Screening & Client Engagement: Midterm Exam Study Guide

Empathy

• focuses on identifying the clients feelings and responding to them in a way that shows you understand their feelings

• Suspend your judgements and attitudes and feel with your client; look at the situation through the perspective of the client

• Responses include conveying understanding, caring, perception and giving the client the feeling that you really listened to them

• Reflect and mirror the feelings of the client and provide feedback that they can agree or disagree with

• Helps employ more effective therapeutic interactions that help the client cope with their issues

• Example: “I see that you are feeling pain, I can tell that there is something you are struggling with. Am I understanding correctly what you are feeling?”

genuineness

• being freely and openly themself, no discrepancy between what the individual is saying or doing and what the person is experiencing

• Outer words and behaviors match the counselors inner feelings

• Other terms: authenticity, honesty, congruence, and realism

• Being non-defensive and human enough to admit our errors, share our feelings, and not hide behind professionalism

• Example: “I’m feeling very sad about what happened to you and seeing how hurt you are”

respect

• allowing the client to make choices and experience both failure & accomplishment

• Believing that the client has the ability and power to make it in life

• Counselor appreciates the dignity and worth of the client as another human being

• Counselor accepts that each individual is unique, has a right to choose, possess free will and has the capability to make his or her own decisions

• Example: “I can tell you are struggling with what to do. It sounds like you are torn between what you should do, stay or leave.”

  • Puts responsibility on the client to help them make their own choices, shows that the power to decide is theirs and not the therapists

self disclosure

• being willing to share your feelings, thoughts, and experiences with someone else in order to help them

• What you are sharing has to be shared at the right time and can be used to help the client in their situation

• Meant to be used as a way to benefit the client

• Can be used to help the client feel acceptable as a human being, client can feel less likely to be judged or inferior to the counselor

• Example: “I too have struggled like you have. It can be hard to know how to be open but it also really helped my relationship”

Warmth

• evident in the nonverbal behavior of the counselor

• Behaviors like smiling, soft touches, or other natural responses like crying with a client

• Shows that the counselor is human as well and they they can provide support whenever it is needed, provide warmth that humans provide for each other

• Example: client talks about how they lost a partner and the therapist goes to give the client a hug and maybe cry with them a little

Immediacy

• the therapist can keep the feelings between them and their clients in the present

• Helps the client work on their problems through the relationship with the therapist and can involve both positive and negative emotions

• Client is able to focus on a present interaction with their therapist while the therapist uses that interaction to help them work through their bigger problems

• Example: “I can tell that you are struggling with your past but its important to focus on how to move forward and not let it hold you back”

• Another example: client gives a gift to therapist to express their gratitude. The therapist expresses how they are getting the feeling that their clients cares for them and the therapist explains how they also care for the client. The therapist prompts the client into thinking about their struggles with forming relationships by asking if they feel they can do anything to build relationships.

  • Shows how the therapist is using their current interaction to work through the clients bigger issues

concreteness

• keeping the client focused on what is happening in the current moment

• Helps the client stay focused on their concerns and feelings instead of starting to rant about other people or things

• A therapist would focus on asking the client how, what, when, and where in order to encourage the client to think about their current thoughts and feelings

• Example: client expresses to their therapist how they are having issues with a friend but then they say how everyone has issue like that. The therapist would then guide the client back to discussing their issues instead of letting the client go on a tangent or dismiss their issues

• Another example: “but how do you feel about it, not your family”

confrontation

• making the client aware of a certain situation

• Important to do it in a respectful manner and make sure that the client is benefiting from the discussion

• Five types:

  • Experiential confrontation: when a client says something, but it is clear to the therapist that what they are experiencing is different

  • Strength confrontation: when the client is “pretending weakness” in an area that the therapist thinks is a strength for the client

  • Weakness confrontation: when the client “plays tough” when it is clear to the therapist that they are struggling

  • Action confrontation: when the therapist confronts the client in order to get them to an agreed-upon goal

  • Factual confrontation: when the therapist uses facts to correct the clients misinformation that they are using to guide their lives

• Example: a client is telling their therapist about how they had a really big fight with their wife and the client is trying to pretend it is not affecting them. The therapist would say “I am so sorry you are dealing with this, but I don’t believe that you are fine with it. It seems like this is really getting to you and you seem upset about this fight”

• Another example: “I don’t believe you can’t move forward. A couple of sessions ago you were talking about just that”

potency

• has to do with how the client see you and if you are someone that is worth seeing

• Means that the therapist is easy to talk to, knowledgable, and helpful

• Also has to do with being able to see the power and potential in a client and helping them see it as well

• Example: “I really feel like you can do it! You have the power to move on and you are so strong and can do it”

self actualization

• has to do with the counselor and their growth throughout life

• Might be described as being human, knowing that they have strengths and weaknesses but that everything in life is a chance to learn and grow

• Means being in touch with their own thoughts and emotions and realizing when they might be getting in the way of being an effective therapist

• Therapists with this quality believe that they can learn from their clients as much as their clients can learn from them

• Interested in helping the client realize that they have their won way of living and that it is okay that it might be different from another person

• Example: client is seeing 2 people and is confused because he doesn’t want to hurt either of them, therapist says how they see they are struggling with their choice and that they understand how he must be feeling because they also have their own dilemmas. Therapist asks the client what he feels like he is getting out of the relationship

  • This interaction shows the therapist isn’t judging the client for being unsure or dating 2 women. Instead the therapist expresses how they also have difficulty figuring things out. The therapist is still trying to help him through his dilemma and accepting him as a human that needs to make choices

Helping relationship

• helping relationship is a planned, defined process that is structured by the counselor: defined activities that guide engagement in the relationship (screening, assessment, and orientation), use of the professional relationship to identify and resolve problem issues (treatment planning and the actual process of treatment) and discharge/termination

• Relationship is time limited: dependent only for the time necessary to identify and resolve specific problems that the client brings to the professional, even meeting sessions have a time limit with a defined agenda

• Has a clear, agreed-upon purpose: relationship exists to assist the client in identifying and resolving personal issues, treatment purposes with outcomes are defined during the assessment and treatment planning

• Has unequal responsibilities: professional brings specific knowledge to the helping relationship along with interpersonal skills to assist the client in resolving issues. Professional is responsible for structuring and guiding the therapeutic relationship to focus solely on the client and making sure their needs are met. Professional is responsible for assessing the treatment needs of the client, interventions that will be required to address those needs, and for determining when discharge is indicated. The counselor is responsible for bringing scientific or evidence based interventions to the counseling process

• Relationship is disciplined: occurs at specified times for pre-determined purposes of assisting the client in resolution of personal issues, client may be tasked with completing therapeutic homework

• Relationship is built on acceptance: one sided relationship where the professional shares knowledge and interpersonal skills while the client presents issues and problems requiring assistance from the professional, client pays for service and seeks professional services that is unavailable elsewhere

• Three vital components: attitudes/values (empathy, positive regard, genuineness, respect, warmth, patience, self awareness, ability to take risks, capacity to ask for help and for feedback, belief in people’s and system’s capacity to change, open mindedness, skepticism, rejection of stereotypes, and humor), skills and knowledge

social relationship

• social conversations so not and usually do not have a conscious goal, there is not usually a fixed agenda about what is being discussed, conversation ambles at a leisurely pace from one topic to another

• Each involved person expects equal attention, both listening and sharing

• Relationship is built on attraction or affection, usually to make friends or for casual conversation

Native American Values

• Privacy: Native Americans have respected the unique individual differences among people, expression of this value includes staying out of others’ affairs and verbalizing personal thoughts and opinions only when asked

• Stillness: quietness or silence, lack of direct eye-contact

• Endurance or lack of complaint: endurance and patience; patience is needed to demonstrate respect for individuals, reach group consensus, and allow time for “second thought”. In a counseling session don’t put pressure to make quick decision or responses because they usually like to reflect first

• Unstructured labor: labor is always directed to a distinct purpose and is done when it needs to be done. Non-materialistic orientation, only that which is needed is accumulated through work

• Collectivism: promotes a sense of longing and harmony with group members cooperating to gain group protection and consensus. Helpful for the therapist to determine the clients relationship with their culture in order to work with those beliefs and understand how one may be in conflict with the clients world view or biased about specific belief systems that differ

• Nonverbal behaviors: many Native Americans prefer listening rather than speaking, there must be a purpose for talking, all words have power to it is important to be careful and thoughtful when talking. When planning treatment & presenting options, avoid asking rapid-fire questions. Many Indian clients are more comfortable with a discourse, story, or demonstrations

• Observational learning: hearing, observing, and memorizing are important skills. Storytelling and experiential activities can be highly effective for a Native American client, a balance among methods that emphasize listening and observation, as well as speaking is important

• Flexibility in time: time happens when it is ready to happen, time is flexible and generally not structured. Allow flexibility when scheduling

• Living in the moment: emphasis on present needs and desires over future rewards, counseling session should have a sense of immediate relevancy for the time and place of each client

• Realism: tend to be realistic minded and have less difficulty accepting and understanding materials and approaches that is concrete or experiential rather than abstract and theoretical. Sessions should begin with numerous concrete explanations, as well as activities to be followed with application of experiential work

• Interconnectedness: life is interconnected to all things, plan for therapy from a holistic perspective is an essential and natural strategy, included in the whole picture would be the extended family

• Spirituality: sacred thought and action are woven into the entire sociocultural traditional life, everything is part of the spirituality of the community. Recognizing all aspects of spirituality and religion is an important part of treatment but it is also important to remember that truth, sacredness, and confidentiality of each Indian tribe’s religious practices should always be respected. Best to keep discussion about spiritual beliefs as general and nonspecific as possible and specifics should only be discussed in proper context with necessary permission

• Concern: concern and carefulness in new situations, quiet concern results from thinking about how their thoughts and behavior might be accepted by those they do not know or in a new situation. Counselors need to show clients that the session can be as informal and open as possible, with open friendliness and sincerity as key factors for easing concern

• Effective communication: taking time in conversation and providing information directly through storytelling, example, and metaphor; also includes listening and using humor to build relationships through communication

Counselor awareness of own cultural values and biases

• culturally skilled counselors believe that cultural self-awareness and sensitivity to one’s own cultural heritage are essential

• Culturally skilled counselors are aware of how their own cultural backgrounds and experiences have influenced attitudes, values, and biases about psychological processes

• Culturally skilled counselors are able to recognize the limits of their multicultural competency and expertise

• Culturally skilled counselors recognize their sources of discomfort with differences that exist between themselves and clients in terms of race, ethnicity, and culture

SBIRT

• Screening, brief interventions and referral to treatment (SBIRT) is used in many primary care centers and emergency rooms to assist those that may be developing an alcohol problem

• Early intervention can decrease the harm to the individual by helping them to identify the problem and resolve ambivalence to the problem in a short period of time

• Brief interventions are effective short sessions that help with decreasing alcohol use as well as tobacco

• Screening: a preliminary procedure to evaluate the likelihood that an individual has a substance use disorder or is at risk of negative consequences from use of alcohol or other drugs

• Brief intervention: refers to any time-limited effort to provide information or advice, increase motivation to avoid substance use, or to teach behavior change skills that will reduce substance use as well as the chances of negative consequences, typically low to moderate risk

• Brief treatment: refers to the delivery of time limited, structured (or specific) therapy for a substance use disorder by a trained clinician and is typically delivered to those at higher risk or in the early stages of dependence

• Referral to treatment: facilitates access to care (including brief treatment) for those individuals who have more serious signs of substance dependence and require a level of care outside the scope of brief services