Working in Counselling Relationships

Question 1

What is the process of counselling

Answer 1

1. Development/Building Phase
   - establish therapeutic relationship
   - info gathering
   - goal setting
2. understanding & action phases
3. termination phase

• theoretical orientation influences all phases

Question 2

Microskills

Answer 2

• use of skills are different depending on theoretical orientation of counsellor
• skills for creating relationships
• don’t underestimate
• fundamentals

Question 3

Building the counselling relationship.

Why is the relationship so important?

Answer 3

• most important/ fundamental element
• Creates atmosphere: safety, trust
• Reducing fear, stigma, hesitancy
• A vehicle & container for intense affect (emotions)
• full exploration, experience of self in way that allows for growth and change
• Models a healthy interpersonal relationship
• Provides motivation to achieve goals
• Provides support/comfort/reassuranceas they undergo a change process - frightening & unfamiliar

Question 4

Building a counselling relationship: the working alliance

Answer 4

• primary goal of “beginning”
• Quality & strength of the reciprocal relationship between both
• Best predictor of treatment outcome, accounts for an ~30% of outcome variance in therapy: monitor what clients think
  1. Agreement on goals
  2. Agreement on tasks
  3. Bond between client and counsellor
• Client’s perspective of alliance that matters
• Rating scales at the end of the session can help assess this SRS, ORS (these instruments measure three key
  components of working alliance)

Question 5

Factors influencing working alliance

• • has to happen 3-5 session
• better shape @ beginning of session, improve quicker & more long term success
• 50% anxiety/depression improve by 8-13

Answer 5

• Seriousness & of Presenting Issues
• Structure: decrease anxiety: guidelines, flexible/negotiable, verbal or written
• Readiness for Change
• • Resistant Clients
• • Reluctant Clients: unmotivated to seek help
• Physical Setting & Proxemics
• Transference & Countertransference
• Client Qualities
• Counsellor Qualities
• -Empathy primary/advanced

Question 6

Why are initial sessions important?

Answer 6

• Counselling relationship really begins at the point of first contact – usually phone call schedule first appointment
• Clients often experience changes as they wait to have their initial session
• Be mindful about what it may mean for client to enter counselling
• Be aware of cultural diversity in clients and differences in comfort in disclosing personal information
• Promoting safety and trust is key
• Common microskills include: questions, clarifications, paraphrasing, summarizing, reflection of affect/meaning

Question 7

Types of initials session

Answer 7

1. Information Oriented Interviews: questions, clarification, obtain data, specific questions, factual
2. Relationship Oriented Interviews: focused on attitudes & emotions
   - Preferences towards either of the above types are influenced by theoretical orientations
   * **- depends on type of initial session you use: setting of work; theoretical orentation

Question 8

Goals of initial sessions

Answer 8

• Provide client with info about the counselling process & limits to confidentiality to ensure informed consent –i.e. cover “ESENTIALS”
• Establish rapport, initiate development of the therapeutic relationship, engender hope and positive expectations
• Orient the client to the counselling process
• Assess urgency of the client’s issues
• Explore client expectations & goals for counselling
• Obtain a basic history of the client, their presenting issues & current life circumstances
• Assess readiness for change
• Obtain client commitment to the counselling process

Question 9

Winding down initial sessions

Answer 9

• Helpful to have it known to both
• Leave enough time at the end so that the ending does not feel rushed
• Can be helpful to cultivate hope about the helping process & and solidify a follow up appointment
• Check in with client about how they felt about the session, & how they are feeling about working with you, inquire about questions they may have
• maintain boundaries around time/relationship these can get tested at the end of a session

Question 10

The working stage of counselling

Answer 10

• Occurs after a working alliance is established
• Characterized by insight generation & experimentation with new ways of thinking, being & relating with varying degrees of success
• Accurate empathy is critical throughout initial & working phases of counselling
• Common microskills in this phase involve reframing, leading, multifocused responding, self-disclosure, immediacy, & confrontation
• Respecting and working with client’s readiness for change is also essential – pacing

Question 11

Stages of change

• can enter into any stage
• can relapse (usually action & maintenance)

Answer 11

Stages of Change

1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance

Question 12

precontemplation - “what problem?”

Answer 12

• Counsellors can help people acknowledge their problems & become more open to change
• Consciousness-raising involves increasing the client’s knowledge of the risks & consequences of continuing their current behaviour(s)
• Involves helping them become aware of the main defenses they are using to cope with their problem
• Goal setting – very basic, unrelated to change but may relate to exploring some ideas
• defensive, enter usually due to mandate, reluctant, very expressive, high risk for terminating

Question 13

Contemplation - “i might have a problem”

Answer 13

• involves a willingness to change,
  paired with some barriers in progressing. - ambivalence about changing.
• dealing with the problem: waiting for the right time, wishful thinking etc..
• Counsel Tasks: help client explore their
  ambivalence, helping clients with self re-evaluation pros/cons of changing
• Goal setting – tentative moving towards specific, thinking about thinking about setting goals

Question 14

Preparation: “what do i do about this problem”

Answer 14

• feeling ready to move towards change but unsure about goals or not committed to changing
• Characterized by some confusion/hesitation rather than ambivalence
• may have made some small changes
• Goal-setting and motivating clients are important tasks of counsellor

Question 15

Preparation - Goal setting

Answer 15

Counsellor’s Tasks: Goal setting and Motivating

• Help client set clear goals for counselling and help them commit to those goals by motivating
• Ineffective goals
• - Unfocused, unrealistic, uncoordinated
• Effective goals
• - Mutually agreed upon
• - SMART- specific, measurable, attainable, realistic, timely
• - Encouraging client to share goals with others

Question 16

Action: “i will try this and see how it works..”

Answer 16

• completely committed, & use maximum effort to achieve this change
• actively moving towards goals
• Counsellor tasks: helping clients trouble shoot and problem solve around their actions – helping clients at times to re-evaluate their goals
• Counsellors LOVE this stage of change – lots of energy – many counselling interventions/techniques are for people
  in this stage

Question 17

Maintenance: I am maintaining the changes I made that work!

Answer 17

• Clients have implemented the changes they were intending on making
• Clients have come to a place where their goals have been met
• Clients are now focused on maintaining changes and consolidating these changes
• Counsellor tasks: primarily to encourage clients to claim responsibility for the changes and celebrate their progress, looking at relapse prevention strategies & preparing client to end therapy
• Often a stage during which clients terminate
• Sometimes clients come into therapy in this stage as they feel they may be at risk for “relapse”

Question 18

Common Pitfals of winding down initial sessions

Answer 18

 Talking too much
 Failing to engage the client
 Being judgemental
 Trying to do too much
 Neglecting to offer help
 Failing to collect relevant information
 Not checking in with your client
 Misdiagnosing
 Trying to fix the problem
 Liking/disliking your client too much
Brew & Kottler,

Question 19

Initial sessions

Answer 19

Relational style of first session (note that limits to
confidentiality isn’t covered )
 Intention of the counsellor is clearly to connect, understand
and communicate that understanding back to the client
 Counsellor is person centered in orientation – watch for the
use of basic microskills in this session
 Think about what you like about this style of initial session
and what you might do differently…
 I will post an “informational” first session on eclass

Question 20

How to help clients win the battle for initiative and achieve success

Answer 20

1. anticipate anger, frustration
2. show acceptance, patience, understanding
3. use persuasion: “foot in the door”/”door in the face”
4. confrontation: denying behaviour, accepting it as true, developing a middle position
5. language
6. mattering: perception that as humans we are important
7. pragmatic techniques: silence, reflection, questioning, describing, assessing

Question 21

8 common architectural characteristics when it comes to physical settings

Answer 21

1. accessories
2. colour
3. furniture
4. lighting
5. smell
6. sound
7. texture
   8 thermal condition
   - distance between client and counsellor

Question 22

Client qualities - YAVIS; HOUND; DUD

Answer 22

Yavis (young, attractive, verbal, intelligent, successful) - preferred client
HOUND (homely, old, unintelligent, non-verbal, disadvantaged)
Dud (dumb, unintelligent, disadvantages) less preferred

Question 23

counsellor qualities - 5 important characteristics that helpers should possess

• 3 characteristics that make counsellors more influencial

Answer 23

• self awareness, honesty, congruence, ability to communicate, knowledge
• perceived exerties, attractiveness, and trustworthiness

Question 24

types of initial interviews

Answer 24

• client initiated

- counselor initiated

Question 25

positives to having a client complete a history questionnaire (client initiated interviews)

Answer 25

1. usefullness & reliability 2. accuracy 3. expendiency 4. positive experience 5 cost saving 6 accountability 7 working alliance 8 reduced number of no shows 9 increased focus on process, not conent 10. professional consideration

Question 26

commonalities regarding all interview types

Answer 26

- anxiety and resistance | - frightened and uncertained

Question 27

Information - Oriented First interview - functions probed, accents, closed questions (open), request for clarification - steps

Answer 27

functions: - intake interview to collect needed info: counsellor focused where responses will be: probed (where, how, who, what), accents n(highlight last few words), closed questions (is do are) (open (what how could)), request for clarification - signal beginning of a relationship 1. identify data 2. present problem, primary & secondary 3. client's current life setting 4. family history 5. personal history 6 description of client during interview 7. summary and recomendation

Question 28

When building a relationship, what battle does each party have to win

Answer 28

battle for structure - administrative control (counselor) | battle for initiative - motivation for change (client)

Question 29

The counselling relationship is comprised of 3 key elements..

Answer 29

1. transference & countertransference 2. working alliance 3. relationship

Question 30

best predictor of treatment outcome is..

Answer 30

enthusiastic collaboration

Question 31

3 components of a working alliance

Answer 31

- agreement on goals, agreement on tasks bond between client & counsel

Question 32

What are microskills for rapport building

Answer 32

- basic attending behaviours | - client observation skills

Question 33

What is Primary and Advanced Empathy?

Answer 33

- Primary: counselor has understood clients major themes, non verbal and verbal communications - Advanced: help explore themes, issues, emotions, new to awareness

Question 34

goals can be

Answer 34

- unfocused: too broad - unrealistic: - uncoordinated:

Question 35

7 specific criteria for judging effective goals

Answer 35

1. mutually agreed upon 2. specific 3. measurable 4. attainable 5. relevant 6. observable 7. understood

Question 36

Counsellor skills in the understanding & action phases

Answer 36

- skills that result in client's viewing their lives differently & thinking, feeling, behaving accordingly - Change Perception - leading - multifocused responding - accurate empathy - self-disclosure - immediacy - humor - confrontation - contracting - rehersal

Question 37

strategies to changing perception are?

Answer 37

- redefining the problem - altering behaviours in a certain situation - perceiving the problem in a more manageable way & acting accordingly

Question 38

Perceptions commonly change through what process?

Answer 38

REFRAMING - offers probably & positive viewpoints/perspective on a situation - change pov gives clients a different way of responding - helps become more aware of situational factors associated w. behavioral

Question 39

Lending - What are some leads Ex. a good quarter back anticipates where the receiver will be going on the field and throws the ball - pass isn't on target, relationship suffers - minimal leads vs. maximal leads

Answer 39

- silence - acceptance - paraphrase - clarification - interpretation - Min: minimal encourages- hmm, yes - Max: confrontation - employed after 9 solid relationships