Skilled Helper Flashcards

Flexibility is essential

• Clients start and work through things differently

  • Engage in each stage and step of the model in their own way

  • Clients often move back and forth between stages/tasks

Stages of Change and Client Readiness for Change

Problem-Management Framework

• Mining

• Organizing

  • Alternatives and different solutions with different paths

• Evaluating 

• Incorporating

Feedback

• Feedback systems are necessary; not just at the end of a session or treatment program, but in the beginning and middle

Shadow Side of Helping Models

• No model or framework

• A needless array of helping models

• Fads included in the framework

• Irrational forgetfulness

• Failure to share the helping model with clients

• Rigid applications of treatment methods

• Failure to grow with the profession; not taking accountability

The Helping Relationship

• Helping is a collaborative process

  • Both helper and client need to develop goals, processes, and systems to help the relationship prosper

• The relationships provides a forum for relearning

• The successful helping relationship demands flexibility 

Alliance Behavior

• Relationships form over time and through continuous investment, don’t force it

• Track evolving needs/wants of client by continually seeking feedback from your client

• Focus on resources and help clients identify their strengths

• Anticipate different views of the relationship

• Don’t be surprised by relationship ups and downs

• Expect and deal with client negativity 

Helpers and Clients as Entrepreneurs 

• Must be willing to take risks to change

• See opportunities in problems/crises

• Live by possibilities (it’s not what I have, but what I could have down the road)

• Can work alone and with others (collaborators); cross-disciplinary

• Show flexibility, vision, action, perseverance, and determination in the face of adversity

• Growth, not fixed mindset

• Comfortable with uncertainty; do not fear but welcome challenges

• High internal locus of control and autonomy

• Celebrate even small successes

• Persuasive; ask unconventional questions; willing to depart from established structures; prefer fixing over blaming

• Change not just behaviors, but systems that cause bad behaviors

• Pursue impactful outcomes; identify & deal with enemies of change

Key Values of the Working Alliance

• Values as the tools of the trade

• Respect as the foundation value

• Empathy as the primary orientation value (orients helpers in every interaction with clients)

• Proactive appreciation of diversity as a sense-of-the-world value

• A bias towards action as an outcome-focused value

• Influence clients to embrace self-responsibility

  • Helping is a natural, two-way social influence process

Develop a Bias Toward Action as an Outcome-Focused Value

• Self-Efficacy: Belief in one’s ability to manage situations or accomplish specific tasks

• Clients tend to take action when two conditions are fulfilled

  • Outcome expectations (they believe their actions will likely enhance their lives)

  • Self-efficacy beliefs (they believe they have what they need to achieve the outcomes they desire)

• Empathy > Sympathy

• Influence clients to embrace self-responsibility, be a helper or supporter of that, as helping is a two-way street

Case Conceptualization 

• A highly effective treatment plan

  • Process and cognitive map

    • Understand/explain the client’s presenting issues/maladaptive patterns of behavior

    • Guide for counseling process

      • Focuses treatment

      • Anticipates/prepares for challenges/roadblocks

      • Preparation for successful termination of treatment

        • How do I get this person ready to stop therapy?

• For counselors

  • Coherent plan for focusing treatment

    • Includes therapeutic alliance to maximize achieving treatment goals

• Format explains nature & origin of client’s presentation and subsequent treatment

  • 8 basic elements

    • Presentation

      • Personal concerns, symptoms, interpersonal conflicts

        • Severity and nature of this

    • Predisposition (culture)

      • Biological, psychological, social, and cultural factors

        • Biological: genetic, familial, temperament, medical factors

        • Psychological: dysfunctional beliefs (inadequacy, perfectionism, dependency, degree of social skills, aggression, lack of assertiveness)

        • Social: early childhood losses, inconsistent parenting styles, enmeshed/disengaged family, values, financial stressors, cultural factors

        • Cultural: level of acculturation, acculturative stress, specific issues, lower level of acculturation, greater stress

          • Acculturation stress: discrimination, second-language competency, microaggressions

    • Precipitants

      • Any physical, psychological, or social stressors that cause/coincide with onset of symptoms or relational conflict

        • Physical: trauma, pain, medication side effects, withdrawal from addictive substance

        • Psychological: losses, relations, disappointments undermining personal competency 

        • Social: losses, rejections undermining social support/status (illness/death of significant others, job demotion, loss of SSI disability)

    • Protective factors and strengths

      • Factors that decrease the likelihood of developing a clinical condition

        • Coping skills, positive support system, secure attachment, experience of leaving an abusive relationship

        • Protective factors opposite of risk factors

      • Strengths

        • Psychological processes that consistently enable individuals to think/act for self/others benefit

          • Mindfulness, self-control, resilience, self-confidence

    • Pattern

      • Predictable/consistent style/manner of thinking, feeling, acting, coping, defending self in both stressful/non-stressful situations

        • Must be identified early

          • Reflects baseline functioning

          • Has physical, psychological, social features

          • Includes strengths 

    • Perpetuants

      • Processes that patterns are reinforced/confirmed by individual and individual’s environment

        • May be physical, pyschological, or social

        • Precipitating factors may continue and become perpetuates

    • Plan for treatment

      • Plan for treatment intervention

        • Includes goals, strategy, methods, and clinical decision-making considerations and ethical concerns

    • Prognosis

      • Individuals expected response to treatment

        • Based on risk/protective factors, strengths, readiness for change, helper’s experience/expertise in therapeutic change

Communication Skills in Helping

• Turn-taking

  • Opportunity for mutual learning

• Connecting

  • Active listening; targeted responses

• Mutual influencing

  • Openness to others

  • Increases shared understanding

• Co-creating outcomes

  • Developed through dialogue (respectful, empathetic)

Empathic Presence/Listening

• Visibly tuning in to others contributes to the intensity of your presence with the client

  • Expresses empathy

  • Nonverbal behavior plays an important part in empathic communication

• Entering the private perceptual world of the other and becoming thoroughly at home in it

  • Sensitivity is needed; temporarily living in the other’s life, and moving about in it without judgement

SOLER

• Face the client squarely

• Adopt an open posture

• Remember that it is possible at times to lean toward the other person

• Maintain good eye contact; Aim your voice

• Try to be relatively relaxed, or natural, in these behaviors

Nonverbal Communication

• Bodily behavior: posture, body movements, and gestures

• Eye behavior: eye contact, staring, eye movement

• Facial expressions: smiles, frowns, raised eyebrows, twisted lips

  • Mirroring behavior is okay, but don’t do things that can be perceived as judgemental 

• Voice-related behavior: voice, pitch, volume, intensity, inflection, spacing of words, emphases, pauses, silences, fluency 

• Observable autonomic physiological responses: quickened breathing, blushing, paleness, pupil dilation

  • Pupils dilate when excited

• Physical characteristics: fitness, height, weight, and complexion

• Space: the distance a person chooses to be during a conversation

• General appearance: grooming and dress

Self-Questions for Helpers on Visibly Tuning Into Clients

• What are my attitudes toward this client?

• How would I rate the quality of my presence to this client?

• To what degree does my nonverbal behavior indicate a willingness to work with the client?

• What attitudes am I expressing in my nonverbal behavior?

• What attitudes am I expressing in my verbal behavior?

• To what degree does the client experience me as effectively present in working with him/her/them?

• To what degree does my nonverbal behavior reinforce my internal attitudes?

• In what ways am I distracted from giving my full attention to this client?

• What am I doing to handle these distractions? How might I be more effectively present to this person?

• What circumstances surround the client, and how do these circumstances affect the way the client understands and deals with their problems/opportunities?

• What age-related psychosocial tasks and challenges is the client currently facing, how does the way they go about these tasks affect the problem situation/opportunity?

• How does the client go about constructing meaning, including such things as determining what is important and what is right?

• How does the client’s personality style and temperament affect his understanding of himself and their approach to the world?

Types of Listening

• Non-listening

• Partial listening

• Audio-recorder listening

• Rehearsing

How to Listen to Client’s Stories

• Experiences

  • What happens to them

• Thoughts

  • The way they think, their points of view, what thoughts go through their minds

• Behavior

  • What they do and don’t do

• Affect

  • Their feelings and moods associated with their experiences/behavior

***IDENTIFY YOUR BIASES, ATTITUDES, AND OTHER INFORMATION ON A ‘SECOND CHANNEL’ TO MAKE SURE YOU ARE ACTIVELY LISTENING AND REMAINING NONJUDGEMENTAL 

Client’s Nonverbal Messages and Modifiers

• Confirming or repeating a claim

  • Why are they repeating it? Are they trying to convince you? Themselves?

• Denying or confusing

• Strengthening or emphasizing

  • Probably important to the client if they put extra emphasis here, good to delve into to understand/learn their perceptions

• Adding intensity

  • Physiological reactions, change in voice, demeanor, etc.

• Controlling or regulating

  • Try to change the direction of the conversation after questions or clarification is prompted

    • May be due to denial

Components of Thoughtful Processing

• Understand clients through context

• Identify key messages and feelings

  • What is the theme? What’s connected? What’s important?

• Use tough-minded listening and processing: hear the slant or spin

  • Usually victimize themselves or paint themselves better, catch this

  • Perception management done by the client

• Muse on what is missing

Shadow Side of Helping

• Filtered listening/selective hearing

  • If you have a preconceived belief about someone, you’re only going to hear the information that fulfills that belief

• Evaluative listening

  • Accurate judgments cannot be made in a split second

• Stereotype-based listening

• Fact-centered rather than person-centered listening

• Sympathetic listening

  • Do NOT feel sorry for someone, it takes away their agency, lets them be a victim, and accountability goes out the window

  • Empathy > sympathy

• Falling for myths about nonverbal behavior

  • Nonverbal communication does NOT account for most communication

  • You can read nonverbal/verbal behavior in a context and still be wrong

  • If a person doesn’t look you in the eyes, they’re lying (FALSE)

  • Not all nonverbal behaviors are universal, culture impacts them

  • Nonverbal behavior stimulates the same meaning in different situations 

• Interrupting that does not promote dialogue 

Cognitive Processing Therapy (CPT)

• Challenging a client’s way of thinking, or distortions 

Cognitive Therapy (CT)

• 3-6 months

• Set goals and have an agenda with the client; schedule deadlines to accomplish goals by assigning homework

  • Progress must be made outside of the session

  • Ongoing action-biased process

Dialectical Behavior Therapy (DBT)

• Situational change is not possible, so attitude change is needed. You are only in control of your feelings and reactions

  • Acceptance and change

    • Accept the circumstances and come to terms with it, implement positive changes if possible

  • Behavioral 

    • What’s actually the problem? What are the problematic actions the client is taking? How can they utilize healthy patterns?

  • Cognitive

    • How can you change/eliminate counterproductive thoughts and actions? How can you replace them with positive behavior?

  • Skillsets

    • Learning new skills and introducing hobbies, incorporating them frequently

Rational Emotive Therapy (REBT)

• Emotions are a result of personal beliefs about the events instead of the events themselves 

Self-Instructional Training

• Guiding your behavior through self-talk; talk yourself through events to help change perspectives and behavior

• Refraining from making immediate and critical judgments about oneself 

• Typically taught to kids

  • Initially overt, becomes covert with time

Stress-Inoculation Training

• Establish the problem, talk through it, and then establish skills to promote coping and fight stress

To conduct therapy

1. Intake interview to understand what is going on with the client; educative, give client reading materials and ideas 

2. Periodic assessments to help determine if the client is making progress

3. Plan of treatment to determine what to do with a client that will benefit them the most, timeline of therapy, goals of therapy, and the steps needed to achieve them

   1. Self-help must be included as the person must be engaged and committed to change

4. Help client become aware of emotions, their reaction to them, how they deal with them, patterns of behavior/coping; come to terms with their thinking patterns

5. Assess the need for medication

6. Goals of therapy is ultimately to relieve the person's issue and promote problem-solving

   1. Help them get the skills they need, such as coping strategies

      1. Strategies may be maladaptive, help improve them

      2. Problematic behavior may be used to an underlying belief/cognitive distortion

         1. Help the client restructure ideas and beliefs toward a more positive format

Basic Principles of CBT

• A person’s problems may not go away, so it’s best to focus not on eradicating the problem but on assessing ways that they can manage them better

  • Conceptualize the client

    • Identify current thinking

    • Set the client up for success in dealing with an influx of stress or inconvenient behavior, thoughts, beliefs, etc. 

    • Help client restructure their perspectives of their problems, recognize the importance of assigning a proper interpretation

  • Good for depression, anxiety, eating disorders, phobias, panic disorders, anger, relationship issues, sleep problems, migraines, substance use and other psychiatric disorders

  • Downfalls include difficulties with challenging beliefs that have been used for a long time, the structure being too much for some clients, and clients must be willing to change

Key Aspects of a Successful Therapist

• Positive regard: Believe that the client is capable of change, hold them in a positive light, and give them the benefit of the doubt

  • Even when missteps or mistakes are made, it’s important to reassure them or praise them for what they did well

• Response to the client: Must be empathic

  • You feel because… statements (own your reaction to their behavior)

• Set up a goal for each problem presented

  • Help them define their goal in behavioral terms

  • What are you gonna do to achieve that goal? What actions are you going to take? 

  • What’s keeping you from accomplishing that goal? 

    • How are those thoughts counterproductive?

• Emphasize the present moment

  • Revisiting the past may be beneficial to capture the root of issues or behaviors

  • If a client has a problem they believe is most important and they have barriers or additional issues that get in the way of handling the other problem first, address them

• Use guided discovery

  • Ask questions, request feedback, challenge ideologies

Three Dimensions of Responding Skills

• Perceptiveness: Accuracy of perceptions

  • ‘Reading’ other people’s thoughts and feelings; not judging, analyzing

• Know-How: Ability to translate perceptions into words

  • Knowing what kind of response is needed for a specific situation, and accurate delivery of it

• Assertiveness: delivering responses into the therapeutic dialogue 

  • Accurate perceptions/excellent know-how are meaningless if you don’t assert yourself and share them comfortably with the client

Basic Formula for Communicating/Empathic Understanding

• You feel… because…

  • You feel [correct emotion expressed by client] because [correct thoughts, experiences, and behaviors that give rise to feelings]

    • If time is needed to process the client’s feelings and behavior, let them know 

      • “Let me think about what you just said for a moment”

Accurate Responding to Clients Feelings, Emotions, and Moods

• Use the right family of emotions and the right intensity

  • Be sensitive in naming emotions

• Distinguish between expressed and discussed feelings

  • Read/respond to feelings and emotions embedded in clients’ nonverbal behavior

• Use variety in responding to clients’ feelings and emotions

• Neither overemphasize or underemphasize feelings, emotions, and moods

• Key experiences, thoughts, and behaviors give rise to the client’s feelings, emotions, and moods; they are the important parts of clients’ stories in themselves

  • The ‘because’ in the empathic-response formula links all of these elements together

Adopt Useful Tactics for Responding with Empathy

• Give yourself time to think

  • Use short responses

  • Gear your response to the client, but remain yourself

• Respond selectively to client messages

  • Paying attention to one or two messages is necessary

    • Don’t respond to every single word, pick out the key issues

  • Sometimes you focus on actions, experiences, feelings, or all three at the same time

• Respond to the context, not just the words

  • Take into account not just immediate words or nonverbal behavior, but everything that surrounds/permeates a client’s statement

    • The context modifies everything the client says

The Shadow Side of Responding

• No response

• Distracting questions

• Cliches 

  • Family member dies and response is “they lived a long good life”; not a good response, respond to how they FEEL

• Interpretations

• Advice

• Parroting

• Agreement and sympathy

• Faking it

Multicultural Counseling and Theory (MCT)

• All methods must be adapted to the cultural context

  • Recognize differences between/within individuals

  • Examine how family and culture affects the individual’s worldview

• MCT emerges from the recognition of previous theory-building

  • Historically, research is empirically tested only on white, middle-class men

• Therapists goal is to release clients from personal, social, economic oppression

  • Free clients from self-blame; become aware of problems existing in a social context

  • The basic underlying tenant is independence

  • Crucial to philosophy and action

• Universal Approach

  • Culture defined in broad, inclusive, universal way

  • Highlights dangers of stereotyping

  • Emphasizes importance/loyalty to cultural group

  • Provides information about acculturation and oppression

  • Importance of gender roles

  • Facilitates identity development

  • Supports self-esteem and awareness

  • Understanding of worldview

• Approaches to MCT

  • Culture-specific focus approach

  • Helper self-examines racial beliefs/attitudes

    • Willing to discuss racially relevant topics and work on oppression

  • Helper views client on two levels

    • Individual

    • Group

  • Recognition of culture as an internalized, subjective perspective developed within differing cultural backgrounds

  • Emphasizes the importance of seeing individuals in context

  • Concern with cultural intentionality

  • Modifies traditional theories to demonstrate respect for human diversity

• Family Therapy

  • Family is defined culturally (roles, relationships, rules differ among/between cultures)

  • Cultural expectations have a role in every family/group experience

  • A significant part of self-concept comes from ethnic heritage

    • Ethnic heritage can shape attitudes/beliefs

• Traditional healing

Nwachukeu’s Theory for Generating Theory/Practice

• Examine other culture

  • What are important interpersonal aspects?

  • Research existing literature including field/interview studies, anthropological studies

• Identify specific skills/strategies

• Try a new theory of helping/skills

• Framework applicable to multiple cultural contexts

Microskill of Focusing and MCT

• Individual, balanced focus of individual, family cultural expectations

• Addressing relational, cultural, environmental, and contextual issues should be a large part of sessions

• Connectedness, relationships, and interdependence in relation to self must be considered

Introspective Developmental Counseling

• Nakian Therapy: Assist the client in finding meaning in life and repairing relationships

  • Moves individuals from self-centeredness to awareness in interpersonal relationships

• Introspective Developmental Counseling and Life Review

  • Combines Eastern and Western frameworks

    • Tamase

Integrative Life Pattern Model

• Raises individual’s awareness of multicultural issues

• Lifelong pattern of identifying primary needs, roles, an goals and integrating within self, work, and family

• Individual makes decisions about total development including physical, intellectual, socioemotional, sexual, vocational, etc.

  • Four major roles in life

    • Loving

    • Learning

    • Labor

    • Leisure

Cultural Identity Development Theory

• Cognitive, emotional, behavioral progression through stages of awareness involving different self-attitudes at different stages

• Typical stages 

  • Awareness of self as a cultural being

  • Facing cultural issues

  • Naming cultural issues

  • Reflection on meaning of self as cultural being

  • Internalization about self-in-system

Constructing Culturally Appropriate Techniques and Strategies

• Implies nonhierarchical relationship between helper and client

• Helpers modify techniques/strategies to fit the client

• Helper considers what is appropriate for one client in one cultural context may not be appropriate for another client/cultural context

• Network Therapy: Integrates community relationships and community into family therapy

  • Focus is to assist the client in building meaningful community/interpersonal relations to foster positive mental well-being

  • Utilizes a treatment team (family, neighbors, friends, etc)

  • Utilizes multiple theoretical approaches

Nudging

• Helpers are ‘choice architects’

  • Organize context for the decision-making of clients

  • Models, methods, and skills can be used as nudges

• Probing and summarizing are often used as nudges

  • Verbal and nonverbal tactics to help clients talk more freely and concretely about any issue at any stage of helping

  • Empathy is necessary, but sometimes it helps to nudge, encourage, and prompt clients to explore their concerns when they fail to do so spontaneously 

Prompts

• Brief verbal/nonverbal interventions designed to let clients know you are with them to encourage them to talk further

  • Verbal prompts: Um, uh-huh, yes, I see, ah, okay, oh

  • Nonverbal: bodily movements, gestures, nods, eye movements, SOLER

Probes

• Help clients name, take notice of, explore, clarify, or further define an issue at any point in the helping process. Designed to provide clarity and move things forward 

  • Statements: indiciates the need for further clarification (tell me more, tell me what that means, try to explain that)

  • Requests: direct requests for further information or more clarity

  • Questions: most common probe, single words or phrases can be questions 

    • repeat the most prominent part/detail of the client’s story to get clarification on an emotion or perception

Guidelines for Using Questions Effectively

• Do not ask too many questions

  • Makes the client feel grilled and interrogated

• Ask open-ended questions

  • Generally help clients fill in what is missing at every stage of the helping process

• Respond constructively to clients’ questions

  • Clients’ questions offer opportunities for collaboration

Guidelines for Using Probes

• Use your ongoing feedback system as a way of probing

• Use probes to help clients engage as fully as possible in therapeutic dialogue

• Help clients achieve concreteness and clarity

• Use probes to explore/clarify client’s points of view, intentions, proposals, and decisions 

• Help clients fill in missing pieces of the picture

• Help clients get a balanced view of problem situations and opportunities

• Help clients move into more beneficial stages of the helping process

• Invite clients to challenge themselves

Follow Probes with Empathic Responses

• After using a probe to which a client responds, share a response that expresses your understanding

• Be hesitant to follow one probe with another

  • An effective probe yields information that you need to listen to and understand

  • An accurate empathic response puts the ball back in the client’s court to explore further

Evaluating Questions for the Use of Probes

• Keep in the mind the goals of probing. Use probes to:

  • Help clients engage in therapeutic dialogue

  • Help nonassertive or reluctant clients tell their stories and engage in other behaviors related to managing their problems and developing opportunities

  • Help clients identify experiences, behaviors, and feelings that give focus to their stories

  • Help clients open up new areas for discussion

  • Help clients explore/clarify points of view, decisions, or proposal

  • Help clients be as concrete and specific as possible

  • Help clients remain focused on relevant and important issues

  • Help clients move on to a further stage of the helping process

  • Use probes to provide mild challenges to clients to examine the way they think, behave, act, both within helping sessions and in their daily lives

  • Make sure that probing is done in the spirit of empathy

  • Use a mix of statements, open-ended questions, prompts, requests, and DON’T over-rely on questions

  • Follow up a successful probe with an empathic highlight rather than another probe

  • Use whatever mixture of highlights and probing needed to help clients clarify problems, identify blind spots, develop new scenarios, search for action strategies, formulate plans, and review outcomes of action

Summarizing

• The ability to summarize and help clients summarize the main points of a helping interchange or session is a skill that can provide focus, direction, and challenge

  • Summaries help…

    • Warm up the client

    • Focus scattered thoughts and feelings

    • Bring discussion of a particular theme to a close

    • Prompt the client to explore a theme more thoroughly

• When is summarizing useful?

  • At the beginning of a new session

    • Prevents client from repeating what has been said before

  • During a session that is going nowhere

    • Helps clients go more deeply into their stories, focus on possibilities, and goals, redirect

  • When clients need a new perspective

    • Bringing scattered elements together may help client see bigger picture

  • Get clients to provide summaries

    • When clients do not seem to know where to go next

    • Keep the ball in the client’s court (what do you think was the most important thing we talked about today?)

Shadow Side of Communication Skills

• Necessary but not sufficient

• Distinguish between helping the relationship and helping technologies

• Find ways of developing proficiency in communication skills

Behavioral Approaches

• John Locke: Blank slate

• John Watson: Learned neurosis

• B.F. Skinner: Operant conditioning

• Ivan Pavlov: Classical conditioning

  • Reinforcement: Rewards and punishments

  • Shaping: Working with small, incremental changes

  • Measurement: Objective, measurable outcomes

  • Action: Dwells more on behaviors than thoughts

• Albert Ellis: Rational-emotive behavior therapy (REBT)

  • Individuals create own emotional disturbances through absolute/irrational beliefs

  • Individual can choose belief system

  • Counselors aid in identifying irrational beliefs and help find meaning in life

  • Theoretical constructs and techniques:

    • Focus on dysfunctional, irrational, unrealistic, distorted thoughts

    • Addresses feelings and behaviors

    • Emphasizes unconditional acceptance

    • Authenticity

    • Clients encouraged to think rationally

  • Philosophy and beliefs:

    • Importance of understanding belief system

    • Belief systems: organized way of thinking about reality

      • Belief systems affect worldview

    • Client’s use of language reflects philosophy and belief system

  • Identifying Irrational Thoughts/Thinking

    • Helpless thinking is a result of irrational thinking

    • Usually includes ‘all or nothing’ statements

      • Usually includes word: should, ought, never, must

        • “Life isn’t fair” = victim mindset

        • “It’s awful”

        • “I can’t stand it”

        • “I must get what I want”

        • “I’m incompetent” 

    • A-B-C-D-E-F

      • A- activating event

      • B - irrational belief about event

      • C- emotional consequence

      • D - disputing irrational beliefs

      • E- emotional effect of disrupting belief

      • F- new feelings/behavior