Directing Clients Towards Action: Introduction to Counseling
Readiness to Change and the Stages of Action
Directing clients toward action is a fundamental component of the counseling process, but the success of action-oriented interventions depends heavily on two specific factors: the client's internal motivation for change and the quality of the guidance provided by the clinician. To understand a client's position in the change process, counselors often look to the transtheoretical model developed by Prochaska and DiClemente, which identifies five distinct stages of change. The first stage is Precontemplation, where the client has no interest in making a change. This is followed by Contemplation, characterized by the client having occasional thoughts about some form of change. The third stage is Preparation, in which the client begins viewing positive change as both possible and desirable. The fourth stage is Action, where the client is actively enacting positive change. Finally, the fifth stage is Maintenance, which involves the client working to sustain the changes they have made. Understanding these stages is critical for determining which skills for encouraging action will be most effective.
Therapeutic Questions in Choice Theory and Adlerian Therapy
Action in counseling is frequently facilitated through two broad forms of questioning: standard therapeutic questions and Narrative or Solution-Focused therapeutic questions. Within the realm of classic therapeutic questions, "The Question" is a hallmark of Adlerian clinicians. It is phrased as: "What would be different if you were well?" This specific inquiry is designed to serve two functions: detecting underlying secondary motivation for symptoms and helping the client focus on what a life without those symptoms would look like. Another significant framework for therapeutic questioning comes from choice theory. Choice theory utilizes four big questions to generate a wide array of therapeutic inquiries: "What do you want?", "What are you doing?", "Is it working?", and "Should you make a new plan?" These questions provide a structured pathway for clients to evaluate their behaviors and desires objectively.
Narrative and Solution-Focused Questioning Techniques
Narrative and Solution-Focused (SF) approaches offer a specific battery of questions designed to shift the focus from problems to solutions and unique outcomes. One such tool is the Pretreatment Change Question, credited to de Shazer and Dolan (, p. ), which is used to help new clients focus on successes they have already initiated. The verbatim example provided is: "What changes have you noticed that have happened or started to happen since you called to make the appointment for this session?" Scaling questions are another essential tool, helping clients to envision potential improvements with greater precision. For example, a clinician might ask: "On a scale of , with being the 'very worst possible' and being the 'very best possible,' how would you rate how well you've been handling your anger this past week?" (SF & SF, , p. ). Percentage questions are also used in this therapeutic context to quantify progress or feelings.
Further techniques include Unique Outcomes or Re-description Questions, which direct clients to describe the specific ways they have successfully accomplished a task, such as asking, "How did you beat the fear and go out shopping?" Pre-suppositional questions operate like projective questions by assuming a positive change has already occurred. An example from SF & SF (, p. ) is: "What do you imagine will have changed when you start staying calm even when other students try to make you mad?" The most famous of these is the Miracle Question. As defined by de Shazer (, p. ), it asks: "Suppose you were to go home tonight, and while you were asleep, a miracle happened and this problem was solved. How will you know the miracle happened? What will be different?" Additionally, Externalizing Questions are used to place symptoms—such as the "fog of depression"—outside of the client's internal identity, while Exception Questions focus on times when symptoms were absent or less severe, such as asking, "When is your anxiety less present?"
Educational and Directive Techniques in Counseling
Beyond questioning, clinicians use various educational and directive techniques to guide clients toward action. Psychoeducation is a central process that provides clients with information regarding their diagnosis, treatment, prognosis, and specific intervention strategies. For instance, a counselor might explain that the first step in managing depression often involve keeping a journal to track emotions, situations, thoughts, and behaviors. Suggestion, a technique originating from hypnosis, involves bringing ideas to a client's mind indirectly. These can be delivered during guided imagery, under hypnosis, or when the client is fully awake, though they can sometimes elicit resistance. An example of a suggestion is: "Let’s consider ways in which you are strong; even stronger than your spouse."
Other directive techniques involve varying levels of counselor judgment and influence. Agreement can enhance rapport and provide reassurance, though it carries the risk of reducing a client's motivation for self-exploration. Disagreement is riskier and can be perceived as unethical, particularly when it concerns the client's personal values. Giving Advice conveys the message, "Here's what I think you should do." While many clients seek advice, many also resist it. Clinicians must always consider if advice is appropriate and should check what the client has already tried to avoid offering "stale" suggestions. Self-disclosure, which can be used as a form of immediacy to share personal information, should always be followed by a check-in with the client and is often helpful when working with culturally diverse populations. Urging involves the interviewer pushing for a specific behavior and is most appropriate in crisis situations, such as domestic violence cases where one might urge a client to seek shelter, though it can still be unhelpful or inappropriate depending on the context. Finally, Approval-Disapproval involves rendering judgments on client behavior. Because clients often seek approval, clinicians must be extremely careful and subtle (e.g., using a simple "good job") when using these powerful tools.
Ethical and Multicultural Considerations
A primary ethical responsibility for clinicians is "checking your values at the door." While all clinicians have personal values, these can lead to judgmental attitudes. The APA code of ethics addresses psychologist values indirectly, whereas the ACA code addresses counselor values directly. This is particularly relevant in cross-cultural advice-giving. Clinicians must carefully evaluate whether to provide advice to clients from different backgrounds, such as a Muslim woman wearing an abaya, a transman with difficult parents, or a gay male youth with religious parents. Self-disclosure is often recommended when working with clients from diverse cultures as a way to join with them, but it should not be used as a vehicle for advice-giving. Importantly, self-disclosure is not a substitute for genuine cultural knowledge.
Questions & Discussion
The following section outlines the prompts for classroom discussion and practical application based on the lecture material dated March , . Students are encouraged to explore the ethics and practicalities of these techniques.
Discussion Prompts: Are values-based referrals acceptable? What other situations can you think of where cross-cultural advice-giving might be risky?
Practice Exercise: Students are instructed to take turns practicing all different forms of therapeutic questioning, including the pre-treatment change question, scaling questions, percentage questions, unique outcomes/re-description questions, pre-suppositional questions, the miracle question, externalizing questions, and exception questions. Students are encouraged to be creative in constructing new versions of these specific question types.