosity and interest

Identify defenses as they arise with immediacy

Validate defenses if/when they are helpful for clients, and acknowledge when they are not

If your open techniques have not gotten your client to address the resistance, you may need to use closed interventions like interpretations or confrontations

externalizing the resistance to make it more workable

If the client has recognized that they are being resistant, but still can't help but resist, try hypothetical questions

steps in challenging your client

• Listen and identify conflict in client communication

• Clarify and clearly point out issues of incongruity

•  Listen, observe, and evaluate

Step 1: Listen and Identify Conflict

Internal conflict: Verbal and nonverbal behavior…Affect and content…Conflicting statements

External conflict:  

• Client and counselor  

• Client and expectations

• Client and important others

• Client and values/norms

An example of affect and content

saying one thing but face saying another

laughing while talking about beig stressed

conflicting statements example

saying you love your partner but you keeo cheating on them

Step 2: Point Out, Clarify, Work to Resolve

Clearly identify the incongruity or conflict.

Draw out and clarify all aspects of the conflict

Periodically summarize the different elements of the conflict

Encourage and support through positive asset search

Provide feedback if neccessary

Step 3: evaluate the change

• Consider the client responses

  • Does the client display change in the here and now?

  • Does the client display change outside of session?

• If the client does not change… 

  • Consider if your confrontation might not have been correct

  •  If you believe the confrontation was correct, then your client might not be ready to hear it