Introduction to Counseling

Therapeutic Relationship

Refers to the relationship between a healthcare professional and a client (or patient). It is the means by which a therapist and a client hope to engage with each other, and effect beneficial change in the client

What are the characteristics of a good counselor?

Warmth, empathy, supportiveness, and hope

Extratherapeutic factors

Refer to the client's factors, such as willingness to change

What are the six stages in the therapeutic process?

Establishing relationship, assessment, treatment planning, intervention, evaluation, and termination

Stage 1: Establishing relationship

Counselors should create an inviting therapeutic environment that invites the clients to share their struggles and suffering without feeling judged.

Stage 2: Assessment

is to evaluate the relevant factors that contribute to the client's presenting issues such as interpersonal relationships, financial situations, medical conditions, and family history.

Stage 3: Treatment and Planning

Tailored to the client's unique needs and presenting issues.

-Reflect optimistic, realistic, and attainable goals that the client is able to achieve

-Concrete and measurable

-Flexible

Stage 4: Intervention

align not only with the counselor's theoretical approach but also with the treatment goals. Interventions are used to help clients gain insight or take action.

Stage 5: Evaluation

responsible for evaluating the therapeutic process and outcomes to determine whether those interventions served the treatment goals.

Formative evaluation

Occurs throughout counseling in order to periodically assess the client's progress toward therapeutic goals.

Summative evaluation

Occurs toward the end of the counseling process to determine whether the therapeutic goals have been accomplished

Stage 6: Termination

Once the client achieves a satisfactory therapeutic outcome, it is time for termination, where the client can generalize what she or he learned in counseling to other life contexts such as family, community, and work.

Therapeutic Alliance

It is defined as "a collaborative process whereby both client and therapist agree on shared therapeutic goals; collaborate on tasks designed to bring about successful outcomes; and establish a relationship based on trust, acceptance, and competence".

Microskills

Refers to basic counseling skills that assist rapport building and begin the therapeutic process

Therapeutic relationship factors

refer to the characteristics of the counselor such as warmth, empathy, and acceptance.

Hope and expectancy

refer to the client's perception that her or his presenting issues will be alleviated or that therapy will have an even better outcome.

Therapeutic models and techniques

refer to theoretical approaches and strategies that counselors employ in treatment and intervention

therapeutic process

cannot be prescribed as a step-by-step model, as it largely depends on the theoretical approaches and work settings of the counselor.

stage 2 assessment is sometimes called

initial interview or intake assessment

Therapeutic alliance comprises three important components of the relationship:

counseling relationship, collaborative goals, and trust

Attending

communicate to the client that you are attending to her story through nonverbal (e.g., head nodding, eye contact) and verbal (e.g., uh-huh, yes) acknowledgment

Silence

pause after the client's statement to help her elaborate more on the story and/or to provide a brief moment for the client to reflect on her story.

Restatement

rephrase the client's primary statement or response to let him know that you are listening and paying attention

Reflection of feelings

reflect the expression, emotions, and/or feelings associated with a particular event or story that the client tells you.

Summarizing

capture the content (both thoughts and emotions) or identify themes or patterns associated with the client's story in order to keep the therapeutic conversation focused and to promote clarification.

Probing

ask open-ended questions to facilitate the client's understanding and exploration of her story.

Rapport

Refers to the relationship between the client and therapist. It includes the connection, the trust, the sharing, the safety, the communication, and the dynamic of a relationship.

How to build rapport?

Body language, Client Feedback, Collaboration, Genuineness, and Flexibility and responsiveness

Body language

Provide supportive nonverbal cues, including eye contact and nodding in agreement

Client Feedback, collaboration, genuineness

A therapist will offer feedback in the moment rather just than in a later session

Flexibility and responsiveness

Research has also found that it is important for a therapist to be flexible and responsive to your needs.

Listening

pay attention to the client's story to accurately capture his thoughts and emotions

Therapeutic Listening

A type of listening that takes place in counseling.

Three Levels of Listening

- Marginal Listening

- Evaluative Listening

- Active Listening

Marginal Listening

Individuals are hearing but not paying attention

Evaluative Listening

Involves concentratng intently on what is being said but only focusing on the literal meaning of words.

Active Listening

Listener receives verbal and nonverbal messages from others, processing, and responds to them in a way that encourages further discussion.

Sensing, processing, and responding

listening can be broken down into three stages each part demonstrating empathic listening:

Sensing

- listeners must receive all verbal and nonverbal cues.

- listeners must register not just the content of the message, but also the process of delivery.

Processing

listeners must remember what was said, obtain clarification when necessary, and integrate the messages received into a whole

top-down processing

involves perceiving things based on your prior experiences and knowledge. In other words, you use what you already know to make sense of the new information you encounter.

bottom-up processing

is when sensory receptors pick up signals for the brain to integrate and process. An example of this is stubbing your toe on a chair, the pain receptors detect pain and send this information to the brain where it is processed.

Responding

- listeners may ask questions or paraphrase the material to communicate that she has heard the client and to encourage ongoing communication.

- listeners may ask questions or paraphrase the material to communicate that she has heard the client and to encourage ongoing communication.

Affect Tolerance

allows counselors to respond empathically to a client' s experience of distress without overly identifying with it or avoiding it.

- being willing and open to experiencing feelings

Mindfulness

- helps counselors train their minds to attend fully to their clients and tolerate affect

What are the five core mindfulness skills?

observing

describing

non judging

non reacting

acting with kindness

Reflective Listening

a core component of a therapeutic approach called motivational interviewing

Simple reflection

- made by repeating or rephrasing the client's statements.

- captures the client's perspective and presents it back to the client in a manner that indicates you understand their perspective.

Complex reflection

makes an interpretation of a client's statement by substituting a new word or making a guess at unspoken meaning (Miller & Rollnick, 2002).

- allows counselors to test hypotheses about the meaning of clients' statements

In order for clients to be aware that counselors understand them, counselors can:

Mimic the speaker's body language and vocal volume.

Use the same vocabulary.

Using the client's own words.

Counselors should:

Listen for themes and cues and get the whole picture.

Counselors should avoid

digressing

Top-down processing

involves perceiving things based on your prior experiences and knowledge. In other words, you use what you already know to make sense of the new information you encounter.

What are the four listening responses?

VERBAL PERSON-CENTEREDNESS (VPC)

LOW PERSON-CENTERNEDNESS

MODERATE PERSON CENTEREDNESS

HIGH PERSON-CENTEREDNESS

Verbal Person-Centeredness (VPC)

described as a key component of supportive therapeutic listening (Bodie & Jones, 2012), and focuses on the last stage described by Bodie (2011): responding.

LOW PERSON-CENTERNEDNESS

messages that are low in person-centeredness criticize or challenge the other person's feelings or perspectives

-may even consist of telling the other person how she ought to feel in that situation.

moderate person-centeredness

responses include an implicit recognition of the other's feelings, but may consist of expressions of sympathy or attempts at distraction, steering away from the distressing situation instead of directly exploring the person's feelings in context

high person centeredness

characterized by explicit recognition of the other person's feelings

-encouragement to elaborate and contextualize those feelings according to the perspective of the other.

INTERPERSONAL COGNITIVE COMPLEXITY

the ability to obtain information about people and social situations

Clarification

is also useful when you want to ensure that the client understands what they are saying, especially if they appear uncertain about their own words.

You can seek clarification by

restating what you think you heard and asking the client if your interpretation is correct.

Another method to seek clarification is to

offer the client a forced choice. asking them to clarify between two possibilities.

Reflection

includes simple and complex reflections, as well as a focus on the client's mood through nonverbal cues.

NONVERBAL COMMUNICATION

describes the group of behaviors that reflect to listeners the degree of distance or closeness between themselves and another person

Paraphrase

when individuals restate what someone is trying to communicate in their own words, showing they understand both the message's content and emotions.

Eye contact

with a client with a client during a conversation is a direct way to show that you're actively listening.