Intro to Psychotherapy Exam 1 Study Guide

Interviewing

The basic process used for gathering data, providing information and sugguestions to clients, and offering workable alternatives for resolving concerns. 

Professionals in many areas also use these skills—for example, in medicine, business, law, community development, library work, and many government offices.

Counseling

A more intensive and personal process with a focus on listening to and understanding a client’s life challenges and then developing strategies for change and growth. 

Most often associated with the professional fields of counseling, human relations, clinical and counseling psychology, pastoral counseling, and social work. 

Psychotherapy

Focuses on deep-seated difficulties, which often require more time for resolution.

Typically offered by clinical and counseling psychologists, clinical mental health counselors, clinical rehabilitation counselors, and clinical social workers.

Intentionality

The important of being in the moment and responding flexibly to the ever-changing situation and needs of clients.

Flexibility

The ability to move in the moment and change style - it is basic to the art form of helping.

Cultural Intentionality

Acting with a sense of capability and flexibility deciding from anong a range of alternative actions.

The individual has more than one action, thought, or behavior to choose from in responding to changing life situatons and diverse clients.

Ethical Codes of Counseling

Do no harm to your clients; treat them responsibly with full awareness of the social context of helping. 

Maintain confidentiality, recognize your limitations, seek consultation, be aware of individual and cultural differences.

Humility

Understand your privilege and be aware of your own assumptions, values, and biases

What are the boundaries of practicing counselors?

Boundaries of competence, based on educaton training, supervised experience, state and national credentials, and appropriate professional experience.

Informed Consent

Telling clients of their rights

When recording a session, we need permission from the client(s)

Confidentiality provides the basis for trust and relationship building

Attending Behavior

Supporting your client with individually and culturally appropriate verbal following, visuals, vocal quality, and body language/facial expressions.

Shows your client that you are listening to them.

Clients will talk more freely and respond openly, particularly about topics to which attention

Selective Attention

Ask yourself: What do clients focus on an what do they avoid? Are you focused on particular thoughts and behaviors while missing other issues?

Used to facilitate more useful client conversations

Attention

Attending with individual and cultural sensitivity is always a must. Observation skills will enable you to stay more closely in tune with your clients.

Open Questions

Often begin with who, what, where, when, why, can, could, or would. Clients provide more details and often talk more in response to these questions.

Cannot be answered with few words

Closed Questions

May start with do, is, or are. May elicit specific information but may close off client talk.

Can be aswered with few words

Encouragers

Using short responses that help keep clients talking.

They may be verbal (repeating key words and short statements) or nonverbal (head nods and smiling).

Paraphrasing

Shorten or clarify the essence of what has just been said, but be sure to use the client’s main words. 

Often fed back to the clien in a questioning tone of voice. 

4 Dimensions:

• Sentence stem: “Damaris, I hear you saying….”

• Key words: use same words as client to describe situation or person

• Essence of what the client has said in a brief and clear form

• Checkout: ask client for feedback on whether the paraphrase was correct or useful

Summarizing

Summarize client comments and integrate thoughts, emotions, and behaviors.

Similar to paraphrazing but used over a longer time span.

Can be used at any time in the session (beginning, midway, at the end).

Checkout/Perception Check

Periodically check in with your client to discove how your interviewing lead or skill was received.

“Is that right?” “Did I hear you correctly?” “What might I have missed?”

Subtractive Empathy

Counselor responses give back to the client less than what the client stated, and perhaps even distort what has been said. 

Often used with homicidality or suicidality

Basic Empathy

Counselor responses are roughly interchangable with those of the client. The counslor can say back accurately what the client has said.

This is the most common counselor comment level in interviews.

Additive Empathy

Counselor responses that add something beyong what the client has said.

This may be adding a link to something the client has said earlier, or it may be a congruent idea or frame of referenc that helps the client see a new perspective.

“Covering the client” in empathy

Discrepencies in Verbal and Nonverbal Behavior

A client may say one thing, but their body says something else.

Additionally, there can be discrepancies in verbal statements. For example, a student may say that they deserved a higher grade than the time spent studying suggests.

What questions lead clients to defensiveness?

Why questions can put clients on the defensive because it may come across as blaming the client or attacking them. 

CACHE

Context: Obtain a general picture of the situation, issue, or problem

Affect: Explore the emotional base, feeling, or emotional state

Concern: Clarify the problem/issue and obtain specifics

Handling: Identify past and potential actions/behaviors

Empathy: General reflective responses supporting a good relationship used throughout

Active Listening

A communicatoin process that requires intentional participation, decision making, and responding to client conversation.

What we listen to and how we respond have a profound influence on how clients talk to us about their concerns.

Our accurate listening leads to client understanding and synthesis, providing clients with clearer pictures of their own stories.

Microaggression

Brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults towards people of color.

Microagressors are often unaware that they are harming another person.

Reflecting Feelings

Helps us reach both negative and positive emotions and feelings. Recognize and reflect the negative but search for positive strengths and feelings. 

Recognized by many as the most significant listening skill after attending behavior and is central to emotional regulation. 

Techniques include: sentence stem, feeling label, context or brief paraphrase, tense and immediacy, checkout, bringing out positive emotional stories and strengths

Sentence Stem

Choose a sentence stem such as “I hear you are feeling…” or “It sounds like you feel…”.

Using the clients name and pronoun, you help soften and personalize the sentence stem.

Feeling Label

Add an emotional word or feeling to the stem.

“Angelica, you seem to feel sad about…”

“It looks like you’re happy…”

Context or Brief Paraphrase

You may add a brief paraphrase to broaden the reflection of feelings. 

The words about, when, and because are only three of many that add context to a reflectoin of feelings.

“Angelica, you seem to feel angry about all the things that have happened in the past two weeks”

Tense and Immediacy

Reflections in the present tense “Right now, you look very angry”) tend to be more useful than those in the past (“You felt angry when…”)

However, some clients have ifficulty with the present tense and talking in the here and now. Review of past feelings can be helpful and may feel safer for the client.

Bring Out Positive Emotoinal Stories and Strengths

Used to counter the negatives and difficulties.

If you only focus on fearful, angry, sad emotions, you may find yourself reinforcing negative cognitions as well as negative emotions.

If you employ positive psychology and bring out strengths at the same time as you discuss serious concerns and issues, you will find that you have helped clients strengthen their abilities, leading to resolution.

Sequence of Basic Listening Skills (BLS)

• Questioning

• Encouraging

• Paraphrasing

• Reflecting Feelings

• Summarizing

Five-Stage Model for Structuring a Session

Stage 1: Empathic Relationship includes initiating the session, establishing rapport, building trust, structuring the session, and establishing early goals.

Stage 2: Story and Strengths focuses on gathering data. Draw out stories, concerns, and strengths.

Stage 3: Goals establishes goals in a collaborative way.

Stage 4: Restory includes working with the client to explore alternatives, confronting client incongruities and conflict, and rewiting the client’s narrative.

Stage 5: Action involced collaborating with the client to take steps toward achieving desired outcomes and achieving change.

Supportive Empathetic Confrontation

Gentle microskill that involves first listening to the client stories carefully and respectfully, and then encouraging the client to examine self and/or situation more carefully. 

Nonjudgemental Empathy

Similar to unconditoinal positive regard, remain neutral, suspend private thoughts and feelings

Skills/Steps Required to Deal with Conflict, Incongruity, and Discrepancies

Step 1: Listen empathically and nonjudgementally

• Identify confluct by observing incongruencies, discrepancies, ambivalence, and mixed messages

Step 2: Summarize and clarify issues of internal and external cognitive experience toward resolution through further observation and listening skills

• Reframe the encounter/situation

• Emphazied more specifics and clarify internal and external conflicts

Step 3: Use Client Change Scale (CCS) to determine whether what was said affects how clients think and feel about their situations.

Identify the Creative Change Process using CCS

• Enable you to assess the value and impact of what you just said, observe whether the client is changing in response to a single intervention, examine behavior change over a series of sessions.

• Level 1: Denial

• Level 2: Partial examination

• Level 3: Acceptance and recognition, but no change

• Level 4: Creation of a new solution

• Level 5: Transcendence

Psychological First Aid (PFA)

Goals are to assess risk, promote safety, and stabilize survivors of disasters and connect them with help and resources.

Assess immediate concerns and needs of the disaster survivors, NOT to provide psychotherapy on site

Discernment

Sifting through out interior and exterior experiences to determine their origin. 

Has broad applications to interviewing and counseling; it describes what we do when we work with clients at deeper levels of meaning.

Also a process whereby clients can focus on envisioning their future as a journey into meaning.

Decision Counseling

“Let’s be practical and find something that works.”

Philosophy of pragmatism: define the problem or issue, generate alternatives, and decide for action.

Person-Centered Counseling

Importance of relationship and empathic understanding, the centrality of emotion, and his emphasis on listening. 

Continue listening, seek empathic understanding, and keep your eye on client desires and goals, not your own wishes.

Logotherapy

Aims to help us become our own best person through discerning meaning and purpose. Those who have a why can find a how and bear any situation.

Skilled use is a powerful way to enable clients to reframe cognitions and emotions and think in new ways, thus leading to behavior change that is suggested by the client rather than the therapist or theory.

Multicultural Counseling and Therapy (MCT) and Feminist Therapy

Both focus on raising personal consciousness of how the individual develops in a cultural/environmental context.

Central attention is given to oppression, sexism, racism, and the LGBTQIA+ community.