Counseling Test 2 (Set 3)

Front 1

What are some examples of open questions to use during the action stage?

Back 1

-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?

Front 2

What are some benefits of open questions during the action stage?

Back 2

-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

Front 3

What is the proper way to use open questions in the action stage?

Back 3

-Collaborative inquiry
-Don’t ask too many at one time
-Allow time to respond
-Vary questions with other skills
-Make sure they are open

Front 4

What does "giving information" in a session refer to?

Back 4

-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.

Front 5

What is the educational function of giving information during a session?

Back 5

-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.

Front 6

What are some questions that arise when giving information during a session?

Back 6

-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?

Front 7

What are some client motivations for giving information?

Back 7

-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?

Front 8

What are some reasons that we give info?

Back 8

-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.

Front 9

Why do we give feedback about client behaviors?

Back 9

to increase self-awareness, lead to behavior change.

Front 10

What's the difference between feedback and immediacy?

Back 10

Similar to immediacy, except it's only about the client, not about the relationship.

Front 11

What is feedback used for?

Back 11

Used to assist client in generating, implementing, and maintaining changes in thoughts, feelings, behaviors

Front 12

What kind of feedback do clients prefer?

Back 12

Clients prefer positive feedback (sandwich negative between two positives)

Front 13

What is it important to give feedback on?

Back 13

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.

Front 14

In what way do we offer feedback and why?

Back 14

-Offered as personal observations by helper. Descriptive statements rather than evaluative.

Front 15

What is process advisement?

Back 15

-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).

Front 16

What is important to know when going about process advisement?

Back 16

-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.

Front 17

What happens when clients resist process advisements?

Back 17

-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.

Front 18

What is direct guidence and what does it do for clients?

Back 18

-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.

Front 19

What are some DOs and DON'Ts of direct guidence?

Back 19

-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.

Front 20

How do you give direct guidence?

Back 20

-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.

Front 21

If Direct guidence doesn't go well we?

Back 21

-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.

Front 22

What happens when we disclose strategies?

Back 22

-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.

Front 23

After a disclosure of strategies in the action stage?

Back 23

-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.

Front 24

What are the four types of actions to take in the action stage?

Back 24

-Relaxation
-Behavior change
-Behavior rehearsal
-Decision making

Front 25

What is the helper's role in the client's decision making?

Back 25

-Helper serves as coach or guide
-Start with these steps and modify as necessary
-If strong reaction, step back, process, and (maybe) alter strategy

Front 26

What is the need to know stuff about relaxation in the action stage?

Back 26

-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

Front 27

How do you teach relaxation?

Back 27

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

Front 28

What is the first step toward acheiving relaxation in the action stage?

Back 28

Identify stress/anxiety as specific problem (relaxation is incompatible with anxiety)

Front 29

What are some things to keep in mind when trying to get a client to learn to relax?

Back 29

-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)

Front 30

When do you want a behavior change?

Back 30

-When you do too much of behavior,
-not enough of a behavior
-or inappropriate behavior

Front 31

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.

Back 31

Test Data Approach

Front 32

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.

Back 32

Parallel Simulation

Front 33

When identifying the problem what are some important things to consider?

Back 33

-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

Front 34

What are the steps to exploring the idea of action for a problem?

Back 34

-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

Front 35

What are some steps to Assess Previous change Attempts and Resources?

Back 35

-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

Front 36

When you generate options together in the action stage, you?

Back 36

-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

Front 37

What are the steps to evaluating options in the action stage?

Back 37

-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

Front 38

How do you choose an option during the action stage?

Back 38

-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”

Front 39

What are the steps to assigning homework in the action stage?

Back 39

-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

Front 40

What do you do when you check on progress and modify in the action stage?

Back 40

-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)

Front 41

What are the steps in teaching behavioral rehearsal?

Back 41

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

Front 42

What are the five steps in decision making during the action stage?

Back 42

1) Articulate options
2)Values Clarification
3) Rate options based on values
4) Evaluate results & revise weightings
5)Follow Up

Front 43

In decision making during the action stage what are the steps of articulating options?

Back 43

Articulate options:
-Explore issue and background
-Articulate various options

Front 44

In decision making during the action stage what are the steps of a values clarification?

Back 44

-Generate < 10 relevant values, desires, needs related to topic
-Weight importance of each (1-10), used only once to force rankings

Front 45

In decision making during the action stage what are the steps of rating options based on values?

Back 45

-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

Front 46

In decision making during the action stage what are the steps of evaluating results and revising weightings?

Back 46

-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

Front 47

In decision making during the action stage what are the steps of following up?

Back 47

-How feel about options, decisions
-Some like systematic approach, others more intuitive

Front 48

What happens if action is approached in early sessions?

Back 48

-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

Front 49

Why are flexibility and creativity are critical in the action stage?

Back 49

-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.

Front 50

Why is it important not to give up when it gets hard?

Back 50

-If intervention fails, try another
-Continuous failure – explore relationship and process of change, provide insight
-Generalization to “real world” can be challenging, disappointing

Front 51

What is important to remember about change?

Back 51

-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

Front 52

When integrating skills into action what are some multicultural things to consider?

Back 52

-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

Front 53

When putting skills into action, what are some difficulties that the helpers might face?

Back 53

-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

Front 54

What are some strategies that helpers can use when turning skills into action?

Back 54

-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

Front 55

What are some ways that we can manage sessions?

Back 55

-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

Front 56

What do you do on the first session?

Back 56

-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

Front 57

What does establishing appropriate boundaries refer to?

Back 57

Appropriate boundaries – length of therapy, fees, avoiding social involvement with clients, no home phone number, not a friendship (address as needs arise).

Front 58

During the first session we should?

Back 58

-Listen attentively and empathically
-Encourage client to talk, be patient
-May offer reassurance/encouragement

Front 59

What are some goals and expectations that we may try to answer during sessions?

Back 59

-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.

Front 60

What do you do when you develop a deep focus?

Back 60

-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?

Front 61

What are the steps to follow when ending your first session?

Back 61

-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.

Front 62

What things are you trying to figure out during an intake?

Back 62

-Demographics
-Presenting concerns
-Client background information/psychosocial history
-Health & medical history
-Defining clients problem
-Risk factors (danger to self, others, substance abuse)

Front 63

What are you supposed to do during subsequent sessions to get the client going?

Back 63

-Sit quietly
-Summarize past session
-Ask what client wants to talk about
-Base decisions on client’s need for structure, etc.

Front 64

What steps do you follow when you are trying to establish a focus with the client?

Back 64

-Clients may have changed perspectives,
-May appear entirely different,
-Respect their choice of focus of session
-Be prepared, yet flexible

Front 65

Helpers should do all of these things in between sessions?

Back 65

-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

Front 66

What are the ABCs of process notes?

Back 66

A) manifest content,
B) underlying content,
C) defenses and barriers to change
D) client distortions,
E) countertransference,
F) personal assessment.

Front 67

Outside of sessions to become better prepared we should?

Back 67

-Look for underlying themes,
-Recurring patterns.
-Supervisors can help develop hypotheses,
-Possible interventions,
-Different perspectives.
-Educate yourself about theories and research, including cultural issues

Front 68

When is it time to terminate?

Back 68

-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.

Front 69

What are some different reasons to terminate?

Back 69

-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

Front 70

When you terminate you should believe in the back of your mind that...?

Back 70

-Assume counseling may again be necessary at future date.
-Assure client this is fine and normal.

Front 71

What did Mann think of termination?

Back 71

Mann, mention it every session

Front 72

When do you prepare clients for termination?

Back 72

-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).

Front 73

What are the steps to a successful termination?

Back 73

-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.

Front 74

When you make referrals?

Back 74

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.

Front 75

When dealing with reluctant/resistant clients?

Back 75

typically in precontemplation stage
Must be creative

Front 76

How do you handle overly talkative clients?

Back 76

-May be a defense
-Interrupt verbally or nonverbally
-Use immediacy

Front 77

How do you deal with overly quiet clients?

Back 77

-Try to understand why
-Go at client’s pace (open questions)
-Positive reframe

Front 78

How do you deal with suicidal clients?

Back 78

-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!

Front 79

How do you deal with sexual attraction toward a client?

Back 79

-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

Front 80

How do you deal with angry clients?

Back 80

-Listen nonjudgmentally, nondefinsively
-Encourage clients to talk about it
-Explore other feelings,
-Express verbally, not physically
-Decide what to do about it

Front 81

Several common pitfalls that occur in the insight stage inlcude all of following accept...?

Back 81

C. Attending to multicultural considerations.

Front 82

Insight does not always lead spontaneously to action because?

Back 82

d. all of the above.

Front 83

Cal mentioned in class, which of the following concerning the relative effectiveness of theoretical approaches to inidividual counseling?

Back 83

C. With a few exceptions, to there seems to be no conclusive evidence from epirical studies...

Front 84

In addition to helping clients with their goals, action is primarily important because?

Back 84

C. It is important for consolidating new thinking.

Front 85

Select the best information intervention in the action stage.

Back 85

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.