Counseling Test 2 (Set 2)

Front 1

What are some ways that you can begin to interpret?

Back 1

-Begin by asking for client's interpretation - allows for assessment of client's current level of insight, stimulates them to think about themselves, gets helper out of providing all interpretations.
-Begin with trial interpretation, see how client responds. Often requires many repetitions.
-Start just beyond client's level of awareness. What they are “half saying”. Can be direct, or phrased tentatively. Should be collaborative process. Most important ones are those that surprise both client and helper.

Front 2

How do you deal with interpretations if they're effective, what do you do if they're not?

Back 2

-Observe, ask, don’t move too quickly.
-If effective, client adds new information or alternative interps, helper responds by reflecting feelings, open questions.
-If rejected, client not ready (return to it later), or inaccurate, explore more and/or ask client for more accurate interp.
-Reformulate, collaborate for more accuracy, etc.

Front 3

What are some difficulties that helpers might have with interpretations?

Back 3

-Feels intrusive
-Can seem aggressive
-Clients may agree just to please
-Keeping clients actively involved
-Giving too many in one session
-Feel inexperienced or unable
-Try to understand own behavior
-Focus on asking clients for interpretations
-Have patience

Front 4

What are some benefits of Disclosures of insight?

Back 4

-Reveals something personal about helpers
-Facilitates client's understanding of thoughts, feelings, behaviors, & issues

Front 5

Why do helpers share insights about themselves?

Back 5

Helpers share insights about themselves in hopes of encouraging clients to think about themselves at a deeper level

Front 6

Why do we as counselors use disclosures of insight?

Back 6

-Use them because they work (used infrequently, but rated highly by clients)
-Helps stuck clients attain awareness
-May make the counselor less threatening to client
-Make clear helpers struggle to understand themselves, too, alter power balance.

Front 7

Do psychoanalysts use disclosure of insight?

Back 7

No! They prefer neutrality or blank screen.

Front 8

What do humanists think of disclosures of insight?

Back 8

Humanists seek transparency, being real, and genuineness with clients.

Front 9

What do cognitive behaviorists think of disclosure of insight?

Back 9

Cogn-behaviorists use it as modeling. Shows helper vulnerability, enhances rapport, shows spontaneity and authenticity, leads to client self-disclosure. Increase bond.

Front 10

How do you use disclosures of insight?

Back 10

Have correct intentions:
-Keep the focus of disclosure on the insight rather than lots of details.
-Don't make them up, use them only if they are genuine.
-Pick something that occurred to you, has been resolved, resulted in a new perspective, is helpful to the client, doesn't make helper feel too vulnerable.
-Keep it short, then return focus to client.

Front 11

What are some valid reasons why disclosure of insight didn't work?

Back 11

Could be client wasn't ready, so try something else.
Could be helper is projecting on to client, so seek supervision or therapy.
Could be clients want more rigid boundaries, so limit self-disclosures.

Front 12

What do you do if disclosure of insight doesn't work?

Back 12

If doesn't work, probably better avoid more, at least for a while.

Front 13

What do you do when clients ask personal info about the helper?

Back 13

Best to answer briefly then move on or try to ascertain the motivation of the client.
Processing can provide insights and strengthen relationship.

Front 14

What are some difficulties that the helper might have with disclosures of insight?

Back 14

-Helper may project on to client
-Disclose to satisfy urge to reveal themselves
-Beginners may use too many self-disclosures- identify with client’s situation, need to differentiate
-May worry about perfect self-disclosures (negative effects, patronizing, feel vulnerable, lose credibility)

Front 15

What is immediacy?

Back 15

When helpers disclose how they are feeling about themselves in relation to the client, about the client, or about the therapeutic relationship in the moment.

Front 16

What does immediacy focus on?

Back 16

Can focus on overall relationship, a specific event in the session, or current personal reactions to the client

Front 17

Is immediacy a type of self disclosure?

Back 17

Can be a type of self-disclosure regarding personal feelings, reactions, or experiences.

Front 18

What is challenging about immediacy?

Back 18

Can be a challenge, to confront clients about issues in the relationship, or a type of information if it is pointing out patterns in the client's behavior

Front 19

How does immediacy differ from feedback?

Back 19

Differs from straight feedback (chpt. 15) in that both people are involved in the communication versus a focus only on the client.

Front 20

How can immediacy provide feedback?

Back 20

Can provide powerful feedback about how clients perceived in interpersonal relationships.

Front 21

What are the four subtypes of immediacy?

Back 21

-Inquires about the relationship or process statements
-Statements of helpers reactions to clients
-Making the covert overt
-Drawing parallels of outside relationships

Front 22

In the four subtypes of immediacy, what are Inquires about the relationship, or process statements?

Back 22

Where the helper asks the client to share feelings about their relationship

EX: Reactions of client to today’s session
-How client feels right now in response to helper statement
-What would you like from me right now?

Front 23

In the four subtypes of immediacy, what are Statement of helper’s reactions to client?

Back 23

Situations where the helper shares own feelings/reactions in moment
-Followed by inquiry into how client feels

Front 24

In the four subtypes of immediacy, what is making the covert overt?

Back 24

Where the helper makes the client’s intentions more open

EX: Late for session, what does it mean (feelings)?
-Keep looking at watch . . .

Front 25

In the four subtypes of immediacy, what is drawing parallels with outside relationships?

Back 25

Where the helper wonders aloud whether client reactions to helper are similar to reactions to others

EX: Others don’t understand you, saying I don’t?

Front 26

What is some of the rationale for using immediacy?

Back 26

-Counseling situation similar to real world, can examine general interpersonal style
-May be similar to some, but different for others (don’t act the same toward everyone)
-Sense of how others might react to client

Front 27

We use immediacy because (Kiesler and Cashdan)?

Back 27

-Can get “hooked” by client
-Clients can push us into constricted and narrow range of responses by their maladaptive behaviors.
-We experience what they do to others.
-How do we resonate or react to the client?
-Use supervision.

Front 28

Immediacy does this for the client?

Back 28

-Resolving problems with helper can model how it can occur with others
-Develop closer relationship
-Greenberg et al., encounter with caring & authentic human can help clients grow
-Can be used to discuss issues of helping relationship and work them out

Front 29

Immediacy can do this for clients part 2?

Back 29

-Challenge maladaptive behaviors. If not commented on by you, how will they know?
-Such honesty can be unusual
-Make covert communication more direct
-It’s a gift, must use in caring way
-Culturally, can be seen as rude, although not typical for any culture

Front 30

How do we go about using immediacy in the right ways?

Back 30

-Be aware of what is happening now (in relationship), and have the confidence and self-understanding to react appropriately.
-Metacommunication, but be supportive of client.
-Take responsibility for own feelings (and behavior), use "I" rather than "You" statements.
-Don't prescribe how clients should change, just point out how you react when client acts a particular way and wonder why they act that way.
-May suggest they gather feedback from others.

Front 31

How can we use the feedback of others to make immediacy more effective?

Back 31

-Ask clients about their reactions, make it two-sided.
-You may get non-flattering feedback that could be accurate (process it) or a distortion (still process it).

Front 32

What are some difficulties that helpers might have with immediacy?

Back 32

-Fear of intruding or making clients angry.
-Helpers may not trust their feelings.
-May use immediacy to deal with own needs.

Front 33

What is neat about the insight stage?

Back 33

Stage leads to new understandings at deep, emotional level with new perspectives, seeing patterns and making connections.

Front 34

What is ideal for clients to do in the insight stage?

Back 34

Ideal if clients “own” new understandings due to active participation in constructing them.

Front 35

What is step 1 in the Interpretation during the insight stage?

Back 35

One: Set the Stage

-Empathy, reflections of feelings, helping client explore set the stage
-Needs to feel safe, not judged
-Formulate challenges & interpretations from observations, collect evidence
-Empathy remains important (perspective taking)

Front 36

What is step 2 in the Interpretation during the insight stage?

Back 36

Two: Look for markers for Challenging
-When client ready to gain insight on own, just need encouragement to construct own
-Expressions of ambivalence, contradictions, discrepancies, confusion, feeling stuck, unable to make decision
-“Sour notes” (don’t make sense), “shoulds”, ambivalence
-Generate hypotheses, perspective take

Front 37

What is step 3 in the Interpretation during the insight stage?

Back 37

Three: Determine Intentions
-Promote insight: appropriate
-Inappropriate: make oneself look good, show off, punish client
-Pause and reflect, think about self, client, figure out what is going on in relationship

Front 38

What is step 4 in the Interpretation during the insight stage?

Back 38

Four: Implement the insight
-Be gentle, tentative, and empathic
-Be curious, not judgmental, be collaborative to discover meanings
-Open question, listen intently, offer tentative interpretation, client adds/modifies, maybe challenge, client shows some insight, restate, ask for elaboration, and so on
-Observe client reactions: be aware of possible negative ones. Continue to explore to process.

Front 39

What is step 1 in the Interpretation during the insight stage?

Back 39

One: Set the Stage

-Empathy, reflections of feelings, helping client explore set the stage
-Needs to feel safe, not judged
-Formulate challenges & interpretations from observations, collect evidence
-Empathy remains important (perspective taking)

Front 40

What is step 5 in the Interpretation during the insight stage?

Back 40

Five: Follow Up
-Often need repetition to sink in.
-Allow sufficient time to work through
-Follow up in subsequent sessions

Front 41

What is step 2 in the Interpretation during the insight stage?

Back 41

Two: Look for markers for Challenging
-When client ready to gain insight on own, just need encouragement to construct own
-Expressions of ambivalence, contradictions, discrepancies, confusion, feeling stuck, unable to make decision
-“Sour notes” (don’t make sense), “shoulds”, ambivalence
-Generate hypotheses, perspective take

Front 42

What is step 6 in the Interpretation during the insight stage?

Back 42

Six: Ask client for understanding
-Your thoughts may differ from clients
-Check out where client’s understanding stands to make sure you are both tracking together

Front 43

What is step 3 in the Interpretation during the insight stage?

Back 43

Three: Determine Intentions
-Promote insight: appropriate
-Inappropriate: make oneself look good, show off, punish client
-Pause and reflect, think about self, client, figure out what is going on in relationship

Front 44

What is step 4 in the Interpretation during the insight stage?

Back 44

Four: Implement the insight
-Be gentle, tentative, and empathic
-Be curious, not judgmental, be collaborative to discover meanings
-Open question, listen intently, offer tentative interpretation, client adds/modifies, maybe challenge, client shows some insight, restate, ask for elaboration, and so on
-Observe client reactions: be aware of possible negative ones. Continue to explore to process.

Front 45

What is step 5 in the Interpretation during the insight stage?

Back 45

Five: Follow Up
-Often need repetition to sink in.
-Allow sufficient time to work through
-Follow up in subsequent sessions

Front 46

What is step 6 in the Interpretation during the insight stage?

Back 46

Six: Ask client for understanding
-Your thoughts may differ from clients
-Check out where client’s understanding stands to make sure you are both tracking together

Front 47

What are some things that let you know the client is ready for insight?

Back 47

-Clients ready & eager for insight
-Clear statement of awareness of problem
-Statement of lack of understanding
-Stated eagerness or willingness to understand
-High level of affective distress, seen as pressure to resolve problem

Front 48

What are some ways that you know that the client is not ready for insight?

Back 48

-Clients telling stories
-Asking for advice
-Blaming others
-Should probably continue exploration for these
-Clients differ on psych-mindedness, but don’t assume stereotypes accurate: learn about your client

Front 49

What are some ways that you know the client is ready for immediacy?

Back 49

-Is client distraught, quiet, unusually talkative, more vague, acting hostile or too friendly?
-Referencing others when might mean you?
-You feeling bored, sexually attracted, angry, stuck, incompetent, prideful, or brilliant?
-You feeling afraid, avoidant of certain issues, reluctant to explore or use insight skills?

Front 50

What are some things that you can keep in check regarding immediacy and clients?

Back 50

-What am I feeling when I am with this client?
-What do I want to do or not do when I am with this client?
-What keeps me from using the skills that I know I would like to be using with this client?
-Supervision can help clarify, help regain objectivity- distance self from reactions and process. Watch for own issues

Front 51

What are some cultural considerations regarding immediacy?

Back 51

-Western values promote individualism and self-actualization,
-Eastern cultures value collectivism and familial obligations.
-Differences can lead to difficulties in understanding dynamics and psychological problems.
-You may be seen as authority figure, so some self-disclosure of insight may be better than being seen as making directives
-Immediacy can be seen as rude, so adjust accordingly

Front 52

What are some difficulties for the helper regarding the insight stage?

Back 52

-Moving prematurely into the insight stage
-Taking too much responsibility for developing insights
-Getting stuck on one theoretical perspective
-Taking clients at face value and not digging deeper
-Forgetting to be empathic
-Clients not needing or wanting insight
-Countertransference

Front 53

How do you overcome difficulties with the insight stage?

Back 53

-Use Exploration skills
-Deal with personal feelings (supervision; therapy)
-Deal with the relationship

Front 54

What are some reasons for the action stage?

Back 54

-Provides opportunity to generate, explore, and choose options for addressing problems and help clients make changes in thoughts, feelings, or behaviors. Exploration - insight – action.
-Taking action consolidates new thinking patterns, more understandable, practical

Front 55

What are some reasons not to take the action stage?

Back 55

-Insight might lead to action, but may not.
-Might not have gained sufficient insight, stay stuck.
-May need specific skills.
-May lack motivation to change - old habits are hard to break.
-May have limited talents and resources.

Front 56

What are some of the philosophical underpinnings of the insight stage?

Back 56

-Focus on making changes in behaviors, thoughts, and feelings, but also exploring feelings, values, priorities, barriers and supports in relation to change.
-Still client centered, facilitate rather than impose change.
-Enhance problem-solving skills/coping skills.
-"What would you like to do differently?"
-Role-play, teach specific skills, help make decisions, help solve problems, learn to relax, etc

Front 57

What are some reasons to start the action stage?

Back 57

-Client has gained insight and starts talking about action
-Client has specific problem and wants relief (e.g., simple phobia: relaxation, exposure)
-Client is stuck in insight and not making changes
-Client is in crisis and needs to make some changes immediately
-Some aren't psychologically minded and need change quickly.
-Can perhaps return to insight later

Front 58

What are some assumptions of behavioral theories?

Back 58

-Don’t focus on “unconscious”, focus on behavior
-What creates/maintains symptoms?
-Assume behaviors are learned
-Focus on present rather than past
-Specific, clearly defined goals.
-Active, directive, prescriptive role for helpers
-Relationship is necessary but not sufficient for change
-Determine adaptive behaviors, cognitions rather than personality change
-Reliance on empirical data and scientific methods
-Behaviors, (some) emotions, cognitions are learned

Front 59

What's the jist of operant conditioning?

Back 59

-Operant conditioning - behaviors controlled by consequences: often used with children, chaning bad habits.
-Positive reinforcers, primary, secondary follows behavior and increases likelihood behavior will recur.
-Shaping, reinforcing closer & closer approximations
-Punishment occurs after a behavior and reduces probability it will recur (present aversive event, "time-out", taking reinforcers away).
-Often leads to avoiding getting caught rather than decreasing problem behavior. Generalization.
-Extinction by withholding reinforcers (best if paired with reinforcing incompatible behavior).

Front 60

What are some things to remember about operant conditioning?

Back 60

-Sounds easy, but research suggests that it is challenging due to the complexity of human behavior
-For example, we may reinforce the client for talking about making changes more than making changes
-May reinforce client for displaying affect, but not for processing affect

Front 61

What is modeling?

Back 61

-Modeling - learn by seeing another engage in behavior.
-Monitors reinforcement or punishment.
-Learning occurs, but performance depends on perception of reinforcement or punishment.
-More imitation if models are similar to observers, more prestigious, higher in status and expertise, several models perform same behaviors.

Front 62

What is cognitively mediated learning?

Back 62

Cognitively mediated learning - (S-O-R and S-O-R-C model).
We respond to our interpretation of stimuli.
What we think about events matters.

Front 63

What do Behavioral & Cognitive theories for action provide?

Back 63

-Provide specific strategies for change
-Action necessary to attain goals
-Reinforcement, modeling, intentions all important for action stage

Front 64

What are some goals for the action stage?

Back 64

-Encourage clients to explore possible new behaviors
-assist in deciding on actions
facilitate development of skills
-provide feedback about attempted changes
-assist clients in evaluating action/modifying plans
-encourage clients to process feelings.
-Helper maintains empathy, explore action rather than prescribe.

Front 65

What are some types of action that can be used during the action stage?

Back 65

-Relaxation
-Behavior change
-Behavioral rehearsal/assertiveness
-Decision making

Front 66

What are some skills to use during the action stage?

Back 66

-Open questions for action
Information
-Feedback about client
-Process advisement
direct guidance
-Disclosures of strategies

Front 67

In the action stage are exploration skills still useful?

Back 67

YES. Exploration skills like reflections and restatement are still useful.