Counseling quiz

desensetization

The client is guided through a hierarchy of situations from least to most anxiety provoking within the context of a safe and relaxed counseling environment. For example, a college student with a severe lisp can be gradually exposed to feared speaking situations that range from (a) an informal conversation with the clinician, (b) a formal presentation to the clinician, and (c) the same formal presentation to unfamiliar listeners in a classroom setting.

Relaxation

Tension is reduced in muscle groups to alleviate a client’s feelings of anxiety. For example, a client with a hyperfunctional voice disorder can be instructed to (a) alternately contract and release laryngeal muscles, (b) mentally visualize a peaceful setting, and (c) engage in deep diaphragmatic breathing.

Counterquestion

A client may ask questions that appear to be requests for technical information but are actually intended to gain the clinician’s confirmation or validation of a decision that has already been made. The clinician can respond to these types of remarks by posing a counterquestion that encourages the client to reveal the true intent of the original query. For example, a clinician may recognize that a mother who repeatedly inquires about the interpretation of her child’s cognitive and language test scores may not truly be seeking technical information. The clinician can pose a counterquestion, such as, “Is there something in particular about these test scores that bothers you?” At this point, the mother may acknowledge that she recently refused to allow an Individualized Education Plan (IEP) team to label her child as “mentally retarded,” and she is actually seeking support for this decision from the clinician.

Reframing

A client or family is encouraged to modify views or attitudes toward a negative situation that cannot be changed. For example, a clinician may point out that family members have analyzed and improved their interpersonal relationships as a result of the client’s stroke and subsequent aphasia. This technique should be introduced in the later stages of the therapeutic relationship only after the client or family has demonstrated a genuine acceptance of the communicative disorder.

Open-ended and indirect questions

Questions are formulated in a manner that does not restrict the client or family’s response to a simple one- or two-word utterance. This technique is used to elicit spontaneous and detailed responses that provide insight into the client’s attitudes, knowledge, and feelings. One common example of an open-ended question is, “What are your major concerns about wearing a hearing aid?” A typical indirect question is, “I’d be interested in knowing your opinion of the new hearing aid.”

Role Playing

Problematic situations associated with the communicative disorder are identified, and structured opportunities are provided for a client to act out more appropriate behaviors in hypothetical contexts. For example, an adolescent who frequently misunderstands conversational messages may refuse to request clarification because “people will think I am stupid.” Scripted scenarios can be developed and used to rehearse specific repair strategies for obtaining needed information without embarrassment.

Empathetic listening

The clinician reflects back the content or emotions expressed by a client’s message in a nonjudgmental manner. This is generally accomplished by merely repeating or rephrasing the client’s comments in an objective fashion. Effective listening is characterized by consistent eye contact, attentive body language, and behaviors that encourage continued communication, such as head nods and “um hmm.”

Paraphrasing content

The clinician rephrases a client’s message or statement in his or her own words. This “mirroring” allows the client to hear the message from another source and gives him or her the opportunity to amplify, clarify, correct, revise, or confirm the meaning.

summarizing content

This technique involves succinct, accurate paraphrasing of larger segments of client interaction (e.g., at least 10–15 min). The intent is for the clinician to capture the overall gist of the important elements of the preceding discourse.

Group counseling considerations

• appropriate group size and composition

• set group norms and procedures

• promote atmosphere of trust and unity

• less directive leadership role as the group matures

• encourage self-disclosure

• manage dominant members who dominate group time

• determine hidden agendas

• extinguish irrelevant comments

• reinforce constructive comments

• recognize the need for more specialized counseling

• determine the appropriate time to terminate the group

family systems counseling

approach that acknowledges the central role of the family in a client’s development and progress.

Key concepts:

• change in one family member affects the entire family system

• the family unit is greater than the sum of its parts

• families exist within the context of the larger society

family systems counseling considerations

• empathetic listening

• dont let clinicians feelings become a factor in therapy

• emphasize important points through repetition

• brief summary at the end of sessions

• purpose of counseling to provide info on communication disorder management, not fix client’s personal problems

• dont lose focus of session, becoming conversation

stages of counseling

establish the therapeutic relationship, implement counseling intervention, terminate the therapeutic relationship

emotional reactions to communicative disorders

grief, anger, depression, guilt, shame, anxiety, inadequacy, isolation