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85 Cards in this Set

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What are some examples of open questions to use during the action stage?
-What kinds of things have you tried?
-How did it work when you tried that?
-What ideas do you have about what to do in this situation?
-What might happen if you tried that?
What are some benefits of open questions during the action stage?
-Gently guide clients through action stage.
-Encourages client to solve problems (with support)
-Communicates respect
-Minimize imposing own values
-Teach how to think through problems & possible solutions
What is the proper way to use open questions in the action stage?
-Collaborative inquiry
-Don’t ask too many at one time
-Allow time to respond
-Vary questions with other skills
-Make sure they are open
What does "giving information" in a session refer to?
-Facts, Data, Opinions
-Like info about psychological tests, opinions or specialized knowledge from education (like info about types of actions) or life experiences. Provide answers to questions if it is therapeutically appropriate. May educate client about psychological condition.
What is the educational function of giving information during a session?
-Can help demystify problem, symptoms, disorder, interventions.
-Sometimes best to let client do the work, explore feelings about circumstances, etc.
-Sometimes we simply don’t know.
What are some questions that arise when giving information during a session?
-What does client already know?
-What is motivating you to give info at this time?
-For whom is info helpful (you or client)?
-Do you want to stop exploration?
-Reduce client anxiety?
-Educate client?
What are some client motivations for giving information?
-Make you feel like expert?
-Avoid exploration or insight?
-Familiar defenses (e.g., dependency)?
-Will giving info foster dependency in client?
-Client think you’re a physician?
-Testing your credibility?
What are some reasons that we give info?
-Show client how much you know?
-Normalize the experience?
-Explain what is happening in session?
-Give only info necessary (won’t remember the rest)
-Keep focus on client.
Why do we give feedback about client behaviors?
to increase self-awareness, lead to behavior change.
What's the difference between feedback and immediacy?
Similar to immediacy, except it's only about the client, not about the relationship.
What is feedback used for?
Used to assist client in generating, implementing, and maintaining changes in thoughts, feelings, behaviors
What kind of feedback do clients prefer?
Clients prefer positive feedback (sandwich negative between two positives)
What is it important to give feedback on?
Give feedback about a) what clients can change and b) as closely as possible to the behavior rather than waiting. Give with empathy and support.
In what way do we offer feedback and why?
-Offered as personal observations by helper. Descriptive statements rather than evaluative.
What is process advisement?
-Direct client to do things in session. Type of advice or direct guidance, but confined to directing what goes on in session (e.g., “show me how you reacted . . . “).
-Process advisement - directs clients to do things within helping sessions (demonstrate how acted in outside situation).
What is important to know when going about process advisement?
-As experts, helpers can offer suggestions about what clients can do in sessions to facilitate change process.
-Behavioral exercises allow clients to express and accept inner experiencing.
-Pay attention to nonverbals, read up on exercises, and do them first under supervision.
What happens when clients resist process advisements?
-Clients may resist process advisement.
-May feel “weird”, not convinced it will help.
-Helper may be reticent, lack confidence, or not be clear, or lack rationale.
-Avoid control struggle, but be supportive, clear, present rationale and, if necessary, explore reluctance of client.
What is direct guidence and what does it do for clients?
-Direct guidance is making suggestions, giving directives, or providing advice for what they think clients should do.
-Information provides facts or opinions, direct guidance suggests actions for clients.
What are some DOs and DON'Ts of direct guidence?
-Don't be Dr. Phil
-Make sure clients make own decisions and have adequately explored issue.
-May feel pressured to please you. Other times, though, very effective.
-Given by trusted helper whose expert opinions, based on solid knowledge (research) after extensive exploration and insight.
-For parenting, coping strategies, thinking of alternatives. Clients choose their actions.
How do you give direct guidence?
-Assess client motivation.
-Distinguish between honest request for guidance versus expression of dependency.
-If latter, deal with feelings involved first. Assess own motivation.
-If client gets upset, use immediacy skills.
If Direct guidence doesn't go well we?
-We may not have presented task well, apologetic, unclear, no rationale.
-If they refuse, let it go. Don't get into a control struggle.
-Use listening skills. If clients choose not to change, work on acceptance of this and other alternatives.
-Recommend small specific changes. Write down homework assignments, follow up on them in next meeting.
What happens when we disclose strategies?
-Can tell clients what has worked for you without asking them to try it (like self-disclosure).
-Provides ideas or alternatives without demands.
-More tentative way of giving information or direct guidance.
-Be sure of your intentions.
After a disclosure of strategies in the action stage?
-Turn focus back to client after disclosure.
-Risk that clients may be unduly influenced by disclosure.
-Provide as tentative option.
-Don’t disclose to relieve own feelings.
What are the four types of actions to take in the action stage?
-Relaxation
-Behavior change
-Behavior rehearsal
-Decision making
What is the helper's role in the client's decision making?
-Helper serves as coach or guide
-Start with these steps and modify as necessary
-If strong reaction, step back, process, and (maybe) alter strategy
What is the need to know stuff about relaxation in the action stage?
-For stress & anxiety
-Muscles relaxation allows more openness and ability to handle things
-For fears, test taking or speaking, social situations, or general tension during session
-Not for paranoid, those with fear of losing control, or delusional clients
How do you teach relaxation?
Teach relaxation:
-Get comfortable
-Start relaxation with toes up through head
-Pick a word, sound, or prayer, thought or phrase. Repeat each time you breathe out.
-Let all other thoughts go
-Do for 3-5 minutes then sit quietly for a minute
What is the first step toward acheiving relaxation in the action stage?
Identify stress/anxiety as specific problem (relaxation is incompatible with anxiety)
What are some things to keep in mind when trying to get a client to learn to relax?
-Check out willingness, before, during, after (thoughts, feelings, etc.)
-Did they like it? Will they practice?
-Other approaches like deep breathing can work
-Mindfulness: awareness from attending nonjudgmentally to present experience, aware of emotions, take out, observe, let go (similar to eating example)
-Jacobson deep muscle relaxation (tense/release, visualization)
When do you want a behavior change?
-When you do too much of behavior,
-not enough of a behavior
-or inappropriate behavior
Auditor uses a set of dummy transactions designed to test the control activities that management claims to have incorporated into the processing programs. Disadvantage - tests processing at only one moment in time.
Test Data Approach
Uses a controlled program to reprocess sets of client transactions and compares the auditor-achieved results with those of the client. Disadvantages - costs and coordination effort.
Parallel Simulation
When identifying the problem what are some important things to consider?
-can use approval reassurance to support client
-Ask for specific example of specific problem (Tell me about the last time you got angry, describe the situation to me)
-One problem at a time (list then order multiple problems), start small.
-Help client assess appropriateness of change
-Can change behavior or thought
What are the steps to exploring the idea of action for a problem?
-Explore idea of action for problem
-May be ambivalent (unhappy, yet afraid of change)
-May not be ready (stage of change): precontemplation/contemplation not ready, preparation action more ready
-Key to success is good decision about change, not simply inducing change
-Explore thoughts, feelings about action, pros and cons (questions page 330)
-Primary skills here are open questions and reflection of feelings, can use 2-chair
-May commit to change, or decide against
What are some steps to Assess Previous change Attempts and Resources?
-Ask what have you tried before?
-Describe strategies you have used.
-Internal & external factors facilitating or inhibiting change
-What parts of what you tried worked?
-What parts didn’t work? Etc.
-Use restatements & reflections, approval-reassurance
-Assess social support
When you generate options together in the action stage, you?
-Thought-showering (brain storming)
-If resources no option, what recommend to others?
-Direct guidance, disclose about strategies
-“Grandma’s rule”, do behavior first, then reward
-“Premack’s principle”, pair low frequency behavior with high frequency one
What are the steps to evaluating options in the action stage?
-Systematically evaluate
-Specific, realistic, within realm of possibility, consistent with their values
-What options appealing and why.
-May use information to educate about options
-Ask to list advantages/disadvantages
-Choose options to change self rather than others
How do you choose an option during the action stage?
-Assess current level of functioning (Antecedents, Behaviors, Consequences – or SORC) and/or collect baseline data (observe own behavior in context)
-Determine realistic goals for change
-Identify realistic reinforcers (short or long term)
-Best to increase positive than decrease negative behavior
-Behaviors must be observable, behavioral, specific
-Target specific behaviors to change, not outcomes
-“Baby steps”
What are the steps to assigning homework in the action stage?
-Tasks must fit the problem, not too difficult, based on client’s strengths
-Direct guidance, disclosure of strategies
-Don’t be bossy, follow direct guidance with open questions to check client reactions
-Identify potential facilitating and restraining forces to implementation
-Figure out ways to handle restraining forces
What do you do when you check on progress and modify in the action stage?
-Nonjudgmental assessment of what worked, or didn’t and why
-Might make apparent more restraining forces
-Forgive self for relapses
-Helper gives feedback about progress (reinforce, acknowledge difficulties)
What are the steps in teaching behavioral rehearsal?
1) Assess actual behavior in specific situation (can role play situation)
2) Determine goals (specific, clear)
3) Provide a model
4) Client role-plays
5 & 6) Assign Homework & modify based on experience
What are the five steps in decision making during the action stage?
1) Articulate options
2)Values Clarification
3) Rate options based on values
4) Evaluate results & revise weightings
5)Follow Up
In decision making during the action stage what are the steps of articulating options?
Articulate options:
-Explore issue and background
-Articulate various options
In decision making during the action stage what are the steps of a values clarification?
-Generate < 10 relevant values, desires, needs related to topic
-Weight importance of each (1-10), used only once to force rankings
In decision making during the action stage what are the steps of rating options based on values?
-Evaluate all options (-3 – 0 - +3) based on values & discuss reasons
-Multiply rating for each option by weight for the value, add scores for each option
In decision making during the action stage what are the steps of evaluating results and revising weightings?
-Evaluate results & revise weightings
-See how they fit for client
-Scores may not reflect what client wants
-May change options or values with clarity
-May do problem solving to make options more appealing
-May use behavioral rehearsal or 2 chair to think through options
In decision making during the action stage what are the steps of following up?
-How feel about options, decisions
-Some like systematic approach, others more intuitive
What happens if action is approached in early sessions?
-usually brief & focused on exploring possibility of change,
-thinking about change,
or if client wants to return
-Hard for beginners, either avoid to move too quickly & become too directive
-Also for clients, past failures can be demoralizing
Why are flexibility and creativity are critical in the action stage?
-Steps aren’t always implemented in the sequential manner presented in the model.
-Need to know them and apply them, sometimes, flexibly.
-Empathy, Support, and Encouragement remain very important in helping clients make the difficult changes often required in the Action stage.
-Benevolent coach rather than harsh parents or dictators.
Why is it important not to give up when it gets hard?
-If intervention fails, try another
-Continuous failure – explore relationship and process of change, provide insight
-Generalization to “real world” can be challenging, disappointing
What is important to remember about change?
-Be humble, change is hard, people are complicated
-Changes and decisions can have huge consequences
-Often took years to unfold, can be hard to change
When integrating skills into action what are some multicultural things to consider?
-Some clients expect action, want advice, need to deal with expectations
-May need to incorporate spirituality into action stage if important to client
-Barriers like lack of resources, discrimination, language problems, age, cultural directives, ask clients, be sensitive
When putting skills into action, what are some difficulties that the helpers might face?
-Moving too quickly to action
-Needing to be the expert
-Too much investment in client changing
-Imposing one’s values on clients
-Not being bold enough in encouraging changes
-Not being supportive enough
-Getting stuck on one action idea
-Adhering too rigidly to steps
What are some strategies that helpers can use when turning skills into action?
-Strategies to overcome difficulties
-Self-reflection (consult with peers, seek counseling, get supervision, relax, etc.)
-Use exploration skills – seek to understand client better, rebuild trust, etc.
-Deal with therapeutic alliance –open questions, immediacy, listen for feedback from client, appropriate self-disclosure
-Acknowledge own missteps
What are some ways that we can manage sessions?
-No “right” way, each helper is different as is each client
-Learn skills, then develop own style and integrate skills into who you are as counselor
-Apply scientific method to helping interactions
-Be open to feedback
What do you do on the first session?
-First sessions: start session, establish goals, clarify expectations, develop a focus, end session
-Introduce self, explain structure of helping process, briefly self disclose credentials (especially if asked), discuss limits of confidentiality
What does establishing appropriate boundaries refer to?
Appropriate boundaries – length of therapy, fees, avoiding social involvement with clients, no home phone number, not a friendship (address as needs arise).
During the first session we should?
-Listen attentively and empathically
-Encourage client to talk, be patient
-May offer reassurance/encouragement
What are some goals and expectations that we may try to answer during sessions?
-Goals and expectations –
-Why is client here at this time?
-What are goals? (Intakes will help provide this information at the clinic.)
-Expectations of client must be realistic.
-Set goals/expectations to be consistent with time at the clinic (10+ months at beginning, reducing as the year progresses).
-Might need to refer if problems are too severe (unlikely here as intake should cover that) or choose not to engage in counseling at this time if client isn’t ready.
What do you do when you develop a deep focus?
-What is troubling client now
-One problem at a time, clear focus
-Specific incident or behavior
-If client has trouble focusing, that can become the focus
-Don’t impose own wishes on client
-Redirect focus on to client from others
-Don’t jump from topic to topic
-Once identified, broaden focus to related influences
-How is problem affected by and influencing other parts of past, present, future life?
What are the steps to follow when ending your first session?
-Keep track of time (5-10 minutes left, note session is close to ending)
-Some will do "doorknob" disclosures.
-Ask how session went for them.
-Ask for summary of session, encourage them to think about issues during the week.
What things are you trying to figure out during an intake?
-Demographics
-Presenting concerns
-Client background information/psychosocial history
-Health & medical history
-Defining clients problem
-Risk factors (danger to self, others, substance abuse)
What are you supposed to do during subsequent sessions to get the client going?
-Sit quietly
-Summarize past session
-Ask what client wants to talk about
-Base decisions on client’s need for structure, etc.
What steps do you follow when you are trying to establish a focus with the client?
-Clients may have changed perspectives,
-May appear entirely different,
-Respect their choice of focus of session
-Be prepared, yet flexible
Helpers should do all of these things in between sessions?
-Need to think about clients between sessions,
-Origin of problems,
-Underlying themes,
-Appropriate interventions.
-Watch videos, process what thinking/feeling during session, observe client reactions
What are the ABCs of process notes?
A) manifest content,
B) underlying content,
C) defenses and barriers to change
D) client distortions,
E) countertransference,
F) personal assessment.
Outside of sessions to become better prepared we should?
-Look for underlying themes,
-Recurring patterns.
-Supervisors can help develop hypotheses,
-Possible interventions,
-Different perspectives.
-Educate yourself about theories and research, including cultural issues
When is it time to terminate?
-Terminate when as much has been accomplished as possible within contractual arrangement.
-Could be several cycles of explore/insight/action with different problems.
-Prepare client to be self-reliant.
-When to end
-Externally imposed time limits
-Figure out what can and what can't be accomplished.
What are some different reasons to terminate?
-May have plateaued
-Sometimes clients initiate, sometimes counselor
-Ethical principles – terminate when feel clients are no longer working productively – only continue when clients benefitting and making changes
When you terminate you should believe in the back of your mind that...?
-Assume counseling may again be necessary at future date.
-Assure client this is fine and normal.
What did Mann think of termination?
Mann, mention it every session
When do you prepare clients for termination?
-Best to prepare client 2-3 weeks in advance, especially if you think they will have strong reactions to it (may be related to one of their problems).
What are the steps to a successful termination?
-Look back - review what has been learned and how they have changed.
-Look forward - set an ending date, discuss future plans, consider need for counseling down the road
-Say goodbye - clients may express thanks, both share feelings, both say farewells.
-May be some disappointments with relationship ending, sense of loss, not being "cured", not know what to say to thank helper, distress over unsolved problems.
When you make referrals?
May lack experience/skills for client issues
May need different type of help (marital/family, medication, etc.)
Explain reason so client knows why referral necessary.
When dealing with reluctant/resistant clients?
typically in precontemplation stage
Must be creative
How do you handle overly talkative clients?
-May be a defense
-Interrupt verbally or nonverbally
-Use immediacy
How do you deal with overly quiet clients?
-Try to understand why
-Go at client’s pace (open questions)
-Positive reframe
How do you deal with suicidal clients?
-Actively address and directly assess (see assessment on page 380)
-If clear intent, clear viable plan, means to carry it out, then high risk
-Consult!
How do you deal with sexual attraction toward a client?
-Common occurrence, but acting on it is unethical
-May discuss with supervisor, or carefully reflect
-May be a function of the intimacy of the helping relationship
How do you deal with angry clients?
-Listen nonjudgmentally, nondefinsively
-Encourage clients to talk about it
-Explore other feelings,
-Express verbally, not physically
-Decide what to do about it
Several common pitfalls that occur in the insight stage inlcude all of following accept...?
C. Attending to multicultural considerations.
Insight does not always lead spontaneously to action because?
d. all of the above.
Cal mentioned in class, which of the following concerning the relative effectiveness of theoretical approaches to inidividual counseling?
C. With a few exceptions, to there seems to be no conclusive evidence from epirical studies...
In addition to helping clients with their goals, action is primarily important because?
C. It is important for consolidating new thinking.
Select the best information intervention in the action stage.
B. The crisis # for the battered women's shelther is 555-HELP, let me write it down for you, and if you like we can call from my office.