Practical skills Flashcards
(28 cards)
What is situational clarification
- Involves recognizing and addressing ambiguities or misunderstandings in ongoing dialogue and the client-therapist relationship
- It’s crucial in counselling, particularly when there’s a breakdown in mutual expectations
- The objective is to restore these expectations by closely monitoring interactions and discussing any ambiguities observed
What is required from the therapist in order to do this skills
- This skill is more complex than basic listening since it involves a conversation about the ongoing conversation, known as a meta-conversation
- The original discussion is considered from a certain distance
- Therapist needs to maintain both an observer’s and a participant’s perspective during the interview to identify ambiguities effectively
- Listen carefully, put yourself in client’s position, monitor what is going on closely
- Failure to clarify situations can lead to implicit expectations and confusion
- Therefore, the general principle is to initiate meta-conversation when uncertainties arise, or implied expectations become apparent
Instances of situation clarification
- Initial contract - setting expectations, goals and roles of the therapy process
- discussing boundaries in the client-therapist relationship - the therapist initiates a discussion to ensure clarity and alignment of expectations
- client wants quick fix or solutions from the therapist
Tutorial
Steps of situation clarification
1.Paraphrase / Reflection of Feeling (“If I understand correctly…”)
2. Step out of the conversation and start Situation Clarification (“Maybe it’s good if I say something about this…”)
3. What you cannot or do not want to do as a clinician and why not
4. What you can/want to do as a clinician and why
5. Check the response. (If necessary, explain further and repeat step 3 and 4)
6. Make agreement according to ‘renewed’ approach according to step 4
7. Back to conversation
Thinking aloud
- Explaining the background to questions or clarifying thought processes
- counsellors should be open, clear, and straightforward with their clients, expressing their thoughts and considerations openly
- Aims to reduce client anxiety and promote joint cooperation in counselling sessions
Purposes of thinking aloud
- allows clients to understand what is on the counsellor’s mind, reducing anxiety and making the counsellor more relatable
- helps counsellors avoid feeling stuck and allows clients to participate in the problem-solving process
- contributes to openness in questioning, as clients understand the origin of the counsellor’s questions, facilitating a smoother interview process
- essential for counsellors to understand the client’s frame of reference and encourage clients to do the same (by modeling), ultimately enhancing joint cooperation and the likelihood of finding solutions together
List of differential skills
- Advanced accurate empathy
- Confrontation
- Positive relabeling
- Examples of one’s own
- Directness
Advanced accurate empathy
- Involves the counsellor not only accurately reflecting the client’s feelings (which shows understanding) but also bringing out the underlying emotional tone in the client’s story
- This skill requires keen listening to what is said between the lines and attention to non-verbal behaviour
- Overall, the use of advanced accurate empathy aids in ordering the client’s information, leading to a deeper understanding and facilitating progress in the counselling process
What can the therapist do and what benefits does that bring?
- The therapist can use contextual information and previous interactions to understand the client better and make connections between different aspects of the client’s story
- This helps in gaining new insights and guiding the client towards a deeper exploration of their feelings
- Involves making connections between various parts of the client’s narrative, even if the client hasn’t recognized these connections themselves
- This can provide the client with a clearer understanding of their emotions and experiences
How can summarizing be used to express AAE?
Organizing the main points of the client’s issues in a coherent sequence, which helps the client gain a broader and more differentiated view of their problems
Example of AAE
Client: [Looking anxious and moving about on his chair] Well, my girlfriend keeps on saying I do everything wrong, and, well, I just don’t know what to do any more.
Helper: You are beginning to have doubts because you never do things right in your girlfriend’s eyes, but I also hear an anxious note there, in the sense of: I hope she will not leave me?
What is confrontation in therapy?
- presenting the client with a different perspective on themselves or their situation, aiming to provoke new insights and promote constructive change
- It’s a more pronounced form of advanced accurate empathy, where interpretations are significantly distant from the client’s frame of reference
- Contrary to its ordinary usage, counselling confrontation doesn’t imply hostility but rather aims at revealing discrepancies between the client’s self perception and reality
- This revelation can be unsettling, so it’s crucial for the counsellor to maintain a calm, professional, and accepting tone during confrontation
What could be potential response from clients to confrontation?
- Clients may initially resist or deny confrontations, so it’s important for counsellors to present them tentatively, allowing clients time to process and dispute if necessary
- Confrontation should be used sparingly and responsibly, considering the client’s readiness to accept it and the potential impact on their well-being
What are the two types of confrontations?
- Weakness confrontations - point out areas of discrepancy or weakness
- Strength confrontations - highlight the client’s strong points
- Effective therapists balance these confrontations, gradually moving from weaknesses to strengths, fostering a trusting relationship over time before challenging the client with action-oriented confrontations
Example of confrontation
Helper: Now you have told me a lot about the various jobs you have held and that it was always the boss who caused the problems. In this job, too, you are likely to get fired because the boss is so difficult. But I never hear you talk about your share of responsibility in these problems; it is always only the other person …?
Positive relabelling
- Reframing negative aspects of the client’s problems into positive interpretations
- Aims to alter the client’s negative self-image by giving a favourable meaning to their complaints and symptoms
- Contrary to simply stressing healthy aspects, positive relabelling focuses on assigning positive motives to behaviours or thoughts that the client perceives negatively
- For example, slowness may be relabelled as cautiousness, or agitation as liveliness
Functions of positive relabelling
- Primary positive relabelling is to change the client’s negative self-image, potentially alleviating the need for significant behavioural changes
-> By accepting the positive relabelling, clients may find contentment with their current situation or become more empowered to take targeted action - To offset undesirable societal standards of behaviour that may exacerbate the client’s issues
-> By offering alternative interpretations that validate the client’s experiences, counsellors can help clients navigate societal norms that may not accommodate individual reactions
When is positive relabelling appropriate?
- When clients provide negative explanations for their behaviours or when they struggle to understand their problematic situations
- It can serve as a correction by the therapist or help clients regain understanding and control over their circumstances
What is important in delivery of PR?
- While positive relabelling can be supportive, it’s essential to ensure the interpretation is credible and not dismissive of genuine problems
- Sometimes, facing negative aspects of life before turning them into positive factors may be more beneficial
Example of PR
Client: I loathe myself for being so terribly slow. I really am disgustingly slow and lazy.
Helper: Still, this slowness, as far as I can see, is due to the fact that you first want to think carefully about things before committing yourself.
What are ‘‘Examples of one’s own’’?
self-disclosure and it involves the therapist sharing their own experiences with the client
What functions does it serve?
- It demonstrates empathy and understanding by showing that the therapist recognizes and has experienced similar situations, thereby reducing the distance between them and improving the therapeutic relationship
- It encourages the client to reveal their own personal views and experiences, potentially fostering deeper self-disclosure
- It helps the client articulate thoughts or feelings that they may struggle to express on their own, particularly in a well-established counsellor-client relationship
When is it appropriate?
- When the therapist believes it will facilitate the client’s communication and when establishing rapport at the beginning of a session
- However, it’s essential for the therapist to ensure that their self-disclosure remains relevant to the client’s experiences and doesn’t overshadow the client’s concerns
- Overuse of this skill can lead to client suspicion and a loss of credibility
Directness
- Involves a frank discussion about the current interaction between the client and the therapist
- Also known as “you-me-talk,” “immediacy,” or “direct mutual communication”
